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DME MAC launches manual wheelchair prepay probe

DME MAC launches manual wheelchair prepay probe

INDIANAPOLIS - Few providers in Jurisdiction B seem to be affected so far by a recent prepayment review for manual wheelchair bases, including the adult tilt-in-space models, coded E1161.

“We have so many audits, we can't tell one from the other,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “We don't have a lot of people billing E1161 in Region B since they changed it to a rental, so I don't think we're doing as many as we used to. It's possible, but I haven't seen it yet.”

The probe, launched by National Government Services, was prompted by data analysis from 2013, which showed an increase in submitted charges for manual wheelchair bases and accessories and a high CERT error rate in Jurisdiction B. As a result, providers with affected claims have been asked to submit copies of the detailed written order (DWO), dispensing order and proof of delivery, among other things.

Common errors include coding issues, such as using the wrong HCPCS or diagnosis code, incomplete progress notes and failure to include the delivery ticket or other documentation, say industry experts.

To avoid those types of problems, provider Jackie Semrad says she “documents, documents, documents.”

“We audit our own claims before we even order the equipment,” said Semrad, owner of Reliable Medical in Brooklyn Park, Minn. “We really want to make sure that this is a product that is going to be covered.”

When it comes to sending in documentation, Kelly Wolfe, president of Regency Billing and Consulting, tells her clients to use a checklist.

“It's discouraging,” says Wolfe. “I just reiterate to all the providers that they really need to look at the local coverage determinations on everything and whether there are progress notes from the doctor.”

Toscano recommends going through Advanced Determination of Medicare Coverage (ADMC) before providing equipment, especially in light of the prepayment review.

“That way you have an affirmative decision out of ADMC,” she said, “and there shouldn't be any questions if the file is audited."


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