NGS Expands Scope of Power Chair Prepayment Review

The widespread prepayment review conducted by National Government Services (NGS) and involving Group 2 power chairs is getting wider.

In a March 12 bulletin, NGS, the Jurisdiction B DME MAC, said it was expanding the current review to “include all Group 2 power wheelchairs… that do not possess the capability of adding a power seating option.” The impacted HCPCS codes are K0820-K0829.

Previously, the NGS review applied only to chairs in the K0823 code – Group 2 standard power chairs with captain’s seating and weight capacities up to and including 300 lbs.

“Submitted claims from multiple suppliers will be reviewed to assure that all coverage criteria and documentation requirements were met,” NGS said.

On Feb. 27, NGS announced the results of its 2012 fourth-quarter prepayment review for those K0823 power chairs.

From Oct. 1 through Dec. 31 of 2012, the review asked for additional documentation for more than 1,000 such claims. Just 122 of the claims were paid in full, NGS said, with the remaining claims “completely or partially denied, resulting in an 80-percent claims error rate.”

Among the most common reasons for denial: failure of the documentation to prove that an optimally configured manual chair would not have sufficed. That accounted for nearly a quarter of denials.

NGS said other common denial reasons included medical records that didn’t establish that a face-to-face examination with a physician had occurred, and that medical records didn’t disqualify the use of canes, walkers or other lesser mobility equipment instead of a power chair.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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