Are errors from 2007 relevant?

Thursday, July 7, 2011

WASHINGTON - The Office of Inspector General's review of power wheelchair claims from four years ago has industry stakeholders questioning the validity of the findings in its July 7 report.

The OIG reviewed 375 claims for power wheelchairs provided to Medicare beneficiaries in the first half of 2007 and found 52% had insufficient documentation and 9% were medically unnecessary.

"This is when all the changes were going on," said Peggy Walker, a billing and reimbursement adviser for The VGM Group's U.S. Rehab. "Nobody knew what the heck they were doing in 2007."

Providers at that time were in the middle of transitioning from having to submit certificates of medical necessity for power wheelchair claims to having to submit a seven-element prescription, and proof of a face-to-face exam, among other documentation changes.

Stakeholders would like to see a report from the first half of 2011 instead--not only because providers are more familiar with documentation requirements but also because new measures are in place to reduce errors. One of those measures: A provider must have an assistive technology professional on staff to provide certain power wheelchairs.

"A lot has happened since 2007," said John Letizia, chair of AAHomecare's Complex Rehab and Mobility Council and owner of Laurel Medical Supplies in Ebensburg, Pa. "In today's environment, we're dealing with a completely separate set of rules."

Of course, some providers still struggle with documentation. Stakeholders say a more recent report would probably show providers that do multiple power wheelchairs a year are able to document correctly, while those that do only a few a year still have issues.

Another criticism of the report: Stakeholders would also like to know how many of the claims found to have insufficient documentation or found to be medically unnecessary were overturned through appeals. She suspects it was a high percentage.

Now that the report is out there, however, providers can only hope that lawmakers will take into account the age of the data. 

"It's not using appropriate data," Letizia said. "That hurts everybody: It hurts our industry, and it hurts the beneficiary, because of the damage it does to the industry."

The OIG recommends that CMS enhance re-enrollment screening standards for current providers, review physician records, continue education and review the claims found to be in error. CMS agreed with all but the first recommendation.