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HHS Report Confirms that the Complicated Medicare Documentation Requirements for Power Wheelchair Claims Obstruct Regulatory Compliance by Physicians and Wheelchair Providers
Date:1/15/2010

ciencies of this system are evident when, as the OIG found, only 7 percent of claims for complex rehabilitation wheelchairs meet Medicare's documentation standards."

In order for home medical equipment providers to be reimbursed by Medicare, a claim for a power wheelchair requires numerous types of documentation, including a seven-element prescription from a physician, supporting documentation from the patient's medical record supplied by the physician, an onsite home assessment report, a detailed product description, and a specialty evaluation (for complex rehabilitation power wheelchairs).

The American Association for Homecare also notes that:

  • Power wheelchair providers, patients and physicians have struggled for years to meet overly complex regulations and requirements in order to provide the medically required equipment to Medicare beneficiaries.
  • The home medical equipment sector has repeatedly pointed out the disconnect between physicians' practices and Centers for Medicare and Medicaid Services (CMS) claims requirements.
  • Physician organizations have met with CMS to appeal for more appropriate standards that are conducive to the practices of physicians.
  • Members of Congress have requested that CMS address the complexities of the Medicare documentation requirements for appropriate and timely claims adjudication.
  • Power wheelchair providers have appealed to CMS for years to improve the efficiency and consistency of the claims adjudication process by developing a simple, consistent, and accessible process by which standardized paperwork is reviewed.

"It is important to note that during most of 2006 and early 2007, the time leading up to and including the period covered by the OIG study, there were numerous and often contradictory changes in coding, documentation requirements, and compliance standards," said Tyler Wilson. "These have contributed to the confusion among
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SOURCE American Association for Homecare
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