'Mobility Matters' Documents Wheelchair Denial

ARLINGTON, Va. — The American Association for Homecare sent the latest edition of its bimonthly Mobility Matters bulletin to lawmakers on Capitol Hill last week. The issue documents the case of a 68-year-old amputee from Yucca Valley, Calif., whose Medicare claim for a power wheelchair was denied.

According to the bulletin, two years ago, the man, who was referred to as John, sought a power wheelchair from Medi-Source Equipment & Supply, a home medical equipment provider in rural Yucca Valley. Both his legs had been amputated; after a stroke he had the use of one "good" arm that constantly ached.

"His power wheelchair, battered and broken down, lay crumpled on the side of his caregiver's garage," Mobility Matters reported. "At the time, that garage was the place that John called home. Often his power wheelchair served as both his transportation and his bed. But his power chair had seen its last day."

Here's the rest of the story from the bulletin:

Under Medicare regulations, power wheelchairs are supposed to last at least five years before being replaced, but John's had worn out after three years from heavy use.

"His power wheelchair served as his only means of getting around," said Esta Willman, owner of Medi-Source. "When his caregiver wasn't available, he literally slept in his wheelchair. He couldn't get out of it on his own. He came to our place, and we started the process to provide him a new chair, thinking that even if the Medicare claim was initially denied, his extenuating circumstances would allow it to be approved on appeal."

Tyler Wilson, AAHomecare president, said the chain of events in this particular case reinforces the need for substantial changes in the way that Medicare claims for home care equipment are handled by CMS. He said that across the country, small and large providers are outraged over the broken process — claims rejected for Medicare beneficiaries who clearly need power wheelchairs, a high percentage of these denials later overturned in administrative appeals, good providers pushed to the brink of bankruptcy because of delays in getting paid for legitimate claims and new standards for documenting medical necessity applied retroactively to claims filed long before the new guidelines were established.