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Mobility Matters: Frustrated Mobility Providers Ask White House to Address Gross Mismanagement of Mobility Benefit
Date:2/10/2011

ent claims presented by medical equipment providers after delivering power wheelchairs to Medicare patients.  

With the level of technology available today, neither of these objectives should be major hurdles. Unfortunately, the government hasn't delivered workable solutions. In fact, recent audit reports by their Durable Medical Equipment Medicare Administrative Contractors (DME MACs) demonstrate not only the extent to which the government has failed to provide a reasonable process, but also call into question the competency of Medicare's payment system for medical equipment providers.

From December 2008 until November 2010, the DME MACs, who administer Medicare claims for CMS, conducted 11 industry-wide audits of reimbursement claims from their four geographical regions. The results were astounding.  In their published reports, the DME MACs said that out of 7,309 claims, 5,977 were denied for an error rate of 82 percent.  

In a November 2009 executive summary of an improper payments report, CMS specifically stated that the error rates are not related to fraud, but "may be an indication of a program weakness that requires more oversight and diligence by CMS."  That is a gross understatement. The reimbursement process for the mobility benefit is so riddled with subjectivity and confusion that providers and physicians don't know how to comply with the criteria that is established, and frequently changed. The long history of the documentation and audit issues clearly pinpoint CMS as the culprit, while providers, physicians and beneficiaries have been the victims.

The denial rate for claims has been high not just in DME MAC audits, but also for most audits conducted on mobility assistance providers, such as those conducted by the U.S. Department of Health and Human Services' Office of Inspector General.  At times, CMS has introduced new criteria for submitting claims and then absurdly applied the changes retroactive
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SOURCE American Association for Homecare
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