Medicare officials say program should curb fraud

Clark told Corker that only 13 percent of those who seek a power wheelchair end up getting one. He said the idea that the company is simply trying to sell as many chairs as it can regardless of merit was incorrect.

The cost for the devices ranges from $1,500 for scooters to $3,600 for more complex power wheelchairs over the course of the rental period.

Under Medicare rules, power wheelchairs are covered only when patients need them for daily activities within the home and when canes, walkers or manual wheelchairs are considered as insufficient assistance.

Medicare will only pay after a physician meets with patients face-to-face and prescribes the wheelchair. A supplier recommends the type of wheelchair needed and also submits a claim to Medicare. Under the demonstration project, a doctor or supplier will submit a prior authorization request along with all relevant documents supporting Medicare coverage. The contractor then decides whether a request has met the requirements for coverage.

Medicare officials said such prior authorization is routinely required in the private sector. It does not add paperwork, but simply requires that documents be submitted earlier in the review process.

Stephen Peake, a medical director at Blue Cross Blue Shield of Tennessee, applauded the Centers for Medicare and Medicaid Services for the new program and that he would welcome it being used in Tennessee. He said if the program’s results mirror those with his company then it will result in significant savings for taxpayers.