Wednesday, December 31, 2003

Power wheelchair audits
With J. Everett Wilson

Q. My DME is facing an audit of our power wheelchair patients. Is there anything I should do to help my case?

A. With audits involving power wheelchairs, the carrier is going to be collecting information through your records, the patient’s physicians’ medical records and, whenever possible, the individual beneficiary. It is important to understand that the carrier will deny as many claims as possible where the beneficiary’s medical condition did not qualify them for a power wheelchair. To qualify, a patient must be unable to operate a manual wheelchair, and they are typically completely non-ambulatory with severe weakness of the upper extremities.

The mere fact that you have a properly completed certificate of medical necessity in your file will not preclude a denial of the claim. It is wise to take the additional step of interviewing the beneficiaries who are part of the investigation. The results of these interviews will be critical to the possibility of prevailing in any subsequent appeal of an overpayment determination.

With the help of a qualified health law attorney, you should create an affidavit form questionnaire that addresses all of the regulations governing the qualifications for power wheelchairs as opposed to manual wheelchairs. Once the form is complete, contact the beneficiaries and request to schedule a brief interview about their power wheelchair use. Your staff should conduct the interviews in-person, and a notary public should be present to witness the proceedings and notarize the beneficiary’s signature on the completed form. It is important to obtain these affidavits to counter any contentions by the carrier that the beneficiaries did not require use of the power wheelchairs.

J. Everett Wilson, Esq., is managing partner at Wilson Suarez Lopez & Gennett: (305) 446-7300