Senators: PMD error rate 'beyond belief'
WASHINGTON – Sen. Bob Corker, R-Tenn., took CMS to task for high error rates on power mobility devices (PMD) during a congressional hearing Sept. 19.
"There's a huge problem here," said Corker, citing a 2011 Office of Inspector General (OIG) report. "Isn't an 80% fault rate almost beyond belief, even for the federal government?"
Corker, along with Sen. Richard Blumenthal, D-Conn., held the hearing to review a seven-state demonstration project that requires prior authorizations for PMDs. The demo kicked off Sept. 1.
CMS’s Deborah Taylor defended the PMD demo as a way to lower that error rate, and curb fraud and abuse.
"Prior authorization can be an important tool for CMS to reduce fraud and improper payments," said Taylor, CFO and the director of the Office of Financial Management, who testified at the hearing.
Corker stated during the hearing that TV commercials that appear to ensure callers they can get PMDs for free should "set off alarm bells," but following the hearing he and Blumenthal realized that the problem is not that simple, stakeholders say.
"The senators came in with the impression that the problem was largely one of TV advertising leading to fraud and abuse," said Seth Johnson, vice president of government affairs for Pride Mobility Products. "I think they came away with the fact that there's a whole list of things that need to be fixed."
Among those things: holding Medicare contractors accountable for not reducing error rates and learning from the private sector. For example, BCBS of Tennessee's Stephen Peake testified that his managed care plan has a negligible PMD error rate because providers can learn from denials and create better claims.
"We clearly articulate why the claim is denied," said Peake, medical director. "If you read our denials, you'll know what you need to do to get the patient what they need."
Systems like these ensure the payer, physician and PMD provider are on the same page, and The Scooter Store’s Michael Clark testified that he’d like to see more of that from Medicare.
"Instead of determining what constitutes medical necessity, Medicare denies based on technical documentation deficiencies," said Clark, chief administrative officer and general counsel. "Managed care programs try to see: Does the patient need it or not?"
Despite the points made during the hearing, AAHomecare’s Walt Gorski says senators should be more worried about "the big picture."
"When you have an error rate somewhere between 80% and 100%, that clearly shows the system is broken," said Gorski, vice president of government affairs for AAHomecare. "Heads should roll—people should lose their jobs. But that's not happening here."