Responses: Medicare denial if pt.has electric wheelchair

Responses: Medicare denial if pt.has electric wheelchair

Randall McFarland, CPO

ORIGINAL POST:
For your information we had an appeal recently denied because we delivered an
elastic knee support to a client who has a Medicare-provided electric
wheelchair. Medicare states that the wheelchair was provided because the
person is not ambulatory, so it would be inappropriate for them to pay for
something that is for ambulation.
   Be careful when providing certain services to clients who have electric
wheelchairs!

Randy McFarland, CPO


RESPONSES: separated by a blank line
     Thank you for your warning and advice. I have recently
had a close call with an electric wheelchair incident. I delivered a
prosthesis to a bilateral lady who had lost her other leg one year
prior. She was doing well with her unilateral prosthesis and did quite
well during the fittings for her other side as a bilat. The therapist
called me as a follow-up one week later and inquired about payment for
an electric wheelchair. What electric wheelchair? I inquired.
Apparently, she had ordered the chair at the same time she ordered the
prosthesis just in case she needed it later. Thankfully, I was able
to stop/cancel the wheelchair order, otherwise, I may have lost
thousands of dollars on the recently delivered prosthesis.
    Medicare definitely sees the electric wheelchair as the end to
ambulation. In the future, I will certainly ask this not often thought
of question. And yes, the prescribing MD has a letter on the way.
Joan

Randy- Can't a case be made for an elastic knee support to have a dual
purpose of
keeping the knee warm for pain or swelling management as well as minimal
support for walking? Mark
    Mark-We did state that the support was intended to relieve fluid pressure
and provide warmth to the knee, Medicare felt that the knee support was not
medically necessary and not covered as client is considered to be
non-ambulatory.
    In the denial letter, it was suggested that we could have asked the
beneficiary to call a toll free phone number (only for beneficiary use)
800-899-7095 to inquire about previous services. Randy

THANK YOU !! I saw a patient last Thursday who I had fitted last year as a
unilateral TT. He came in last week as a bilateral, riding in an electric,
four wheel chair. I gave him a stump shrinker and told him I would cast
him in two weeks. I never gave the chair a second thought. What a great
heads up this was!