OIG: Wheelchair documentation is more often wrong than right

 - 
12/30/2009

Three out of five claims for standard and complex power wheelchair claims did not meet Medicare documentation requirements during the first half of 2007, the Office of Inspector General (OIG) states in a new report. Those claims accounted for $112 million of the $189 million in total improper payments allowed for that time period.

The OIG based its report on a review of 375 claims for standard and complex power wheelchairs.

Other findings in the OIG’s report:

  • Two out of five claims had multiple errors;
  • Suppliers submitted incomplete documents almost three times as often as they failed to submit requirement documents;
  • Complex power wheelchair claims had a higher documentation error rate than standard power wheelchair claims; and
  • Standard power wheelchair claims submitted by low-volume suppliers had a higher documentation error rate than those submitted by high-volume suppliers.

(Anyone else find this last finding especially interesting? Does it mean that a provider like The Scooter Store has the cleanest claims?)

The OIG recommends that CMS improve compliance with documentation requirements by conducting additional reviews of claims; recovering overpayments and considering further actions against suppliers that do not meet requirements; and increasing education for suppliers and prescribing physicians about requirements. Additionally, the OIG recommends that CMS take action on the sampled claims found to be in error. CMS concurred with the OIG’s recommendations.

To read the OIG’s report in full, go to: http://oig.hhs.gov/oei/reports/oei-04-07-00401.pdf.

Liz Beaulieu

Comments

[...] has been some interesting chatter on the NRRTS listserv today about the OIG report on power wheelchair documentation (If you’re not part of the NRRTS listserv you should be; go [...]

"(Anyone else find this last finding especially interesting? Does it mean that a provider like The Scooter Store has the cleanest claims?)"

Well yes, when they settled with Medicare for millions, that payment guaranteed that future claims were clean, right? That's what I get out of it.
I do not know how many power wheel chairs and scooters we have turned away just because the physician cannot/will not provide the necessary documentation. This documentation is not a check-list for the MD to complete, by the way; however, those "clean claims" from the "higer-volume providers" do use them. How is that?