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Power Wheelchairs Essential to Reasonable Quality of Life for Many Medicare Beneficiaries
Date:4/9/2013

stead, however, over the past nine years the Centers for Medicare & Medicaid Services (CMS) has implemented a series of policies and regulations that have restricted the availability of power wheelchairs to Medicare beneficiaries. In fact, government officials have skewed their oversight findings to reflect negatively on durable medical equipment providers and Medicare beneficiaries.

Nearly two years ago, the U.S. Department of Health and Human Services Office of Inspector General (OIG) issued a report trumpeting that 61 percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 "were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity." The same report said that 80 percent of claims for power wheelchairs supplied to beneficiaries in the first half of 2007 did not meet Medicare requirements.

But a less ballyhooed section of the report noted that medical necessity was actually questioned on just nine percent of the claims for power mobility devices that were reviewed. And of those nine percent, seven percent simply needed a different type of power wheelchair, while only two percent needed a less expensive piece of equipment. The issue that the OIG didn't report on is that CMS has a subjective documentation process that allows for claims to be denied for frivolous reasons involving documentation that have absolutely nothing to do with the medical needs of the patient.

That power wheelchairs are often not medically necessary would come as a huge surprise to people like Ryan Wilson and the Cannons.

They depend on the Medicare power mobility benefit every day. Their quality of life is linked to being able to use the power chair that Medicare provided. Thousands of people who receive power wheelchairs from Medicare are exactly like them—immobile without a power wheelchair. Their power wheelchair is critical to their abili
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SOURCE American Association for Homecare
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