DME MAC launches manual wheelchair review

Wednesday, December 24, 2014

INDIANAPOLIS – So far, few providers in Jurisdiction B seem to be affected by a recent prepayment review for manual wheelchair bases, including adult tilt-in-space models (E1161).

“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,” said billing consultant Sylvia Toscano, owner of Professional Medical Administrators. “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 using the wrong HCPCS or diagnosis code; submitting incomplete progress notes; and failing to include the delivery ticket or other documentation, say industry experts.

To avoid 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 a product that is going to be covered.”

When it comes to submitting documentation, Kelly Wolfe, president of Regency Billing and Consulting, tells her clients to use a checklist, though only a handful of them offer those types of chairs.

“It’s discouraging,” says Wolfe. “I’m looking at some of their paperwork and it seems sufficient to me. 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. When they’re denied in a probe, they’re having a hard time going back to the doctor and getting what they need.”

Toscano recommends going through the Advanced Determination of Medicare Coverage (ADMC) process 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.”