Tag: Power mobility devices
CMS adjusts requirements for replacements
July 18, 2024HME News Staff
WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five-year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need...
Two charged in Medicare scam for power mobility
August 31, 2023HME News Staff
BROWNSVILLE, Texas – Maria Luisa Yzaguirre and Jeremiah Yzaguirre, both of Harlingen, Texas, have been charged with conspiracy to commit health care fraud, aggravated identity theft and money laundering. The charges allege that between 2019 and 2023, the Yzaguires submitted more than $14 million in claims to Medicare for power wheelchairs, power scooters, parts and repairs for 37 individuals. In multiple instances, they allegedly billed Medicare more than $600,000 for parts and repairs...
OIG: Medicare improperly paid for PMD repairs
June 2, 2022HME News Staff
WASHINGTON – Medicare improperly paid $7.9 million for power mobility device repairs between Oct. 1, 2018, and Sept. 30, 2019, according to a new report from the Office of Inspector General.
The OIG looked at Medicare Part B paid claims for 37,013 beneficiaries for whom suppliers submitted charges for 244,667 claim lines totaling $40.1 million for PMD repairs provided during the audit period. (A claim line represented one PMD repair for a beneficiary on a single date of service.)...
SWO alleviates confusion for PMDs
February 6, 2020Liz Beaulieu, Editor
WASHINGTON - Providers of power mobility devices have perhaps the most to gain from a new standard written order that went into effect Jan. 1, stakeholders say.The SWO replaces four types of orders, including the seven-element order, which was a sticking point particularly for PMD providers.“Some providers were sending me thumbs up emojis when I told them about the SWO,” said Dan Fedor, director of reimbursement and education for U.S. Rehab, a division of the VGM Group.The elimination...
CMS shifts mobility codes into nat'l prior authorization program
June 8, 2018Liz Beaulieu, Editor
WASHINGTON - CMS says a demonstration project requiring prior authorization requests for power mobility devices in 19 states will become permanent and will expand to all states.
CMS announced June 1 that it will transition nearly all of the codes included in the demo project, which was set to expire on Aug. 31, to its national prior authorization program on Sept. 1. Currently, the agency has two codes in the national program: K0856 and K0861, two complex rehab codes.
“This is something...
AAH surveys providers on PMD demo
May 15, 2018HME News Staff
WASHINGTON - AAHomecare's Complex Rehab & Mobility Council is collecting feedback from providers about the prior authorization demonstration project for power mobility devices currently taking place in 19 states. Responses to the council's brief online survey are due by May 25. “The PMD prior authorization program has been a win-win for the HME industry and for CMS, and information from this survey will bolster our efforts in working toward a nationwide, permanent prior authorization...
CMS plans to extend PMD demo
February 9, 2018HME News Staff
WASHINGTON - It looks like CMS plans to extend a demonstration project requiring prior authorizations for power mobility devices, according to a notice posted in the Federal Register on Feb. 7. The demo, in place in 19 states, is set to expire at the end of August. The Paperwork Reduction Act of 1995 requires federal agencies to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of...
Q&A: Permobil's Darren Jernigan on a tough election
November 23, 2016Tracy Orzel
NASHVILLE, Tenn. - This election hasn't been easy on anyone, even on those who won. “I was one of the few democrats that survived in Tennessee,” said Darren Jernigan, director of government affairs at Permobil, who is about to start his third term as a state representative. “(The elections) are every two years—it's wearing me out.” HME News recently spoke with Jernigan about “serving two masters” and what stakeholders should expect in the new political climate.HME...
PMD claims without G code are suspect, OIG says
January 23, 2015HME News Staff
WASHINGTON - The Office of Inspector General (OIG) calls into question claims for power mobility devices (PMDs) without corresponding G-code claims in a new report.CMS introduced G0372 in 2005 for physicians to establish and document the need for PMDs.The OIG found that for PMD claims with corresponding G-code claims, Medicare paid the claims in accordance with federal requirements for face-to-face requirements of beneficiaries. It found for claims without corresponding G-code claims, however, that...
Audited providers fight fire with fire
July 24, 2013Elizabeth Deprey
Faced with more audits for power mobility devices than ever, providers are taking drastic measures to appeal denials.
“I'm going to interview patients on video and bring it to the administrative law judge,” said Cory Baker, compliance officer at Abilene, Texas-based Choice Medical Supply. “I don't see how they could see this video and say the patient doesn't need it.”
Baker says 45 of his company's claims have been audited.
“None of these...