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Homecare Providers and Consumer Advocates Urge Congress to Stop Ineffective Medicare Payment Review Process for Mobility Equipment
Date:12/8/2011

nal three months for payments to cover the cost of obtaining the equipment? It is an unreasonable request. We don't have access to funding that will keep our businesses operating while we wait for government reimbursements. Congress must step in and stop this."

Providers and manufacturers predicted there would be major job losses in states where providers go out of business and where manufacturers adjust to the reduced demand in nearly fifty percent of the market.

The rationale CMS uses to justify the prepayment program is reducing fraud, claims errors, and improper payments. But the new prepayment review program will not address those problems. The power mobility community has made numerous recommendations to CMS for preventing errors and fraud in this area – but they have been ignored.  The root causes of the error rate in the power mobility sector are complicated rules and the subjectivity of the Medicare claims reviewers. Moreover, Medicare's process for auditing claims is expensive, inefficient, and distorts the error rate for power wheelchairs and other home medical equipment claims.

Tyler Wilson urged that CMS work with the power mobility community to derive a system that will curtail fraud, while allowing providers to keep their doors open. He noted support for pending legislation, HR 3399, The Fighting Fraud and Abuse to Save Taxpayer Dollars Act (FAST Act), which would establish an electronic prior authorization program along with a clinical medical necessity template.

"We understand the need to prevent fraud and abuse," Wilson said. "But it can't be done through capricious actions that hurt Medicare beneficiaries and providers."

The American Association for Homecare represents providers of durable medical equipment and services who meet the hea
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SOURCE American Association for Homecare
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