TriCenturion Releases Widespread Power Chair Probe Results, Continues Pre-Payment Review
TriCenturion, the Jurisdictions A & B Program Safeguard Contractor (PSC), has released the results of its widespread pre-payment probe for power wheelchairs coded K0823.
The Charge Denial Rate (CDR) for K0823 claims studied in the probe was 87.51 percent in Jurisdiction A and 93.36 percent for Jurisdiction B, numbers that led TriCenturion to continue a widespread pre-payment review in both jurisdictions.
Many of the reasons given for denying claims seemed to be paperwork related, as TriCenturion noted many claims failed to document the date of the required face-to-face examination by the physician; lacked a date stamp to verify supplier receipt within 45 days; or did not have the length of need documented.
TriCenturion said problems with medical records and information also led to a large number of denials. Among the problems noted: Medical records did not state that the reason for the visit was to conduct a mobility examination; functional limitations were not addressed in the face-to-face evaluation; letters of attestation were submitted without supporting information in the medical record; and supplier-created mobility evaluation forms were submitted as documentation in place of the medical records.
Product description problems leading to denials included amounts on the delivery slip not matching the amounts stated on the detailed product description; and the omission of the detailed product description.
All suppliers submitting claims for K0823 power chairs in Jurisdictions A & B will be subject to the continuing pre-payment review. Suppliers whose claims are chosen for review will receive an Additional Documentation Request letter that indicates what specific information needs to be submitted. Suppliers are required to submit the requested information within 30 days, or claims will automatically be denied. Additional documentation can be mailed or faxed to TriCenturion. l
This article originally appeared in the November 2007 issue of Mobility Management.