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Power Mobility Coalition Voices Concern Over Government Reports Outlining Lack of Oversight in the Medicare Durable Medical Equipment Benefit
Date:9/2/2008

Organization Calls on Medicare to Expedite Mandatory Accreditation, Adopt Clearer Documentation Standards

WASHINGTON, Sept. 2 /PRNewswire-USNewswire/ -- The Power Mobility Coalition (PMC), an association of manufacturers and suppliers of power mobility devices, raised concerns today about recent findings that questioned whether the Center for Medicare & Medicaid Services (CMS) accurately reviewed durable medical equipment (DME) claims that suppliers submitted for reimbursements after providing medical equipment to Medicare beneficiaries.

The Health and Human Services (HHS) Office of the Inspector General (OIG) report entitled, Medical Review of Claims for the Fiscal Year 2006 Comprehensive Error Rate Testing Program (A-OI-07-00508), compared an OIG and CMS review of the same Medicare DME claims, including power mobility devices, which resulted in vastly different error rates. The CMS contractor assessed a 7.5% error rate while an OIG contractor assessed a 28.9% error rate.

To help correct problems, the OIG recommended that physicians receive additional documentation training and that CMS issue a written policy clarifying the review process to be followed by their Medicare contractors. The PMC has worked with Congress, CMS, physician organizations, and suppliers to establish an objective documentation standard to provide consistency in the DME claims process.

It is evident by the report, however, that an objective standard still eludes CMS as attested by the differing interpretations of the DME claims process by both OIG and CMS. "It appears that there is inconsistency in determining what constitutes medical necessity for Medicare beneficiaries to obtain the equipment," says Stephen Azia, PMC Counsel. "The physician must be the gatekeeper of the PMD benefit and the veracity of his or her best medical judgment should not be second-guessed by a medical reviewer who has never seen or examined the beneficiary. These results just highlig
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SOURCE The Power Mobility Coalition
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