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Problems Plague Medicare's Method for Measuring Payment Errors
Date:6/8/2012

and reasonable standard: providers find that the policy guidelines are routinely applied differently in different regions of the country, and can even vary within the same region or claims office. The full Mobility Matters article can be downloaded here.

"The OIG report reinforces the fact that the documentation process for Medicare reimbursements must be addressed in a substantial way," said Tyler Wilson, president of the American Association for Homecare.  "These claim denials are killing legitimate businesses. Providers are paying for products and services that are medically necessary for Medicare beneficiaries. Then, largely for technical reasons, the reimbursements for providers are being denied, and they must go through a lengthy and costly appeals process to receive payment."

Furthermore, Wilson said, "Confusing rules and red tape in Medicare are making it harder for patients to get a wheelchair or other types of medically required equipment and services that helps them to remain safe and independent at home."

Wilson cited the cash flow shortfalls caused by these payment delays as well as excessive government audits as major reasons why many providers are going out of business or deciding to no longer provide certain products to Medicare patients.  

Denied claims are a particular problem for power wheelchair providers.  Requirements for documenting medical necessity for mobility equipment has changed many times over the last decade, confusing physicians, clinicians, providers and Medicare beneficiaries. Power wheelchair providers said nearly 90 percent of their claim denials are reversed by Administrative Law Judges, but the payment delays and administrative costs associated with making appeals place an unfair financial burden on their businesses.

Three years ago, a CMS report provided insight on the ag
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SOURCE American Association for Homecare
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