OIG audits power wheelchair claims

Sunday, March 23, 2008

WASHINGTON - The Office of Inspector General (OIG) continued its investigation into power wheelchair pricing last week, asking providers to fill out multiple-page surveys for certain claims.

Providers have until March 28 to fill out the surveys. The OIG seeks documentation on medical necessity, acquisition costs and services for a range of standard and complex power wheelchair codes.

Industry leaders encourage providers to leave no stone unturned in filling out the surveys.

"It's important that providers provide as much information as possible and in as much detail as possible," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "Pre-delivery, at-delivery and post-delivery--all those costs are built into the fee schedule. This is a real opportunity to demonstrate to the OIG that the provision of power wheelchairs is very service intensive and that product costs represent only part of the picture."

The OIG sent the rehab industry reeling in October, when it released a report that stated Medicare pricing for 28 power wheelchair codes was 45% higher, on average, than median Internet pricing. The industry fought back, saying that Medicare providers, unlike Internet retailers, must provide numerous services.

The OIG's investigation casts a wider net than industry leaders expected. OIG officials told them in January that they would look at only two codes: K0823, a standard power wheelchair code similar to the former K0011; and K0861, a complex power wheelchair code.

"Now it looks like they're looking at several codes," said Sharon Hildebrandt, executive director of NCART. "Some of the surveys I've seen so far ask for information on K0849, K0856, K0857."

Industry leaders couldn't say how many surveys the OIG sent to providers. It appears, they said, that the investigation includes a variety of providers, even those who submit only a few claims each month.

The OIG asked providers to fill out surveys for anywhere from one to five claims, according to Don Clayback, vice president of government relations for The MED Group.

"We need to look at this as a great way to educate the OIG on all the things that are involved in providing power wheelchairs," he said. "It's a step in the right direction."