Tag Archives: MAC Audit

Power Wheelchair Suppliers Voice Concerns over New Government Program

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On September 19, 2012, power wheelchair suppliers voiced their concerns over a new government program called the Power Mobility Devices (PMDs) Demonstration at a Senate Special Committee on Aging. Durable Medical Equipment Suppliers (DMES) protested the program because it requires the permission of a Medicare Administrative Contractor (MAC) prior to the delivery of a power wheelchair to the consumer.

To see the Power Mobility Devices (PMDs) Demonstration operational guide from the Centers for Medicare and Medicaid Services (CMS), click here.

Wheelchair Claims Have High Error Rates.

Federal health officials believe these changes are necessary because eighty percent (80%) of the power wheelchair claims that were submitted in 2011 to Medicare did not meet program requirements. That error rate means more than $492 million of improper payments, according to the Associated Press (AP).

The New Program in Detail.

The new program was initiated on September 1, 2012. It now requires all power mobility claims from Medicare patients in California, Florida, Illinois, Michigan, New York, North Carolina and Texas to be submitted for prior authorization. According to a press release by the American Association for Homecare, those seven states receive almost fifty percent (50%) of all the power wheelchairs obtained through Medicare each year.

Click here to see the press release from the American Association for Homecare.

Medicare will only pay for a power wheelchair after a physician and patient meet face-to-face, and the physician prescribes the wheelchair. A DMES is then responsible for recommending the type of wheelchair the patient needs and submitting the claim to Medicare. Under the new program, a doctor or DMES will submit a prior authorization request along with all relevant paperwork supporting the Medicare coverage. The MAC then decides whether the request meets the requirements for coverage.

Under the CMS guidelines, power wheelchairs are only covered by Medicare when patients need them for daily activities and when canes, walkers or manual wheelchairs won’t work for mobility assistance.

Medicare Beneficiaries Get a Sense of False Hope from Television Ads.

According to the AP, a ranking member of the committee suggested the television advertisements for motorized wheelchairs and scooters give consumers the wrong impression about how Medicare coverage can be obtained. He argues these commercials imply Medicare beneficiaries just need to sign a form to receive a power wheelchair. The committee discussed giving authority to regulate the television ads to the CMS.

To listen to testimony from the hearing, click here.

Comments?

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Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.

The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, termination from the Medicare or Medicaid Program and administrative hearings.

For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.

Sources:

Freking, Kevin. “Wheelchair Suppliers Say Crack Down on Medicare Fraud Goes Too Far; Insurer Applauds Effort.” Associated Press. (September 19, 2012). From: http://www.washingtonpost.com/politics/health_care/wheelchair-suppliers-say-effort-to-crack-down-on-medicare-fraud-goes-too-far/2012/09/19/032ee93a-02ab-11e2-9132-f2750cd65f97_story.html

American Association for Homecare. “American Association for Homecare Expects Medicare to Move Past its Deny-at-All-Costs Culture that Routinely Denies Claims for Power Wheelchairs” The Sacramento Bee. (September 20, 2012). From: http://www.sacbee.com/2012/09/19/4835272/american-association-for-homecare.html

Swann, James. “Power Wheelchairs On the Congressional Hot Seat.” Bloomberg BNA. (September 20, 2012). From: http://www.bna.com/power-wheelchairs-congressional-b17179869795/

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.

“The Health Law Firm” is a registered fictitious business name of George F. Indest III, P.A. – The Health Law Firm, a Florida professional service corporation, since 1999.

Copyright © 1996-2012 The Health Law Firm. All rights reserved.

Jurisdiction 12 Gets New Medicare Administrative Carrier

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.

As of March 1, 2012, Highmark changed its name to Novitas Solutions, Inc. (Novitas). Novitas has now assumed the duties of Highmark as the Part A and B Medicare Administrative Contractor (MAC) for Jurisdiction 12.

Additionally, Novitas will now serve as the Part A and B MAC for Jurisdiction H, which includes Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas and the Indian Health Service (IHS).

First Coast Service Options, Inc. (First Coast), is also a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. First Coast is the current MAC for Jurisdiction 9, which includes Florida. Although plans for a merger between First Coast and Novitas are not known at this time, it is speculated that such an arrangement may occur in the future.

Sources Include:

Blue Cross Blue Shield of Florida, Inc. Press Release, “Diversified Service Options of Florida to Acquire Highmark Medicare Services:  Will Expand Medicare Operations” (Dec. 8, 2011).

Healthcare Data Management, “What Happened to Highmark Medicare Services?”  (Mar. 16, 2012).  From:  http://www.healthcarebiller.com/2012/03/16/what-happened-to-highmark-medicare-services/

Novitas Solutions, Inc. Press Release, “Highmark Medicare Services Inc. Changes Name to Novitas Solutions, Inc.” (Apr. 10, 2012). From: https://www.novitas-solutions.com/parta/info-alerts.html

George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.