TriCenturion to Conduct PWC Probe

COLUMBIA, S.C.–TriCenturion, the Jurisdiction A/B DME program
safeguard contractor, announced that it has started a widespread,
pre-payment, probe review of the Group 2 standard captain’s chair
with patient weight capacity up to and including 300 pounds (HCPCS
K0823). The review will be conducted in both Jurisdictions A and
B.

In a bulletin issued last week, TriCenturion said data analysis
was completed for dates of service Dec. 1, 2006, through March 31,
2007, on all new power wheelchair codes that went into effect on
Nov. 15, 2006. The allowed amount for Group 2 power wheelchairs
accounts for more than 90 percent of the total allowed amount for
all new power wheelchair codes in each jurisdiction, the bulletin
said.

More specifically, TriCenturion reported, the allowed amount for
K0823 accounts for more than 77 percent of the allowed amount for
Group 2 power wheelchairs in each jurisdiction.

“Widespread probe reviews are used to determine the extent of
potential problem areas across multiple suppliers. TriCenturion
believes a proactive approach to the increased provision of HCPCS
K0823 will allow for identification of possible problems in the
billing of this item,” the notice said.

To evaluate compliance with Medicare coverage and coding rules
and to identify contributing factors to the variance of expected
treatment, the contractor said suppliers with K0823 claims billed
to the Jurisdiction A or B DME MAC are subject to the review.

Suppliers whose claims are selected for review will receive an
Additional Documentation Request letter asking for specific
information to determine if the item billed complies with the
existing reasonable and necessary criteria. If suppliers don’t
provide the requested information within 30 days, the claim will be
denied.

Once the claims review has been completed, results will be
analyzed and published in a PSC Medical Review article.