Power wheelchair documentation: 'CMS is going to go berserk over this'

WASHINGTON - With the first-month purchase option eliminated for standard power wheelchairs, CMS is on high alert that providers will try to move more Medicare beneficiaries into complex power wheelchairs, according to industry stakeholders.

"We've already started to see it happen," said Ron Reed, owner and CEO of Benchmark Mobility in Indianapolis. "At least one provider we know of is trying to jam beneficiaries into tilts, because they're going to get paid faster. CMS is going to go berserk over this."

In January, CMS started paying for standard power or Group 2 wheelchairs over the course of 13 months, instead of in one lump sum in the first month. The policy doesn't apply to complex power or Group 3 wheelchairs.

Industry stakeholders expect CMS to keep a close eye on utilization for this complex power wheelchair: K0861 (Group 3, standard single-power option with tilt).

"We may see attempts to put more beneficiaries into those sooner rather than later," said Peggy Walker, a billing and reimbursement adviser for The VGM Group's U.S. Rehab. "It's one of those things where they may need it down the road, anyway, but they may be put in it sooner than they would have without the change."

What this means for providers: They'll want to make sure claims for complex power wheelchairs are bulletproof, industry stakeholders say.

"Documentation is going to be really important," Rita Hostak, vice president of government relations for Sunrise Medical, warned a group of providers recently.

That's easier said than done, with CMS now dinging claims for things like illegible physician signatures, industry stakeholders acknowledge.

"If providers do everything correctly, they'll be OK," Walker said. "But what's correct to you and I and what's correct to a nurse reviewer isn't always the same."

If CMS does increase scrutiny of providers submitting complex power wheelchair claims, it's barking up the wrong tree, industry stakeholders say, because providers have minimal control over the process.

"It's all driven by the evaluation process done by the physical therapist," said Chris Henry, CEO of The Medical Store in Burlington, Vt. "Quite frankly, we don't have much of a say. I have a say in what chair is selected, but not what group it's in. That's completely up to the physical therapist."

Ultimately, the increased scrutiny represents just another day supplying wheelchairs, industry stakeholders say.

"Wheelchair providers are already under a lot of heat with pre- and post-pay audits," said Tyrrell Hunter, president of Majors Mobility in Topsham, Maine. "It can't get much worse."