On May 17, 2017, Performant Recovery, the National DMEPOS RAC announced that it will begin to recover underpayments, or incorrect reductions owed to suppliers, for wheelchair accessories and cushions for Group 3 complex power rehab wheelchairs.
Section 2 of the Patient Access and Medicare Protection Act (PAMPA) mandates that adjustments to the 2016 Medicare fee schedule amounts for certain DME based on information from competitive bidding programs not be applied to wheelchair accessories (including seating systems) and seat and back cushions furnished in connection with Group 3 complex rehabilitative power wheelchairs (codes K0848 – K0864). The change was effective January 1, 2016, however, Medicare was unable to implement changes to the claim processing systems until July 1, 2016. During that time frame, payments were based on adjusted fee schedule amounts. The underpayment recovery will apply to claims for accessories for dates of service 1/1/2016 – 6/30/2016.
DME suppliers rarely experience RAC underpayments, so this is a welcome change. Even better? This review was suggested by The van Halem Group’s own Wayne van Halem! “Many folks don’t know this, but the RACs are funded to find underpayments, in addition to overpayments,” expressed van Halem. “And in this environment, every little bit helps!”
Resources:
https://www.performantrac.com/IssuesUnderReview.aspx