NGS: Q1 PWC Claims Error Rate Remains High

National Government Services (NGS), Medicare’s Jurisdiction B DME MAC, has released the results of its 2014 first-quarter widespread prepayment review for power wheelchairs.

The power chairs being scrutinized are in Group 2 with HCPCS codes K0820 through K0829. Related options and accessories are also part of the prepayment review.

In its news announcement, NGS said it examined 389 claims between Jan. 1 and March 31, 2014. Just 48 of the claims that were evaluated were paid in full, which resulted in a claims error rate of 87.7 percent.

NGS listed the following as the most common reasons for denials:

-- Documentation of the face-to-face examination failed to prove a manual wheelchair would not meet the beneficiary's mobility needs in the home.

-- Documentation of the face-to-face examination did not prove that the beneficiary had a significant mobility limitation requiring a power wheelchair.

-- Documentation of the face-to-face examination failed to prove why a power operated vehicle wouldn't meet the beneficiary's mobility needs in the home.

-- Coverage criteria have not been met showing the beneficiary does not have sufficient upper-extremity function to self propel an optimally configured manual wheelchair in the home.

-- Coverage criteria have not been met showing the beneficiary's mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.

NGS added that it did not receive the requested additional documentation for 20 of the claims being examined.

About the Author

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

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