Kevin Lyons

About six of every 10 power wheelchairs provided to Medicare beneficiaries were medically unnecessary or lacked enough medical documentation to prove they were needed, according to a report from the Office of the Inspector General (OIG) at the U.S. Department of Health and Human Services.

An executive at the American Association for Homecare, whose members include companies that sell power wheelchairs, calls the report “misleading.” Walt Gorski, vice president of the trade group, says the OIG findings include paperwork errors made by medical professionals who were coping with a Medicare payment system that had undergone a massive overhaul several months earlier.

Power wheelchairs are advertised heavily on TV; the ads typically stress that the equipment is covered by Medicare.

The federal Medicare program provides health insurance to about 46 million Americans.

OIG: $95 million spent on ‘wrong’ equipment

OIG investigators — acting as watchdogs within the Department of Health and Human Services — reviewed 375 claims for power wheelchairs that were supplied to Medicare recipients in the first half of 2007. The OIG determined 9 percent of power wheelchairs were medically unnecessary; another 52 percent of claims for power wheelchairs lacked enough medical documentation to prove the equipment was needed.

In total, Medicare paid about $189 million for power wheelchairs during the first half of 2007, but $95 million went toward power wheelchairs that weren’t needed, according to the OIG report. Medicare reimburses most of its suppliers $5,000 to $10,000 for each power wheelchair, according to the report.

“Regardless of whether a more expensive or less expensive power wheelchair was needed, Medicare paid for the wrong equipment to meet these beneficiaries’ needs,” the OIG report says.

Industry representative: Simplify payment process

Gorski says Medicare’s approach to assigning billing codes to power wheelchairs is so complex that errors are likely to be made.

“The power wheelchair coverage policy is the most complicated policy of all from the durable medical equipment segment. There are so many facets, and it can be so subjective that a claims reviewer could deny any claim for power mobility based on his or her mood,” Gorski tells InsuranceQuotes.com.

Gorski says the OIG and the federal Centers for Medicare & Medicaid Services “must look to simplify the coverage policy and inject common sense back into the auditing process.”

In its report, the OIG says it didn’t try to determine whether claims were given correct billing codes or whether they met “non-clinical documentation requirements,” although it has acknowledged previously that nearly one of every 10 power wheelchair claims was miscoded, and 60 percent didn’t meet documentation requirements.

Necessary or unnecessary?

Before providing a patient with a power wheelchair, a supplier must receive medical evidence from a doctor. The suppliers then bill Medicare for reimbursement. Power wheelchairs are covered if they are medically necessary for a patient to perform everyday activities that they otherwise wouldn’t be able to do with a cane, walker, manually operated wheelchair or mobility scooter.

The OIG provided several examples of power wheelchair claims that it considered unnecessary.

In one instance, a supplier of a power wheelchair provided a letter from a physician stating, among other things, that a patient was recovering from knee replacement surgery, was obese, was unable to walk safely with a cane or walker, was unable to propel a manual wheelchair because of severe pain, had severe osteoarthritis, had a history of brain surgery and had poor balance.

But the physician’s records about that patient noted the Medicare recipient had adequately recovered from knee replacement surgery and would need only a cane or a walker. Still, this patient received a power wheelchair, the OIG report says.

Recommendations for improvement

The OIG made several recommendations for the Centers for Medicare & Medicaid Services (CMS), such as:

• Enhance Medicare screening standards for current suppliers of durable medical equipment (such as power wheelchairs), prosthetics, orthotics and related supplies.

• Review records from sources other than suppliers, such as prescribing physicians, to determine whether power wheelchairs are medically necessary.

• Beef up continuing education for power wheelchair suppliers and prescribing physicians.

In a written response, CMS agreed with the OIG on all but the first recommendation, saying it already has tools for improved screening of its current suppliers.

“The CMS continues to support efforts to reduce improper power wheelchair payments, including increased prepayment reviews of power wheelchairs,” wrote Donald Berwick, administrator of CMS. “Moreover, CMS plans to pursue additional provider and supplier education to ensure suppliers and prescribing physicians understand Medicare’s coverage and documentation requirements for power wheelchairs.”

Follow Kevin Lyons on Twitter: twitter.com/stakingaclaim.

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Jeremy Bowler has his finger on the pulse of American insurance consumers.

As senior director of the global insurance practice at J.D. Power and Associates — which measures consumer satisfaction for everything from cars to banks to appliances — Bowler keeps tabs on how Americans feel about auto, home and health insurers as well as insurance agencies.

What Bowler is seeing are some grumpy policyholders:

• After peaking in 2009, customer satisfaction with auto insurance companies declined significantly in 2010, according to the J.D. Power and Associates U.S. National Auto Insurance Study.

• Consumer satisfaction with auto insurance claims declined in 2010, but still ranked better than the low levels detected in 2008, according to the J.D. Power and Associates U.S. Auto Claims Satisfaction Study.

• In the homeowner’s insurance category, customer satisfaction fell in 2010 to its lowest level in five years, according to the J.D. Power and Associates U.S. National Homeowners Insurance Study.

Bowler shares with InsuranceQuotes.com his take on consumers’ relationship with insurance companies and on becoming a better insurance consumer.

InsuranceQuotes.com: In releasing the 2010 U.S. National Auto Insurance Study, you noted that consumer shopping for new insurers has hit levels not seen since before the recession. What’s the reason for this move?

Jeremy Bowler: We have been tracking customer shopping “incidence” and behavior for four years. Over that time, we have certainly witnessed fluctuations in the marketplace, but with the aggressive price competition and related advertising, shopping incidence remained reasonably stable, reflecting the fact that advertising alone tends not to trigger the majority of consumers to shop.

When we talk about shopping incidence, I’m referring to the proportion of all auto insurance customers who obtained a competitive quote in the past 12 months. Insurers think of this statistic as an indicator of the number of policies that were being “shopped” in the past year. Since a majority of customers just let their car insurance auto-renew, the carriers who are desperately trying to grow are spending their large advertising budgets in efforts to encourage more shopping behavior among consumers.

In the second half of 2009, shopping incidence fell dramatically, perhaps as consumers hunkered down in the midst of the stock market collapse. Starting in the first quarter of 2010, however, we observed unprecedented levels of auto quote activity, raising the question whether this was a short-lived phenomenon, based on pent-up demand from the prior two quarters, or rather a new … level of churn in the personal auto insurance marketplace.

InsuranceQuotes.com: You’ve mentioned that homeowners’ views of insurers may be skewed by a slew of advertising from insurers promoting discounts on auto insurance. How do feelings about auto insurance ads affect feelings about homeowner’s insurance companies?

Bowler: A majority of the advertising focuses on the personal auto market, with GEICO and Progressive at the head of the pack in terms of advertising spending. Both have communicated strongly the opportunity to save if you switch insurers, and the multiple discounts they offer. In contrast, the typical homeowner’s policy renewal is far less likely to highlight the discounts a customer may benefit from. This could well contribute further to the perception among homeowners that their policy offers less value than it once did.

InsuranceQuotes.com: What advice do you have for auto insurance companies about how to improve the claims experience for consumers?

Bowler: While there is no “right way” or one-size-fits-all approach to handling claims, a common theme does emerge from the 2010 report. Whether an insurer uses exclusive or independent agents, or sells direct to the customer via the web or a call center, be prepared to handle the customer’s initial claim report via whichever channel the customer chooses … .

Subsequently, make sure to proactively communicate the progress of the claim or repair; if the customer has to call you, they’re going to be far less pleased with the process. … We see a significant proportion of customers indicating they would prefer to have received updates via e-mail or the web rather than via the phone, suggesting a missed opportunity for the industry.

Finally, it is absolutely critical to first set, and then manage, the customer’s expectations regarding total repair time.

InsuranceQuotes.com: How does your work involving research into consumer perceptions of insurance affect your insurance-buying habits? What kind of insurance consumer are you?

Bowler: While I’m probably not much different from the next person where my own personal insurance is concerned, I’ve no doubt offered a few more referrals in the past 10 years of managing the J.D. Power and Associates insurance practice. Like many customers, I was extremely loyal to one insurer for decades, but was prompted to shop by a life-event “trigger.”

InsuranceQuotes.com: What have you learned about insurance that could help all consumers?

Bowler: When shopping for a new carrier, first I’d recommend thinking about what your needs are and how you would prefer to be provided service. Are you a homeowner, or do you only require car insurance? Would you prefer to have a local agent, available for walk-in appointments, or do you travel regularly and therefore are more likely to benefit from a 24/7 call center? Depending upon your preferences, there are multiple companies that offer products and service options to meet your needs.

Beyond that, I always encourage friends and family to not settle for a single quote, but rather obtain at least two or three competitive quotes when shopping.

Finally, once you’ve selected your auto insurance carrier, make sure you’re prepared in the event you should ever be in an accident. Do you have a phone with a camera? If not, you might want to purchase a disposable camera to keep in the glovebox along with a pad and paper. Being prepared to capture details at the time of an accident can prove invaluable should the liability for the accident be called into question.

–John Egan

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For the third time… no medical is a big risk in my opinion. For Bodily Injury Liability I have half a mil myself, it isn’t that much more expensive with the right people.
You are not covered for medical expanse and car repairer because you haven’t asked for it.

Getting all mixed up about all these ideas? It is understandable to get confused with all this car insurance stuff but don’t hesitate to ask for help. Here is a short Q&A that will enlighten people’s cloud of thought about auto insurance.

Q: What are the various kinds of auto insurance? What does each policy covers?

A: There are many types of auto insurance. Some of these are liability coverage, collision coverage, comprehensive coverage and personal injury protection. The liability coverage is necessary for it pays the damages and injuries of the policy holder, the beneficiaries and properties during an accident. Collision coverage is favored by many since damages will be paid by the insurance company regardless of who is at fault in the accident. It is also a good move to acquire comprehensive coverage because it also pays for damages brought by natural calamities. Lastly, personal injury protection takes care of the medical bills for the treatment of injuries of the driver sustained in the accident regardless of who is at fault in the accident.

Q: How does a deductible work?

A: Increasing or decreasing deductible is the consumer’s prerogative. Consumers can decide the amount to be paid for the different parts that encompasses the whole policy. Let’s assume a person pays a deductible, which is worth $500 for a personal injury protection, and then in this case, the claim shall not be covered by the insurance company. When this person gets involve in an accident, the auto insurance company will still give out $500 as long as the insurance holder already completed the payment. The simple rule is that the higher the deductible, the lower the premium cost. Just always go for deductibles that are affordable.

Q: How much should coverage cost?

A: The value of coverage is decided by the insurance holder. States set minimum coverage requirements but a person can still increase the limit. Limit should be kept in the extent that it is still manageable. Let say the state requires person to have $20,000 liability coverage then the additional payments beyond this amount will be paid by the individual.

Q: What to do to get the best auto insurance deal?

A: There are plenty of ways to strike the auto insurance deal available. First step is to browse online. The internet offers hundreds of auto insurance sites. People can log in auto insurance quote comparison sites and see how car insurance prices differ. Subscription to mailing list of auto insurance companies is also useful because this provides the latest information about auto insurance deals. A visit to the local auto insurance company is also recommended to personally interact with an expert.

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