National Government Services (NGS), Medicare’s Jurisdiction B DME MAC, has released the latest results of its ongoing widespread prepayment medical review for certain types of power wheelchairs.
The review involves Group 2 power wheelchairs without the ability to accommodate a powered seating option, as well as power wheelchair-related options and accessories, NGS said in its Jan. 30 news announcement.
From October through December 2013, the DME MAC examined 613 claims for HCPCS codes K0820-K0829 that were developed for additional documentation.
“Of these claims reviewed, 124 were paid in full,” NGS said. “The remaining claims were completely or partially denied, resulting in a 79.8-percent claims error rate.”
As part of the announcement, NGS gave the four most common reasons for claims 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 has not been met showing the beneficiary does not have sufficient upper-extremity function to self-propel an optimally configured manual wheelchair in the home.
In addition, NGS noted that it did not receive additional documentation from suppliers as requested for 58 of the claims that the DME MAC wanted to examine.
