- February 16, 2020
- Posted by: Thomas Anderson
- Category: DME Billing, DME Billing Services
The latest on the improper rate of payments for Power mobility devices was around 46.3 percent with a projected amount of improper payment standing at $3.7 million. Inconclusive documentation, errors with medical necessity with Power Mobility devices claims are largely the reasons for improper reimbursements. POV’s as well as PWC’s are collectively classified under the PMD and are covered under Medicare Part B DME benefit. PMD is identified as mobility assistive equipment and are a part of a class of DME.
A patient of Medicare has to meet all the general criteria of coverage to satisfy medical necessity requirements for all the power mobility devices.
♦ He or she has a mobility limitation that significantly impairs his or her ability to participate in one or more Mobility-Related Activities of Daily Living (MRADLs) in customary locations in the home
♦ His or her mobility limitation cannot be sufficiently and safely resolved by using an appropriately fitted cane or walker
♦ He or she does not have sufficient upper extremity function to self-propel an optimally configure manual wheelchair in the home to perform MRADLs during a typical day
For Power Wheel chairs, the patient has to meet all the general coverage criteria for the PMD’s as well as the following:
♦ He or she does not meet the coverage criteria for a POV
♦ He or she has the mental and physical capabilities to safely operate the PWC or if he or she is unable to safely operate the PWC, has a caregiver who is available, willing, and able to safely operate the PWC (but is unable to adequately propel an optimally configured manual wheelchair)
♦ His or her weight is less than or equal to the weight capacity of the PWC and greater than or equal to 95 percent of the weight capacity of the next lower weight class of PWC
♦ His or her home provides adequate access between rooms, maneuvering space, and surfaces for operating the PWC
♦ Using a PWC will significantly improve his or her ability to participate in MRADLs, and the patient will use the PWC in the home
♦ He or she has not expressed an unwillingness to use a PWC in the home
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