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Billing/Reimbursement

Medicare Audits Deny Wheelchairs for 22 Severely Disabled Nashville Area Patients

December 9, 2013

GOODLETTSVILLE, TN – Medicare is taking back more than $200,000 it paid for complex rehabilitation wheelchairs that were delivered to 22 severely disabled Nashville area patients, leaving a local company in the red and questioning Medicare’s payment review process, says the American Association for Homecare.

Ben Shapiro, chief operating officer of Ed Medical Inc, Goodlettsville, Tenn, reports that CMS ruled that these severely disabled patients did not qualify for the wheelchairs his company provided. Most of these patients received their wheelchairs from one to three years ago, and in several cases the patients have passed away.

A spokesman for Rep Diane Black (R-Tenn), told Medtrade Monday that “Congressman Black [who has jurisdiction in Goodlettsville, Tenn] takes the concerns of health care providers in her district very seriously. Our office has reached out to Mr. Shapiro, and Congressman Black [pictured, upper left] is exploring what can be done to address this issue with her colleagues on the Ways and Means Committee.”

According to CMS’ rules, wheelchairs must be purchased by suppliers and delivered to patients before claims can be submitted for reimbursement. But, once claims are paid, CMS’ auditors subject suppliers to frequent audits. They often apply new rules retroactively, resulting in denials of claims that were originally paid, such as in this case.

Shapiro has experienced questionable audits and denials in the past, but he said that nothing has been as inappropriate as the recent decisions on these 22 patients.

“These are not borderline cases,” he said. “All of these patients are severely disabled. They badly need these wheelchairs to have any mobility or quality of life. It is disgraceful that some claim auditor is overruling a physician’s order that also includes a twenty-page physical therapy evaluation performed by an independent wheelchair seating clinic. These patients have diagnoses of multiple sclerosis, muscular dystrophy, amyotrophic lateral sclerosis, quadriplegia, and paraplegia.

“This all just makes you sick to your stomach,’’ Shapiro continued. “Medicare is trying to save money by depriving some of the most vulnerable people in our society of the medical equipment they need to stay at home with their families and live independently. There is something very disturbing about this approach to healthcare.”

“These are more examples of what’s wrong with Medicare’s procurement system for home medical equipment,” said Tom Ryan, president of the American Association for Homecare. “The out of control audits, and documentation rules, as well as the bidding program, need to be fixed.”

Several billing/reimbursement experts will be presenting at Medtrade Spring 2014 in Las Vegas, and these people can help providers avoid costly audits. CLICK HERE to register for Medtrade Spring, held from March 10-12, 2014, at the Mandalay Bay Convention Center, Las Vegas. Early bird rates end on December 31, 2013.