Part B Insider (Multispecialty) Coding Alert

Published on Mon Jan 18, 2010 PDF

• You may think the seat can't get any hotter for durable medical equipment suppliers, but the OIG 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 that CMS paid for power wheelchairs in a sixmonth 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.