Home Health & Hospice Week

You may think the seat can't get any hotter for durable medical equipment suppliers, but the HHS Office of Inspector General just turned the heat up another notch. Three out of five 2007 wheelchair claims the OIG inspected did not meet Medicare documentation requirements, the watchdog agency says in a new report. Two out of five claims had multiple errors per claim, the OIG says.

Out of $189 million the Centers for Medicare & Medicaid Services and Medicare beneficiaries paid for power wheelchairs in a six-month period during that year, $112 million was improper due to faulty documentation, the OIG says based on a 375-claim sample.

Biggest offenders: Complex rehab power wheelchairs had a higher documentation error rate, the OIG says. So did standard power wheelchairs submitted by low-volume suppliers.

The specialty evaluation report was another hot spot. It was "one of the documents most often not submitted by complex rehabilitation power wheelchair suppliers," the OIG says. The OIG wants CMS to improve compliance with Medicare's power wheelchair documentation requirements by conducting more review of wheelchair claims, recovering overpayments, taking "further actions" against suppliers that don't meet documentation requirements, and increasing education.

Not so fast: The authorities shouldn't be pointing a finger at suppliers for this problem, insists the American Association for Homecare. "The regulatory documentation requirements are confusing, onerous, and must be improved," the trade group maintains.

"The OIG study does not illustrate a problem with provider compliance but rather it reflects the obstacles providers face with Medicare documentation and its paperwork requirements," AAHomecare President TylerWilson says in a release.

"The paperwork requirements are confusing, shifting, and inconsistent."

Wheelchair suppliers must have numerous types of documentation for wheelchairs, AAHomecare points out, including:

• a seven-element doctor's prescription,

• supporting documentation from the patient's medical record supplied by the physician,

• an onsite home assessment report,

• a detailed product description, and

• a specialty evaluation for complex rehabilitation power wheelchairs.

"The inequity and inefficiencies of this system are evident when, as the OIG found, only 7 percent of claims for complex rehabilitation wheelchairs meet Medicare's documentation standards," Wilson observes.

Plus: CMS has already slashed Medicare wheelchair payment rates by 35 percent in the past five years, AAHomecare says. "The OIG report actually confirms what wheelchair providers and physicians have said for the past three years," Wilson says. "The Medicare documentation requirements for power wheelchairs are inconsistent, far too complex, and must be improved."

Despite the industry's vigorous defense and the looming competitive bidding program, the report could put wheelchair rates squarely in lawmakers' sights when they're looking for funding for other provisions in the health care reform package, observers worry.