People who are hoping to get a power wheelchair with the help of Medicare now need a government contractor to sign off on the request before the devices can be delivered. A new program than began on September 1st requires wheelchair providers in seven states to get approval from a Medicare contractor in order for someone to receive a power wheelchair. Medicare officials claim that the program is necessary and say 80% of the claims submitted for power wheelchairs fail to meet Medicare requirements for coverage and that in turn leads to $492 million in improper payments every year. Wheelchair providers say the new program goes too far and one supplier, Scooter Store, says that since the policy was implemented every claim they have submitted has been denied.
Healthcare fraud has become a big concern and Medicare officials and members of Congress are concerned that recent TV ads are making it seem that seniors and the disabled can get a power wheelchair for free. Those in support of the government contractor sign off program argue that the ads are misleading and give patients a false hope that all they need is a doctor to sign off on a form and they will immediately qualify for a wheelchair. Under Medicare rules, power wheelchairs are covered only when patients need them for daily activities within the home when manual wheelchairs and walkers are considered insufficient assistance.
Under the previous process Medicare would pay for the wheelchair after a physician met with the patient in person and prescribed the use of a power wheelchair. A supplier would then recommend the type of wheelchair needed and would submit a claim to Medicare. Now, legislators are asking doctors and suppliers to submit a pre-authorization request supporting Medicare coverage to a government contractor who determines whether the request is valid.
Adding an extra review stage of the documentation will help cut down on claims that are not covered by Medicare, backers of the program claim – which is a worthy goal. As with many cases of fraud prevention, the end result is those who really need the assistance end up having to go through extra steps to qualify. Potentially more people will not qualify which could be quite disappointing to them if, based on recent TV ads, they expected the process to be easy and broader than it truly is now. Currently the cost for medical mobility devices can range from $1,500 for scooters and $3,600 for power wheelchairs, which precludes many people from buying their own.