DME MAC A Announces K0823 Review Results

NHIC Corp., the Jurisdiction A DME MAC, has announced the results of its latest widespread prepayment review for group 2 standard power chairs.

The review examined claims for HCPCS code K0823, standard power chairs with captain's-style seating and user weight capacities up to and including 300 lbs. This latest review period covered claims from Oct. 1 through Dec. 31, 2012.

NHIC reported an 86.6 percent charge denial rate for the 270 claims it examined. The claims were from 133 different providers.

The DME MAC added that it did not receive responses to its Additional Documentation Requests for 42 of the claims.

Of the remaining 228 claims, NHIC allowed 25 and denied 203.

NHIC said half of the denied claims lacked sufficient clinical documentation to support medical necessity for the power chair.

Problems with the required face-to-face examinations were cited in several instances of insufficient documentation. For instance, NHIC said the documentation "did not clearly indicate that the reason for the visit was a mobility evaluation" or "did not provide a clear picture of the patient's specific mobility limitations, i.e., upper and lower body strength, range of motion, coordination, pain levels, physical deformities and physical endurance."

NHIC also cited common errors with the seven-element order, including that the orders were incomplete and missing one or more of the required elements (16 percent of denials). Another 10 percent of denies claims were missing confirmation that the supplier had received a copy of the seven-element order within the required 45 days after the face-to-face examination was completed.

Detailed product descriptions were missing completely in 8 percent of denials, and incomplete in 11 percent of denials, NHIC added.

Twenty-seven percent of the denied claims didn't include "a financial attestation statement stating the LCMP [Licensed/Certified Medical Professional) provider did not have a financial relationship with the supplier providing the wheelchair."

About the Author

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

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