RAC to perform rare underpayment review

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Thursday, May 18, 2017

ATLANTA – Performant Recovery, the DMEPOS RAC, will perform an underpayment review for Group 3 power wheelchair options. The Patient Access and Medicare Protection Act mandates that adjustments to the 2016 Medicare fee schedule amounts for certain DME based on information from the competitive bidding program cannot be applied to wheelchair accessories, including seating systems, and seat and back cushions furnished in connection with codes K0848—K0864. The change was effective Jan. 1, 2016 but CMS was unable to implement changes to its processing systems until July 1 2016. Payments during that time were based on adjusted fee schedule amounts. “DME suppliers rarely experience RAC underpayments, so this is a welcome change,” said Wayne van Halem, president of The van Halem Group, a division of the VGM Group. “Many folks don’t know this, but the RACs are funded to find underpayments, in addition to overpayments and in this environment, every little bit helps.”