Industry Fires Back at OIG Report on PWC Documentation

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.”