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February 10, 2016

Powered Wheelchairs: CMS Expands Payment Scrutiny

A trial program that requires prior-authorization before payment for power mobility devices, or powered wheelchairs, will be expanded by the Centers for Medicare and Medicaid Services.

The agency started testing the prior authorization process in a selected group of states (California, Florida, Michigan, New York, North Carolina and Texas), which it suspected had the highest cases of fraudulent claims. On Tuesday, the agency issued a notice on expanding the test, starting on Oct. 1, to 12 other states.

CMS indicates that the existence of the program appears to be a major factor reducing improper wheelchair claims, as physician orders and supplier billings have changed as result of the demonstration.

Separately, CQ HealthBeat’s Rebecca Adams reported last week that a bipartisan group of House members have asked the Department of Health and Human Services inspector general to investigate how Medicare officials set prices and oversee the suppliers that are chosen to provide equipment such as wheelchairs.

The lawmakers also questioned if every contractor has fulfilled its obligations, whether suppliers were chosen outside of the area where the patients live and how CMS enforces program rules.



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