PWC audits on the way

Saturday, June 30, 2007

COLUMBIA, S.C. - TriCenturion, the program safeguard contractor (PSC) for jurisdictions A and B, has begun a widespread, pre-payment probe for the following: power wheelchair Group 2 standard captain's chair with patient weight capacity up to and including 300 pounds (K0823). The review will be conducted in both jurisdictions A and B.
According to a June TriCenturion bulletin:
Data analysis was completed for dates of service Dec. 1, 2006, through March 31, 2007, on all new power wheelchair codes that went into effect on Nov. 15, 2006. The allowed amount for Group 2 power wheelchairs accounts for more than 90% of the total allowed amount for all new power wheelchair codes in each jurisdiction. More specifically, the allowed amount for K0823 accounts for more than 77% of the allowed amount for Group 2 power wheelchairs in each jurisdiction.
TriCenturion uses widespread probe reviews to determine the extent of potential problem areas across multiple suppliers. It believes a proactive approach to the increased provision of K0823 will identify possible problems in the billing of this item. Areas of confusion can be addressed through focused education to suppliers.
Suppliers whose claims are selected for review will receive an Additional Documentation Request (ADR) letter asking for specific information to determine if the item billed complies with the existing reasonable and necessary criteria. Failure to supply the requested information within 30 days of the request will result in denial of the claim.