Are You Prepared for a Motorized Mobility Audit?

If the DMERCs were to audit your K0011s (motorized wheelchair with programmable controls) and/or your E1230s (power operated vehicles/scooters), would you survive the audit?

As part of the government's 10-point plan to curb fraud and abuse in this market, the local medical review policy (LMRP) was reviewed carefully, giving consistency on how the DMERCs will audit and reimburse for these items. Not only will there be pre-payment reviews, there will be numerous post-payment reviews to verify that the provider should have been paid based on the documentation obtained.

For K0011s and E1230s, Medicare will apply the national policy on old as well as current dates of service. The policy states that a “patient must be bed- or chair-confined without the use of a wheelchair, and this equipment is for use inside of the home.” A power chair or power-operated vehicle (POV) is covered if the patient is also “unable to operate the wheelchair manually.”

For the Record

What should you look for in a patient file? First, verify that your patients truly qualify for the equipment you are providing them, based on Medicare guidelines. If you are providing a scooter, does the patient have the upper trunk stability to operate it safely? Did one of the specialists on the certificate of medical necessity order the scooter? Just because the doctor signed a CMN does not mean the patient meets medical guidelines. And, just because Medicare paid you does not mean you will keep your money!

The CMN alone will not give you the necessary documentation to prove the patient meets the criteria set forth by policy. Essentially, CMNs serve as a screening tool, allowing the DMERCs to review the basic coverage criteria electronically.

What else do you need in the patient's medical records? The supplier will be required to obtain:

(a) a copy of the patient's medical records from the treating physician,

(b) a copy of the delivery slip,

(c) any evaluations obtained prior to the delivery of the motorized vehicle,

(d) the distance a patient can walk either with the assistance of an ambulatory aid or independently,

(e) the strength and function of the upper and lower extremities, and

(f) all of the diagnoses that apply to the patient's limited means of ambulation (neurological, muscular or cardiopulmonary disease or condition — diagnoses on question No. 6 of the CMN).