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Homecare Community Dismayed that Medicare Will Start Prior Authorization for Wheelchairs without a Clinical Template for Physicians to Document Need

Tue, 08/07/2012 - 2:42pm
Bio-Medicine.Org

WASHINGTON, Aug. 7, 2012 /PRNewswire-USNewswire/ -- The American Association for Homecare is disappointed that Medicare is implementing a prior authorization program for power wheelchairs without including a key component.  Physicians, providers, and advocates for disabled Americans insist that patient care will be jeopardized without a clinical template to help physicians document a patient's medical need for mobility assistance. 

Last week, the Centers for Medicare and Medicaid Services (CMS) announced that prior authorizations will begin September 1, 2012. Under the three-year demonstration program, all power mobility claims in California, Florida, Illinois, Michigan, New York, North Carolina, and Texas must be submitted for prior authorization.  Medicare beneficiaries in these states annually receive nearly 50 percent of the power wheelchairs obtained through Medicare.

"Most stakeholders, such as physicians, providers, and advocates for people with disabilities, would support the prior authorization program if the clinical template were included," said Tyler Wilson, president and CEO of the American Association for Homecare. "Prior authorization when combined with a clinical template can vastly improve the documentation process. But this decision by CMS is very disappointing. There will be Medicare beneficiaries forced to leave their homes for expensive nursing homes and other care facilities because they won't receive the power wheelchairs prescribed by their physicians."

Under the documentation guidelines that will remain in place, CMS contractors routinely deny claims for power wheelchairs. But most Medicare beneficiaries receive the medical devices anyway while their providers appeal these decisions. In fact, many denied claims are overturned during the appeals process. But the stakes are higher under the prior authorization program: Medicare patients would not obtain a power wheelchair until after the denials
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