OIG to review PAP supplies, PMD repairs

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Friday, October 18, 2019

WASHINGTON – The Office of Inspector General has updated its Work Plan to include new reviews for PAP replacement supplies and power mobility device repairs.

Medicare paid approximately $945.8 million for replacement supplies in 2017 and 2018, but OIG has previously found that most claims did not comply with Medicare requirements.

For supplies and accessories used periodically, orders must specify the type of supplies needed, the frequency of use, if applicable, and the quantity to be dispensed, and suppliers must not automatically ship refills on a predetermined basis.

PMD repairs

Medicare paid approximately $46.7 million for PMD repairs in 2018, including replacement parts. Suppliers must maintain documentation from the physician or treating practitioner indicating that the PMD being repaired continued to be medically necessary and that the repairs were reasonable and necessary.

DME suppliers must also maintain detailed records describing the need for and nature of all repairs, which includes a justification for the replaced parts and the labor time. In addition, if the expense for repairs exceeds the estimated expense of purchasing or renting another PMD for the remaining period of medical need, no payment can be made for the amount of the excess.