AAHomecare Counters 'Misleading' OIG Report on PWCs
ARLINGTON, Va. — On Wednesday, the American Association for Homecare issued a "Mobility Matters" article countering "misperceptions in the recent OIG report on power wheelchair documentation."
In its July 7 report, the HHS Office of Inspector General said 61 percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 failed to meet medical necessity guidelines.
But AAHomecare officials quickly labeled the report "misleading" and said the root problem lies in the complexity of the power mobility coverage policy and CMS' poor job in educating physicians and providers on exactly how to document medical necessity for the power chairs.
Here's an excerpt from the "Mobility Matters" article:
The Inspector General's Office (OIG) of the U.S. Department of Health and Human Services issued a report last week concluding that 61 percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 "were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity." But their report clearly indicated that medical necessity was actually only questioned on nine percent of the claims.
The OIG report reaffirmed that the major problem is not mobility equipment going to Medicare beneficiaries who don't need it, but the government's failure to establish a process that fairly and adequately documents a Medicare beneficiary's medical necessity for a power wheelchair. In fact, the vast majority of claims cited in the OIG report were flagged as improper because information was missing in the medical records of the patients that received power wheelchairs.
The fact that the OIG concluded that information was missing in 52 percent of the claims underscores that the government needs to fix the documentation process for determining the medical necessity for power wheelchairs. Despite the repeated pleadings of stakeholders — providers, physicians, clinicians, Medicare beneficiaries, consumer advocates and others — the Centers for Medicare and Medicaid Services (CMS) continues to utilize a flawed system that leaves physicians, providers and Medicare beneficiaries confused about what documentation is needed to satisfy their requirements.