NHIC Corp., the Jurisdiction A DME MAC, has released the results of its widespread prepayment review for power wheelchair claims in the first half of this year.
The power chair being examined was HCPCS coded K0823, defined as a Group 2 standard power wheelchair with captain’s chair seating and a weight capacity up to and including 300 lbs.
NHIC said it examined 90 claims from 40 different suppliers from Jan. 1 through June 30, 2014.
The DME MAC requested but did not receive additional documentation for 28 of the claims.
For the 62 remaining claims for which additional documentation was provided, NHIC said it allowed 12 claims and denied the other 50. The result was a charge denial rate of 67.8 percent.
Prior to the announcement, the most recently reported results were for quarter 4 of 2013, which had a charge denial rate of 84.1 percent.
Among the most common reasons for denial, NHIC said, was “insufficient clinical documentation to meet the general coverage criteria as outlined in LCD L21271 for power mobility devices” (31 percent of denied claims) and missing confirmation that the “supplier received a copy of the seven-element order within 45 days after the completion of the face-to-face clinical evaluation, as verified by a supplier date stamp or equivalent” (10 percent of denied claims).
