Power wheelchairs: Repeat performer


So the OIG released its 2010 work plan this week, and it'll come as no surprise to providers, I'm sure, that power wheelchairs are mentioned more than once. Here's the rundown:

  • The OIG will review payments for power wheelchairs to determine whether they were “reasonable and necessary.” Prior OIG reviews have stated that these products are sometimes not ordered by physicians or not delivered to or needed by beneficiaries. The OIG plans to target geographic areas with high-volume claims and reimbursement.
  • The OIG will review documentation supporting claims for power wheelchairs paid by Medicare and determine whether beneficiaries received the required face-to-face examinations from the referring practitioners prior to receipt of equipment. In 2003, Medicare payments for power wheelchairs peaked at $1.2 billion. In 2004, as a result of expanded CMS program integrity initiatives, power wheelchair spending decreased to $850 million; however, problems may persist. In 2007, about 173,300 Medicare beneficiaries received power wheelchairs, costing $686 million.
  • The OIG will review documentation for payments to DME suppliers for standard and complex rehab power wheelchairs to determine whether suppliers meet Medicare’s coverage criteria and medical necessity documentation requirements. It will also determine whether suppliers had documentation from the beneficiaries’ medical records, as required, that clearly supported the medical necessity of the power wheelchairs.
  • The OIG review servicing records from suppliers and interview beneficiaries regarding their experiences with capped rental DME, including hospital beds and wheelchairs, to determine whether Medicare made proper payments for maintenance and repair services.

Should be a fun year.

Liz Beaulieu