Prepay review shows substantial error rate

Friday, October 18, 2013

BALTIMORE – National Government Services, the Jurisdiction B DME MAC, is conducting a widespread prepay review of power wheelchairs without power seating options. The DME MAC processed 636 claims between July 1, 2013 and Sept. 1, 2013, and said 572 claims needed more documentation, according to a recent bulletin. Partial and full denials of those claims resulted in a 77% error rate. Denials were most common when documentation did not prove a manual wheelchair was unsuitable, did not demonstrate why a power-operated vehicle would not meet the beneficiary’s in-home needs, or did not prove the beneficiary had a significant mobility problem. MAC officials remind suppliers they are required to respond to requests for additional documentation.