RAC power wheelchair probes draw ire

Friday, December 28, 2012

ATLANTA – A recent surge of audits in Jurisdiction C are targeting “low-lying fruit,” older claims that are more likely to have problems, say consultants.

RAC auditor Connolly Healthcare in the past few months has focused audits on power wheelchair claims from 2009 and 2010.

“Instead of randomly picking claims to see if providers are doing things correctly, they’re really going back in time—thinking that if they go back (further) they have a better chance of recouping money,” said Kelly Wolfe, CEO of Regency Billing and Consulting. 

Claims from those years are more likely to have flaws, consultants say, since key guidance—including a MedLearn Matters article about the face-to-face requirement—wasn’t available back then.

“The jurisdictions have issued clarifications for the LCDs—that clarity wasn’t there in 2009,” said Sylvia Toscano, owner of Professional Medical Administrators. “If you hold claims from 2009-2010 to the standards we meet now, I’m not sure you’ll have good results.”

Another twist: Many of these older claims are for patients who are now deceased, Wolfe says. That means more difficulty collecting documentation, as physician documentation may have been moved to storage.

Providers say losing a fight for these older claims would mean having to take a wheelchair back or taking a loss—and most don’t want to take a patient’s mobility away.

“These patients have had their chairs for two years, helping them with their quality of life,” said Kevin Greenwood, COO of Ormond Beach, Fla.-based Comfort Medical Supply, who is in the process of responding to 38 power wheelchair audits from the 2009-2010 timeframe.