Buffalo, New York - January 8, 2010

Last week, the Health and Human Services' Office of Inspector General (OIG) issued a report entitled "Medicare Power Wheelchair Claims Frequently Did Not Meet Documentation Requirements". The report was based on a review of power wheelchair claims for the first six months of 2007 and indicated a significant percentage of claims lacked certain components of newly expanded documentation requirements.

The study covered the initial period of the single largest policy overhaul in the history of Medicare's coverage of power mobility. There were dramatic coding, coverage, and payment changes for these devices including significant changes to the documentation requirements.

Unfortunately, this initial period was fraught with a lack of information on what exactly was required on the part of providers, physicians, and CMS contractors. Given these factors, the findings are not a surprise.

Don Clayback, NCART Executive Director, stated, "The report should not be interpreted as evidence of fraudulent claims. Rather, the OIG report provides a clear indication of the widespread confusion and uncertainty that existed with providers and physicians during the implementation of the new requirements. There were major revisions to the level and type of documentation required for power wheelchair claims and these revisions were implemented with the minimal provider and physician education."

Reputable power mobility companies are accredited and have invested in the training and credentialing of their staff to provide quality equipment and professional services to Medicare beneficiaries in their communities. These companies are committed to doing what is required. The problem is the lack of clarity and inconsistency on what documentation is needed.

Gary Gilberti, NCART President, said, "Complex power wheelchair providers have been very supportive of a system that includes documentation of an appropriate clinical evaluation, technology assessment, home assessment and of medical necessity for the equipment. However, the physician and provider education regarding the implementation of the new regulations in late 2006 lacked the level of detail and specificity required for such major changes. In addition, some of the information required and the reporting format is not in line with the typical protocols of prescribing physicians."

Documentation requirements for power wheelchair claims are very complex and can include up to 6 distinct documents which can translate to 10 to 15 pages of paperwork. The level of specificity and volume of information required in order for the documentation to be deemed adequate is greater for power wheelchairs than any other Durable Medical Equipment covered by Medicare.

Accordingly, full compliance is extremely difficult and subject to misinterpretation without clear policies and consistent documentation standards that are fully understood by all parties. While the report indicates that for some claims documentation was not complete, given the diagnoses and the medical needs of those individuals with severe disabilities that does not mean the equipment was not medically necessary and properly prescribed by the beneficiary's physician.

Clayback continued, "We could not agree more with the OIG's recommendation that additional education is needed. As an industry, we have spent the last three years working to clarify the requirements to secure better guidance and obtain better educational materials, particularly for the medical community. We're also glad to hear that CMS will be issuing new information and holding open-door forums to provide more detailed guidance and education for both physicians and providers. We're committed to working with CMS and its contractors to ensure Medicare beneficiaries with disabilities get the equipment and services they need and providers comply with appropriate Medicare regulations."

Release Date: 08-Jan-2010