ARLINGTON, Va. — In the wake of an Office of Inspector
General report that indicated a significant percentage of early
2007 power wheelchair claims lacked proper documentation, the
American Association for Homecare fired back last week with a
message that put the blame squarely on CMS. Calling the
requirements "confusing and onerous," AAHomecare officials renewed
calls that the system must be improved.
Released Dec. 30, the OIG
report found that "three out of five claims for standard and
complex rehabilitation power wheelchairs did not meet Medicare
documentation requirements during the first half of 2007."
"The OIG study does not illustrate a problem with provider
compliance but rather it reflects the obstacles providers face with
Medicare documentation and its paperwork requirements," said Tyler
J. Wilson, AAHomecare president, in the statement. "The paperwork
requirements are confusing, shifting and inconsistent.
"The OIG report actually confirms what wheelchair providers and
physicians have said for the past three years: The Medicare
documentation requirements for power wheelchairs are inconsistent,
far too complex and must be improved so both physicians and
wheelchair providers can serve patients and successfully meet
Medicare regulations. We obviously want to ensure 100 percent
compliance. But the inequity and inefficiencies of this system are
evident when, as the OIG found, only 7 percent of claims for
complex rehabilitation wheelchairs meet Medicare's documentation
standards."
Read the
entire statement on AAHomecare's Web site.
Tim Pederson, chair of AAHomecare's Complex Rehab and Mobility
Council, said the association is developing a more in-depth
response to use on the Hill, but he called the statement an
excellent starting point. "The OIG study was inherently unfair,"
said Pederson, CEO of WestMed Rehab, Rapid City, S.D. "It took a
limited sample of claims data from the first six months of 2007
when the industry was in turmoil. The timing is unfortunate, unfair
and does not reflect reality."
Don Clayback, executive director of the National Coalition for
Assistive and Rehab Technology, echoed the sentiments. NCART also
issued a release lambasting the OIG report, pointing out that the
study covered the initial period "of the single largest policy
overhaul in the history of Medicare's coverage of power mobility.
There were dramatic coding, coverage and payment changes for these
devices including significant changes to the documentation
requirements."
There was also a lack of information and education on exactly
what was required from providers, physicians and CMS contractors,
NCART said, pointing out that requirements for PWC claims can
include up to six distinct documents that can add up to 10 to 15
pages of paperwork.
"The report should not be interpreted as evidence of fraudulent
claims," Clayback stated in the release. "Rather, the OIG report
provides a clear indication of the widespread confusion and
uncertainty that existed with providers and physicians during the
implementation of the new requirements … We could not agree
more with the OIG's recommendation that additional education is
needed," he continued. "We are also glad to hear that CMS will be
issuing new information and holding Open Door Forums to provide
more detailed guidance and education for both physicians and
providers."
Since the 2007 study period, added Gary Gilberti, president and
CEO of Baltimore-based Chesapeake Rehab Equipment and NCART
president, "we believe that most rehab providers have tightened
their documentation policies and are currently collecting the
necessary documentation. Studies done today would probably show
very different results."
The powerful statements from AAHomecare and NCART represent a
concerted effort by the industry to present a "unified message that
will hopefully lead to a real opportunity to work with CMS on the
development of a clear and consistent documentation standard, and a
significant education campaign of all stakeholders involved in the
provision of power mobility devices," according to Seth
Johnson.
Johnson, vice president of government affairs for Pride Mobility
Products, Exeter, Pa., pointed out that nearly a year ago Congress
passed the economic stimulus package, which provides $19 billion
for transitioning to electronic health records and other health
information technology initiatives. "This significant commitment by
Congress and the Administration," said Johnson, "provides a perfect
opportunity for the industry to work with them on the development
of standardized electronic processes for the collection and
evaluation of the medical records necessary to meet Medicare's
requirements for the provision of these products."
Wayne Grau, vice president, supplier relations and government
affairs for The MED Group, Lubbock, Texas, believes that the
industry response could go a long way toward helping lawmakers see
the reality of the situation.
"With their press releases, AAHomecare and NCART are making sure
that this onerous OIG report will not go unanswered, and
congressional staffers will hear both sides of the story," said
Grau. "The industry can no longer allow inaccurate information put
out by government agencies to go unanswered and paint this industry
as the bad guys."
