National Government Services (NGS), the Jurisdiction B DME MAC, has released the results of its 2011 fourth-quarter widespread prepayment medical review for Group 2 power wheelchairs.
From Oct. 1 to Dec. 31, 2011, NGS’s medical review department examined 615 claims for which it had requested additional documentation, according to a news release distributed in March.
NGS says 496 claims were completely denied, resulting in an error rate of 81 percent.
The remaining 119 claims were paid partially or in full.
The prepayment review applies to HCPCS code K0823: Group 2 standard power chairs with captain’s seats and weight capacities up to and including 300 lbs. Related accessories are also included in the review.
The most common reasons for power chair base denials, NGS said, were the following:
— No valid medical records were found in the supplier’s documentation, or the medical records received as additional documentation did not establish medical necessity (55 percent).
— There was insufficient evidence that a physician face-to-face mobility examination occurred.
— The required seven-element order or detailed product description was invalid or incomplete.
— There was no response to the request for additional documentation.
