Review results in 87.7% error rate for power wheelchairs

Thursday, May 15, 2014

INDIANAPOLIS – The claim error rate for Group 2 power wheelchairs without power seating options was 87.7% between Jan. 1 and March 31, according to National Government Services (NGS), the Jurisdiction B DME MAC. Of 389 claims filed, 48 were paid in full, with the rest fully or partially denied. The most common reasons for denials: face-to-face documentation failed to prove a manual wheelchair wouldn’t meet the beneficiary’s needs in the home, the beneficiary had a significant mobility limitation requiring a power wheelchair, or why a power-operated vehicle wouldn’t meet the beneficiary’s needs in the home; and coverage criteria did not show the beneficiary lacks upper extremity strength to propel a manual wheelchair in the home or that a cane or walker were unsuitable alternatives. NGS reminded providers they are required to respond to requests for additional documentation.