Medicare Compliance & Reimbursement

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 suppliers' troubles.

"We are continuing to ... experience absolutely horrific denials for non-ambulatory 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 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.

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.

Tip: Warren gave out his phone number in the forum: 410-786-3633.