The Med Diva

An insider's guide to Medicare Part D and more

Archive for the category “Power mobility devices”

This Medicare article is not about Paul Ryan or Obamacare. It’s about a new Medicare rule for power wheelchairs.

Seven states will require a prior authorization process to get Medicare coverage for power wheelchairs and scooters.

For the past few days, my inbox has been bombarded with news about the Paul Ryan budget and its projected impact—good and bad—on Medicare. I’m not a political pundit and I don’t pretend to be one, so I have no intentions of joining the Ryan-Romney-Medicare bandwagon. What I do want to talk about are the real (i.e., known) issues that are going to affect Medicare beneficiaries now or in the very near future.

Although it was like trying to find a needle in a haystack, I found such a real topic yesterday, in an article from American Medical News.  It turns out that while everyone has been worrying about Mr. Ryan and his proposed budget plans, Medicare beneficiaries in seven states are actually going to have to wait longer than beneficiaries in other states to get Medicare coverage for their power wheelchairs or scooters. This news is for real.

Beginning September 1, 2012, and continuing thereafter for the next three years, the Centers for Medicare & Medicaid Services (CMS) will require prior authorization for power mobility devices prescribed in seven states: California, Florida, Illinois, Michigan, New York, North Carolina, and Texas. CMS is calling this a “demonstration project,” which they said will allow them to collect data that will be used to combat fraudulent claims for power motility devices.
Under the three-year project, providers in the seven states will need to send authorization requests and supporting documentation to a Medicare contractor when ordering power wheelchairs for patients. The contractor will review the request to ensure that it meets national and local coverage requirements. Contractor approval will be necessary before patients can receive the items.  

According to CMS, the prior authorization review process will take about 10 business days. Expedited reviews will be available when a patient’s health would be harmed without access to the power wheelchair or scooter.

Medicare power wheelchair fraud has been rampant in recent years. According to CMS, federal law enforcement agencies have prosecuted more than 600 cases representing almost $3 billion in fraudulent claims since 2009. The seven states chosen for this demonstration project represent more than 40 percent of power mobility device orders through Medicare.

I’m not totally sure that a prior authorization process is the right tactic to take here, although I do give CMS credit for trying new ways to control Medicare fraud. And hey, maybe if CMS saves enough money by reducing fraud, we won’t have to talk about a Paul Ryan budget plan anymore…I’ll leave it at that.


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