Furthermore, because the prepayment reviews will occur after the power wheelchairs have been delivered to beneficiaries, the Association raised the possibility that providers might be forced to "rescind care" or take back equipment if claims are denied.
"With a considerable percentage of the currently high error rates reported on these claims being attributable to paperwork inaccuracies or omissions, suppliers are placed in the position of potentially having to remove denied mobility devices from beneficiaries' homes when the medical necessity may be genuine," the United Spinal Association wrote in its December 8th letter.
The letter goes on to state, "Beneficiaries should not be burdened with the uncertainty of the pre-payment review phase or denied their mobility independence while CMS develops and implements their own, untested, prior authorization process. Nor should beneficiaries, often living on limited fixed incomes, be placed in a position of paying their deductible and 20 percent copayment only to be at risk for having the device repossessed if the claim is denied for any reason."
Meanwhile, providers in New York are considering whether they can even continue operating under these circumstances.
A year ago, CMS implemented a 13-month rental reimbursement policy for mobility equipment that spread reimbursement for power wheelchairs over a 13 month period for providers. Already, many providers across the country have gone out of business. In fact, utilization of the Medicare power mobility benefit dropped more than 25% from a year ago largely because of this mandatory rental policy. Now, the prepayment process would add an additional three months or more to when the rental payments would even begin.
|SOURCE American Association for Homecare|
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