Another key indicator of how poorly the claims are processed is that providers are often successful when appealing denials to Administrative Law judges, allowing providers to eventually be paid. But this has created cash flow nightmares for providers, who now face severe financial ramifications from the controversial competitive bidding program, as well as the end of the first-month purchase option. As a result, some providers are no longer selling standard power wheelchairs or going out of business, making it more difficult for Medicare beneficiaries, especially those in rural areas, to obtain the medical equipment prescribed by their physicians.
At the heart of the issue is the role of physicians. CMS has requested that doctors make handwritten progress notes on their patients, documenting over time the increasing need for mobility assistance. This documentation must be presented to prove medical necessity. But physicians vary widely in what they write on patient progress notes, leading to broad discrepancies over what patient chart notes will be available in individual cases. While health care reform is supposed to give patients better access to physicians, as well as better care, the CMS claims process creates an unhealthy environment where claim review contractors are overruling the clinical assessments made by physicians. Doctors prescribe power wheelchairs after mandated face-to-face examinations of their patients, yet CMS treats the doctors as if they don't know what they are doing.
Even more absurd is that many claims are denied, not because of questions related to medical necessity, but because the physician documentation was presented in a format deemed undesirable by CMS. For instance, physicians are encouraged not to submit prepared forms to help describe why their patient needs a
|SOURCE American Association for Homecare|
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