Mobility Matters Highlights PWC Documentation Challenge

WASHINGTON — As the industry wrestles with competitive bidding, the PECOS and ongoing problems with the oxygen cap, another issue that continues to plague HME providers is documenting claims for power wheelchairs.

A recent review of 1,000 K0823 power wheelchair claims in Jurisdiction A, for example, showed only 237 were allowed while 763 were denied. NHIC, the Jurisdiction A DME MAC, said a whopping 78.9 percent of the claims had documentation that was incomplete.

The American Association for Homecare pointed to the documentation challenge for PWCs once again in its latest editions of Mobility Matters, a bulletin sent to Congress, the administration, policymakers and others.

For years, providers have called out Medicare's "inefficient guidelines for documenting the medical necessity of power wheelchairs," according to the July 16 bulletin. "It is the root cause of claim denials that are frequently reversed, the target of excessive audits and it restricts access to power wheelchairs for patients."

In a rare perspective on the matter from a physician, Jerald Winakur, MD, FACP, CMD, told the bulletin's readers he is as frustrated as providers are about the situation.

Winakur, a clinical professor of medicine and associate faculty member at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio, said CMS has taken what should be a simple task and made it needlessly difficult. "I cannot just order this device as I would a cane or a wheelchair or a walker … I am mandated to see the patient face-to-face even if he/she had just been in last week," Winakur wrote.

He added that he had now preformed several such evaluations. "They take me most of an hour to see my patient, examine him or her, complete the redundant paperwork. I am also required to write a chart note in the patient's medical record re-hashing the same information I have put on a form, rather than just putting the form in the patient record. Then there is all the work my staff has to do behind the scenes — several communications with the provider by phone.

"Even worse," he continued, "doctors and providers cannot get clear guidance as to what information is required by CMS after the mandated 'face-to- face' encounters."