A home care advocacy organization says the Office of Inspector General's recent report about the unnecessary provision of powered wheelchairs to Medicare beneficiaries is misleading and that the real problem is a flawed documentation process.
In a report released earlier this month, the OIG set out to determine, based on supplier reports, the extent to which power wheelchairs given to Medicare beneficiaries during the first six months of 2007 were medically necessary.
[See also: OIG: Most Medicare-provided power wheelchairs unneeded or undocumented.]
OIG's report leads off by stating "Sixty-one percent of power wheelchairs provided to Medicare beneficiaries in the first half of 2007 were medically unnecessary or had claims that lacked sufficient documentation to determine medical necessity." The American Association for Homecare points out that the OIG's report goes on to clearly note "that medical necessity was actually only questioned on nine percent of the claims" and 52 percent were found to have claims that were insufficiently documented making determining whether power wheelchairs were medically necessary problematic.
AAH's statement on the OIG power wheelchair report says that the report "reaffirmed that the major problem is not mobility equipment going to Medicare beneficiaries who don't need it, but the government's failure to establish a process that fairly and adequately documents a Medicare beneficiary's medical necessity for a power wheelchair."
"The fact that the OIG concluded that information was missing in 52 percent of the claims underscores that the government needs to fix the documentation process for determining the medical necessity for power wheelchairs," the statement reads. "Despite the repeated pleadings of stakeholders – providers, physicians, clinicians, Medicare beneficiaries, consumer advocates and others – the Centers for Medicare and Medicaid Services (CMS) continues to utilize a flawed system that leaves physicians, providers and Medicare beneficiaries confused about what documentation is needed to satisfy their requirements."
"CMS must focus on establishing a process that works for the government, providers, physicians and Medicare beneficiaries," said AAH president, Tyler Wilson in the statement. "This should include a template that can assist the prescribing physicians in providing the extensive patient medical information that is being required. And CMS needs to adequately educate providers and physicians on what exactly is required, and how that information must be presented."
In reply to AAH's criticism, OIG spokesperson, Donald White, said the agency does not provide additional comments on its reports but he pointed to the report's objectives: to determine, based on supplier reports, the extent to which power wheelchairs given to Medicare beneficiaries during the first six months of 2007 were medically necessary and whether records from prescribing physicians supported the medical necessity.