OIG Report: More PWC Documentation Problems

WASHINGTON — More than half of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 had claims that lacked sufficient documentation to determine medical necessity, the Department of Health and Human Services Office of Inspector General said July 7.

Based on its review of a 375-claim sample, an OIG report showed 9 percent of the PWCs were medically unnecessary, and another 52 percent had claims that were insufficiently documented.

The report, "Most Power Wheelchairs in the Medicare Program Did Not Meet Medical Necessity Guidelines," is the OIG's latest based on the same 2007 sample. Two previous OIG reports found problems with PWC claims coding and documentation.

"Across all three reports, 80 percent of claims for power wheelchairs supplied to beneficiaries in the first half of 2007 did not meet Medicare requirements," the OIG stated.

But that was in 2007, HME advocates point out, immediately following CMS' overhaul of the power mobility benefit, which in turn was followed by a raft of clarifications that left mobility providers waiting on additional guidance about exactly what documentation was required to support power mobility claims.

They're still waiting, said The MED Group's Tim Pederson, former chair of the American Association for Homecare's Complex Rehab and Mobility Council.

"There was a lot of confusion in the industry then, and I think there still is today," Pederson said. "The report says half of the claims in 2007 didn't meet medical necessity requirements, but if you look into the detail of it, the lack of documentation by the physician in the patient's medical record is by and large the biggest culprit, and we still have a lot of questions about what is acceptable documentation.

"We don't have any more clear guidelines about documentation now than we did then," he said.

According to the OIG report: "Seventy-eight percent of claims without supplier-record errors were not supported by records provided by physicians who prescribed the power wheelchairs. That is, while suppliers' records indicated that power wheelchairs were medically necessary, physicians' records indicated that they were medically unnecessary, or physicians' records provided insufficient documentation or no documentation of medical necessity. In most cases, physicians' records had insufficient documentation to support the medical necessity of power wheelchairs."