National Government Services (NGS), the Jurisdiction B DME MAC, has released the latest results of its ongoing widespread prepayment review for consumer power wheelchairs.
The report covered the July 1 through Sept. 30 claims period, and involved claims for power chairs with HCPCS codes K0820 through K0829.
NGS said it processed 636 such claims – for power chair bases with options and accessories — during the year’s third quarter, and developed 572 for additional documentation.
The DME MAC paid 146 claims in full after reviewing the documentation, and completely or partially denied the rest. The resulting claims error rate was 77 percent.
That’s a higher error rate compared to the previous quarter, when NGS reported a 64-percent error rate.
Among the most common reasons given for denials, NGS said, were that documentation of the face-to-face examination did not prove that a manual wheelchair or a scooter – rather than a power wheelchair — would not meet the beneficiary’s needs.
The other most common reason for denials was that the face-to-face exam documentation did not prove that the beneficiaries had significant enough mobility limitations to warrant power wheelchairs.
NGS also pointed out that 64 claims were automatically denied because the corresponding suppliers did not submit the additional documentation as requested.
