Federal health officials countered that the changes are needed because nearly 80 percent of the power wheelchair claims submitted to Medicare don’t meet program requirements. That error rate represents more than $492 million in improper payments annually.
The new program began on Sept. 1 and requires providers in seven states to get confirmation from a government contractor that Medicare will pay for the device before they deliver it.
Michael Clark, general counsel for the SCOOTER Store, says the pilot project goes too far and every claim his business has submitted under the new program has been denied.
GOP members of the Senate Special Aging Committee called the hearing to learn how the pilot project was working. Sen. Bob Corker, R-Tenn., said that television commercials promoting wheelchairs give him the impression that the companies would figure out some way for the government to foot the bill if customers would only inquire.
“I think most Americans have seen these advertisements on TV and probably question what the federal government is doing. I certainly do.”
Clark told Corker that only 13 percent of those who seek a power wheelchair end up getting one. He said the idea that the company is simply trying to sell as many chairs as it can regardless of merit was incorrect.
The cost for the devices ranges from $1,500 for scooters to $3,600 for more complex power wheelchairs over the course of the rental period.
Under Medicare rules, power wheelchairs are covered only when patients need them for daily activities within the home and when canes, walkers or manual wheelchairs are considered as insufficient assistance.
Medicare will only pay after a physician meets with patients face-to-face and prescribes the wheelchair. A supplier recommends the type of wheelchair needed and also submits a claim to Medicare. Under the demonstration project, a doctor or supplier will submit a prior authorization request along with all relevant documents supporting Medicare coverage. The contractor then decides whether a request has met the requirements for coverage.
Medicare officials said such prior authorization is routinely required in the private sector. It does not add paperwork, but simply requires that documents be submitted earlier in the review process.
Stephen Peake, a medical director at Blue Cross Blue Shield of Tennessee, applauded the Centers for Medicare and Medicaid Services for the new program and that he would welcome it being used in Tennessee. He said if the program’s results mirror those with his company then it will result in significant savings for taxpayers.
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