WASHINGTON — According to the Office of Inspector General,
three out of five claims for standard and complex rehab power
wheelchairs did not meet Medicare documentation requirements during
the first half of 2007. Those claims accounted for $112 million in
improper Medicare payments out of the $189 million total allowed
during the six-month period, the OIG said in a report posted Dec.
30.
Based on a random sample of 375 claims selected for review, the
report said 60 percent did not meet one or more documentation
requirements and two out of five had multiple errors. In addition,
the OIG said, suppliers submitted incomplete documents almost three
times as often as they failed to submit required documents.
Medicare currently requires the following documentation to
support power wheelchair claims:
- power wheelchair prescription;
- supporting documentation from the beneficiary's medical
record; - specialty evaluation report (for complex rehab chairs
only); - detailed product description;
- home assessment report; and
- proof of delivery.
According to the new report, error rates ranged from 1 percent
of claims with no proof of delivery to 40 percent of claims for
which the supporting documentation and detailed product
descriptions were not submitted or were incomplete.
The specialty evaluation report and a detailed product
description were the documents most often lacking on complex rehab
claims, the report found.
The OIG also noted that documentation error rates varied by
power wheelchair type and supplier volume: Complex rehab claims had
a higher documentation error rate (93 percent) than standard power
chair claims (58 percent); and standard PWC claims from low-volume
suppliers — those that submitted fewer than 10 standard PWC
claims in the study period — had a higher documentation error
rate (72 percent) than those submitted by high-volume suppliers (55
percent).
Based on its review, OIG recommended that CMS improve compliance
with PWC documentation requirements by conducting additional
reviews of claims; recovering overpayments and considering further
actions against suppliers that do not meet documentation
requirements; and increasing education for suppliers and
prescribing physicians about documentation requirements.
The OIG also recommended that CMS take appropriate action on the
sampled claims found to be in error. CMS concurred with the
recommendations. For the complete report, go to http://oig.hhs.gov/oei/reports/oei-04-07-00401.pdf.
In October, the OIG issued a controversial report on providers' costs to
purchase power wheelchairs, saying that Medicare could have saved
millions on PWCs if its fees had been the same as prices available
on the Internet. But the HME industry's mobility segment
immediately labeled the report as flawed and misleading,
pointing to the significant difference in cost between an online
retail model and a Medicare provider model.
Now, the OIG said, it also plans to issue a report on the
"appropriateness (e.g., the medical necessity)" of power wheelchair
claims. In addition to determining whether beneficiary medical
records supported the medical necessity of the power wheelchair,
OIG will determine whether documentation from the suppliers and
prescribing physicians was consistent.
