Home Health & Hospice Week

 Region B represents a particular problem, some suppliers say.

Frustrated over inexplicable denials of power mobility claims? Don't hold it inside -the Centers for Medicare & Medicaid Services wants to hear about your troubles.
 
"We are continuing to ... experience absolutely horrific denials for nonambulatory patients who are attempting at their doctor's direction to obtain power mobility," Mike Johns, director of insurance for Sewell, NJ-based Electric Mobility Corp. told CMS during the Feb. 17 Home Health Open Door Forum. EMC manufactures Rascal-brand scooters and power wheelchairs.
 
The problem, he said, seems particularly acute in Region B, where the durable medical equipment regional carrier is AdminaStar Federal. EMC has been challenging the denials through fair hearings and has been experiencing "a great degree of success" once an officer has an opportunity to review the specifics, Johns told the forum.
 
Other mobility equipment suppliers confirm that there have been denial difficulties. Wayne Stanfield with the Home Care Alliance of Virginia says that while his personal business has not experienced unusual denials for mobility equipment, other suppliers in his network have. The problem began with the onset of Operation Wheeler Dealer, he charges. "I can't help but believe they have broken the whole system trying to fix it," Stanfield tells Eli.
 
CMS has had the opportunity to take a look at "any number" of claims from Region B involving a number of different suppliers, John Warren with the CMS Program Integrity Group told listeners. "To date, we haven't found any particular instances of where Region B is reviewing claims inappropriately or denying claims inappropriately," he said.
 
However, Warren invited concerned suppliers to contact him to discuss problems they're experiencing with improperly denied power mobility claims. "Maybe we can figure out a plan of attack," he said. 
 
Editor's Note: Warren gave out his phone number in the forum: 410-786-3633.