E/M Coding Alert - 2003 Issue 37
DME: IR Review A Certainty For Operation Wheeler Dealer
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Article Overview
This article covers CMS and HHS efforts to address suspected fraud and abuse in the power wheelchair and scooter market, with attention to reimbursement review, coverage oversight, supplier enrollment controls, and medical review activity. It is aimed at durable medical equipment suppliers, manufacturers, compliance professionals, and others affected by Medicare mobility-product policy. The piece also reflects stakeholder concerns about how anti-fraud measures may affect legitimate providers, beneficiary access, and physician and patient understanding of coverage rules.
Why This Topic Matters
The topic is important because policy changes in this area can affect Medicare payment, supplier participation, beneficiary access to mobility equipment, and compliance risk for providers in the DME market.
Article Sections
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CMS fraud-fighting initiative and open door forum
Introduces the federal review effort targeting mobility-product billing and summarizes CMS’s limited discussion of the initiative with stakeholders.
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Industry response to reimbursement and coverage concerns
Presents supplier and manufacturer concerns about how payment review and coverage restrictions could affect legitimate businesses and access to equipment.
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Utilization limits
Discusses concerns about reported growth in power wheelchair use and broader market and policy factors that may be influencing demand.
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Provider number freeze
Explains the temporary suspension of new supplier enrollment activity and the concerns raised about its effect on existing and prospective providers.
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Physician and beneficiary education
Covers comments on the need for clearer understanding of Medicare mobility-equipment rules among physicians, beneficiaries, and suppliers.
What You Will Learn
- The general focus of CMS enforcement and review activity affecting power wheelchairs and scooters.
- How stakeholders in the DME industry viewed the possible effects of reimbursement and coverage changes.
- Why supplier enrollment controls and utilization trends were raised as policy concerns.
- What role education and communication issues play in mobility-equipment billing oversight.
Who Should Read This
- Durable medical equipment suppliers
- Mobility equipment manufacturers
- Medical coding and billing professionals
- Healthcare compliance staff
- Medicare policy observers
- Healthcare attorneys
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