Reimbursement:
Require Evaluations For Smooth Wheelchair Payments
Published on Thu Sep 09, 2004
Choose one of these three paths before generating CMN. If Operation Wheeler Dealer hasn't yet taken a bite out of your power wheelchair claims, it's likely to soon - especially if you don't change your practices to reflect the stricter payment environment for the equipment.
The problem: Many suppliers have been hit by pre- and post-payment audits of power wheelchair claims, warned Tammany Mills, president and owner of DME Billing Solutions, speaking in a recent teleconference sponsored by Eli Research and The Coding Institute. More than 1,000 suppliers are on 100 percent pre-pay review or probe audit status, Mills noted.
And if you haven't been hit by review yet, don't get cocky. "You may be a new supplier, you may have submitted a few claims and they have gotten paid for power wheelchairs and you are feeling pretty good about it," Mills offered. "Well, once you get to a certain dollar figure with Medicare, they are going to turn the edit on" - an edit for 100 percent pre-pay review, she stressed.
Under the same scenario, suppliers who have been in business for years find themselves under strict medical review for K0011 chairs if they suddenly start supplying a greater number of them, Mills explained.
The solution: To make sure your claims pass review with flying colors, it's time to add a requirement for power wheelchairs, Mills advised - a specific and thorough evaluation for the equipment.
"Require beneficiaries to be evaluated by their doctor and/or physical/occupational therapist for a power wheelchair before you began any paperwork on the claim," Mills recommended. "This is going to require another office visit from the beneficiary" and that may not make the beneficiary or her physician happy. But you should simply explain that you have changed your policies in response to Operation Wheeler Dealer, she said.
There are three ways to obtain an evaluation showing the patient truly needs and qualifies under Medicare for the equipment and all accessories: 1. Physician. You can ask the physician to perform the evaluation. You can describe the need for the evaluation, as well as the specifics required in it, in a cover letter to the doctor, Mills suggested.
2. Physical/occupational therapist. Another route is to have a PT or OT conduct the evaluation, Mills said.
3. Accreditation. Finally, you can obtain accreditation in rehab seating and conduct the evaluation yourself. The National Registry of Rehabilitation Technology Suppliers and the Rehabilitation Engineering & Assistive Technology Society of North America both offer relevant credentialing programs, Mills noted.
Under this option, you'd inform the prescribing physician of your evaluation policy, conduct the evaluation before beginning other paperwork, and send the results to the physician for her approval and signature. It's key to require the evaluation before beginning [...]
