Power Wheelchairs Targeted For Inherent Reasonableness Price Adjustments
This article was originally published in The Gray Sheet
Executive Summary
CMS plans to develop inherent reasonableness review guidelines to ensure appropriate Medicare payments for motorized wheelchairs as part of a larger initiative to curb provider billing fraud, the agency says
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Unpaid Medicare claim rate is 98.4% for power wheelchairs in Harris County, Texas over the past year, wheelchair distributor The Scooter Store says. CMS' anti-fraud campaign, "Operation Wheeler Dealer," launched in September 2003, singled out Harris County as an area where potential billing fraud appeared "most egregious" and required CMS staff to personally signoff on payments for claims in the region (1"The Gray Sheet" Sept. 15, 2003, p. 4). Medicare paid for more than 31,000 power chairs in 2002 in Harris County, over 10 times the 2001 total of 3,000. TSS charges that the "sharply restrictive" claims review process for Harris represents "geographical discrimination." The firm notes a 95% approval rate for its Medicare power wheelchair claims nationwide...