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

ency's approach to reimbursement claims and cited recent changes to payment guidelines.  In the report, the agency demonstrated how unreasonable they have made some of the guidelines. The Mobility Matters article details some of the arbitrary guidelines, such as prohibiting claim reviewers from considering all available information if physician medical records were incomplete or missing, insisting that a physician's handwriting be completely legible, and not allowing claim histories to be used as a basis for a new claim on behalf of patients.   

While claim reviewers are denying claims based on these and other irrational guidelines, they are frequently overturned in appeals. To make the error rate more accurate and not provide Congress with erroneous information, the OIG has recommended that CMS adjust its methodology to include denials overturned on appeal.

But Wilson said the home medical equipment sector is looking for more substantial change, saying CMS must address the factors creating the unjustified claim denials.  Wilson, for instance, noted that CMS is considering an electronic template that would vastly improve the documentation process for power wheelchairs.  And he said that if CMS designs an adequate process for prior authorization, it would also strengthen the integrity of the Medicare program.

"What's clear is the underlying problems contributing to the error rate must be addressed," Wilson said.  "It's absurd for the private sector to have to pay such a steep price because the government can't implement reasonable reimbursement guidelines."

The American Association for Homecare represents durable medical equipment providers and manufacturers who serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility devices, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than
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SOURCE American Association for Homecare
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