Surprises in The Scooter Store's testimony
Fraud and abuse suggestions
The Scooter Store has recommended two things I'd never heard people talk about before to prevent fraud and abuse.
1. Mandated equipment serial number tracking system. The Scooter Store says this would allow CMS to verify that provider claims represent real deliveries of real equipment from authorized manufacturers.
2. Real time auditing of high-volume physicians. Basically, The Scooter Store says most physicians have an average of two or fewer PMDs every year, so if they're prescribing more than 50 in a 12 month period, they should be audited. (Can you imagine if DOCTORS were audited for PMDs? hmm...)
The Scooter Store estimates that national reimbursements have gone down 23.5% between the first half of 2010 and the first half of 2011.
Scooter Store stats
• The Scooter Store employs 57 fulltime clinicians and quality review personnel to assess claims internally, independent of The Scooter Store's sales channel.
• Only 13% of beneficiaries who contact The Scooter Store have their claims submitted to Medicare.
At the time The Scooter Store submitted its testimony, 100% of prior authorization requests the company submitted were "non-affirmed" a.k.a. denied.
One claim got kicked back because the doctor didn't test oxygen saturation at exertion, when it would have put the patient at significant medical risk to take an exertion test, since her resting saturation rate was only 83%, The Scooter Store says.
They say Medicare contractors weren't using medical judgment in this case, instead relying on "some type of check list."
The company called the whole issue "especially troubling."
The Scooter Store would like to see the demo be significantly smaller and follow a prior authorization model more like the private sector has. The Scooter Store is concerned that the industry 80-90% denial rate, when moved to the beginning of the process, will cause access issues. While the provider and physician are working to get the claim through Medicare, the patient is going without equipment. They'd also like to see a face-to-face exam template, like many other providers and industry sources I've talked to.
The testimony mentions another thing I haven't seen brought up about the demo: a request for an appeals process for the prior authorizations. Basically, The Scooter Store says, resubmitting the same claim to the same arbiter again and again is not the best idea.
With the demo now in full swing, it's hard to say if Medicare is still open to suggestions. Still, it's interesting to see what the biggest power mobility provider in the industry has to say about the demo. Time will tell if anyone was listening.