National Government Services (NGS), Medicare’s Jurisdiction B DME MAC, has announced it will launch a widespread prepayment probe review of manual wheelchairs – including adult tilt-in-space models.
In the Oct. 20 announcement, NGS said the manual wheelchair bases involved in the review are HCPCS coded E1161 – the code for an adult manual wheelchair with tilt-in-space – as well as K0001 through K0009. The K0005 ultralightweight wheelchair code is excluded from the review.
In explaining its reason for the review, NGS said, “During 2013, data analysis has shown an increase in submitted charges for manual wheelchair bases and accessories submitted to Jurisdiction B. Data analysis identified this area as having a high Comprehensive Error Rate Testing (CERT) error rate with an increase in claims and submitted charges in Jurisdiction B.”
As with other widespread prepayment probes, providers with affected claims will be told to submit additional documentation.
NGS indicated the additional documentation requests would seek the following:
— A copy of the detailed written order (DWO) signed and dated by the treating physician. If the claim shows an initial date of service (DOS) of Jan. 1, 2014, or later, NGS noted that the detailed written order must include the physician’s NPI and be signed and dated by the physician prior to dispensing.
— A dispensing order, if the DWO is signed and dated after the DOS for equipment that does not require a written order prior to delivery.
— Documentation showing that the general coverage criteria for the manual wheelchair base and accessories have been met, plus additional criteria for specific manual wheelchairs as stated in local coverage determination L27014.
— Medical records that document the continued medical necessity of the manual wheelchair.
— Documentation of proof of delivery.
— A copy of the Advanced Beneficiary Notice of Noncoverage, if one is on file for the client.
