OIG: Reduced Power Wheelchair Paymentsuld Save $400 Million

Washington

CMS could save millions if it changes the way it pays for power wheelchairs, according to the HHS OIG.

As detailed in the 2004 Redbook, CMS could save $402 million if it adopts policies that the OIG has recommended. About $224 million of that savings would come by aligning power wheelchair reimbursement with median retail rates, and another $178 million would come from improving Medicare coverage criteria compliance.

During a Senate Finance Committee hearing on power wheelchairs in April, the OIG presented a report stating that reimbursement for K0011 claims exceeded retail prices by up to 242 percent. In another report presented at the hearing, the OIG found that most K0011 wheelchair claims did not meet current Medicare coverage criteria.

Since the hearing, CMS has tackled wheelchair policy head-on, attempting to rewrite coverage guidelines and break up the broad K0011 code. The agency hopes to release new power chair coverage guidance by the end of the year and implement new codes for the equipment by next summer.

The Redbook also reported CMS could save $82 million by reducing Medicare Part B payments for enteral nutrition in the home. The report said that Medicare reimbursement for Category I formulas “exceeded median contract prices available to suppliers from the sources we reviewed by 70 to 115 percent.”