OIG Slams Medicare for Wheelchair Reimbursements, Again
The OIG report found that, after reviewing prescribing physicians records, those records did not support the medical necessity of those wheelchairs.
The agency's report said that despite numerous reviews of expenditures for these medical devices, "Medicare has paid significantly more in recent years (since 2007) for power wheelchairs than it did in 2007...(indicating) that CMS (the Centers for Medicare & Medicaid Services) continues to pay for power wheelchairs that are not medically necessary and/or that have claims that do not meet documentation requirements."
Two previous OIG reports found these and other problems with coding and documentation.
The OIG recommends that CMS:
1. Enhance reenrollment screening standards for durable medical equipment prosthetics, orthotics and supplies (DEMPOS) benefits
2. Review records from sources in addition to the supplier, such as records from the prescribing physician, to determine whether power wheelchairs are medically necessary.
3. Continue to educate power wheelchair suppliers and prescribing physicians to ensure compliance with clinical coverage criteria.
4. Review suppliers of sampled claims that were found to be in error.
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