National Government Services (NGS), the Jurisdiction B DME MAC, has announced the results of a widespread prepayment probe for Group 1 standard power wheelchairs in the states of Wisconsin and Minnesota.
The HCPCS code under review was K0816, defined as a standard Group 1 power chair with captain’s-style seating and a user weight capacity up to 300 lbs.
NGS performed the reviews between Aug. 31 and Nov. 16, 2015, and examined nine claims in all.
Four of the claims were ultimately accepted, while the other five were denied, resulting in a claim error rate of 55.56 percent.
NGS said the most common reasons for denying the claims was that documentation of the face-to-face examination did not adequately explain why a scooter or a manual wheelchair would not have sufficiently met the beneficiary’s needs instead. Missing date stamps were also cited as a common reason for denial.
NGS said it would suspend the review “due to low claim volume,” but added it would “continue to monitor activity on the HCPCS code through data analysis.”
