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Effectiveness of Medicare Authorization Program for Power Wheelchairs Rests on Inclusion of a Clinical Template
Date:6/19/2012

WASHINGTON, June 19, 2012 /PRNewswire-USNewswire/ -- Power mobility stakeholders await implementation of a Medicare prior authorization program for power wheelchairs, an initiative that could address the flawed claims approval process that has hampered physicians and providers for years.  If not implemented properly, the program will restrict access to power mobility devices for qualified Medicare beneficiaries, according to Mobility Matters, a bulletin published by the American Association for Homecare.

Under the proposed prior authorization program, the Centers for Medicare & Medicaid Services (CMS) will subject all claims for power mobility to a prior authorization process for a period of three years in California, Florida, Illinois, Michigan, New York, North Carolina, and Texas.  Medicare patients in these states receive nearly 50 percent of all the power mobility prescribed to beneficiaries each year.

The need for a significant policy change was underscored when a Comprehensive Error Rate Test (CERT) on power mobility devices in DME MAC Jurisdiction D found a 100 percent error rate, a score supposedly signifying that none of the power wheelchairs provided to Medicare beneficiaries in that region met the reimbursement and coverage criteria. What the CERT did demonstrate is that CMS guidelines for documenting medical necessity for a power wheelchair are so subjective and absurd that virtually any reimbursement claim can be found to be in non-compliance.

In fact, even the CERT testing methodology used by CMS has been questioned. The US Department of Health and Human Services Office of Inspector General recently concluded that thousands of denied claims cited as improper payments in CERT testing in 2009 and 2010 were later overturned and paid upon appeal. Thus, CMS overstated the improper payments by $4 billion over that two-year period. (CERT testing doesn't track Medicare fraud or abuse; it is designed to simp
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SOURCE American Association for Homecare
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