This sounds like it would be good news for providers, but I am suspicious


Although error rates remain high for standard power wheelchair claims, a CMS contractor announced on Dec. 29 that it plans to discontinue its review due to upcoming changes in payment for K0823.

In the second quarter, from September 2010 through November 2010, Noridian Administrative Services (NAS), the Jurisdiction D DME MAC, found that of 253 claims reviewed, 232 were denied, resulting in an error rate of a whopping 92%.

On Jan. 1, however, Medicare eliminated the first-month purchase option for standard power wheelchairs and started paying for the equipment over the course of 13 months instead of in one lump sum. The change does not apply to complex power wheelchairs.

“NAS will continue to monitor the billing patterns of this and all power mobility devices to determine if further review is necessary,” the DME MAC stated in a bulletin.

Could it be possible that CMS and its contractors plan to merely shift their gaze from standard power wheelchairs to complex power wheelchairs like the K0861? Sunrise Medical's Rita Hostak warned providers recently that CMS anticipates providers will try to move more beneficiaries into complex power wheelchairs due to the elimination of the first-month purchase option for standard power wheelchairs.

“Documentation is going to be really important,” she said.

Time will tell, but in the meantime, here are some things to keep your eye on: The top reasons for denials for K0823 are insufficient medical records submitted to justify medical necessity; medical records without basic policy coverage criteria; no evidence of face-to-face exam; no completed home assessment; no written order submitted with documentation; no valid written order; no dispensing order submitted, only a detailed product description completed by a supplier; and an illegible physician signature.

Liz Beaulieu