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HCPCS Code K0011(Standard weight power wheelchair with control)

Average Medicare DSO 76 days

According to reimbursement consultant Sarah Hanna, electronic submission of the K0011 claim — and the inability for Medicare to physically review the patient’s medical documentation — contributes to the high DSO for this equipment. “With electronic submission of K0011 claims, Medicare has resorted to developing the claim,” says Hanna, vice president of Tiffin, Ohio-based ECS Billing & Consulting (www.ecsbilling.com). “This translates into Medicare sending a letter to the provider requesting more information regarding the patient’s medical need for the wheelchair. This extra step lends to a higher DSO for the claim.” Hanna recommends keeping as much paperwork as possible. “With the increased scrutiny placed on motorized/power wheelchairs, it is best not only to have the CMN on file but also to keep any physical and/or occupational therapy notes/letters and any medical necessity letters from the treating physician.” If this information isn’t readily available, request it from the therapy provider and physician, she suggests. “It will assist you in getting reimbursed when the claim is in development, in need of an appeal or hearing and if there is a post-pay audit.”

Data represents a categorized and weighted analysis of approximately 915,000 Medicare paid claim lines adjudicated by the four DMERCs between May 1 and May 31, 2005, and processed for RemitDATA customers. Figures reflect the average number of days elapsed from date of service to Medicare check issue date. Source: RemitDATA, 866/885-2974, www.remitdata.com