Medicare expands pre-approval program for power wheelchairs

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A Medicare demonstration that requires healthcare providers to request pre-approval before prescribing medical devices such as powered wheelchairs will get new life this fall.

In all, 31 items were added to a 6-year-old program focused on pre-approvals for power wheelchairs and other mobility devices, according to a June 1 notice from the Centers for Medicare & Medicaid Services.

The decision follows a May report from the Government Accountability Office encouraging the continuation — or expansion — of such pre-approvals.

The demonstration started in California, Florida, Illinois, Michigan, New York, North Carolina and Texas, which were chosen because they had a history of high improper payments and fraud. In 2014, CMS expanded the program to include Pennsylvania, Ohio, Louisiana, Missouri, Washington, New Jersey, Maryland, Indiana, Kentucky, Georgia, Tennessee and Arizona. In all, the GAO estimated the demos had saved the government about $1.9 billion.

It had been set to expire on Aug. 31. Instead, the CMS notice declares pre-approval requirements go nationwide for all named devices on Sept. 1.

The national rollout will differ slightly. Items on the Required Prior Authorization List require prior authorization as a condition of payment. Without it, claims will be denied. Under the demo, requesting prior authorization had been optional, with claims submitted without prior authorization subject to prepayment review and a 25% reduction.