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Manual Wheelchairs Pre-Pay Review Quarterly Status Report

Below is the analysis of claim denials for manual wheelchairs HCPCS codes K0001-K0004 reviewed between January 1 and March 31, 2024. The error rate for this quarter is 35.81%. The top 10 reasons for claim denials are as follows:

Rank Reason Percent
1. When a home assessment is based on indirectly obtained information, the supplier must verify at the time of delivery that the home provides adequate access between rooms, maneuvering space, and surfaces for use of the manual wheelchair being provided. Documentation did not include proof of this verification. 18.37%
2. The beneficiary was in an acute care hospital or skilled nursing facility on this date of service. 16.67%
3. The medical records do not document that the beneficiary either has sufficient upper extremity function and other physical and mental capabilities needed to, in the home during a typical day, safely self-propel the manual wheelchair that is provided or has a caregiver who is available, willing, and able to provide assistance with the wheelchair. 14.97%
4. Neither the medical records nor supplier documentation included a home assessment. 11.56%
5. The Standard Written Order (SWO) is missing a description of the item. 6.12%
6. The documentation does not have a valid SWO. 4.42%
7. The records do not document that the beneficiary's condition requires a K0003 due to the inability to self-propel a standard wheelchair in the home and that the beneficiary can and does self-propel a lightweight wheelchair. 4.42%
8. The medical record documentation does not show the beneficiary's mobility limitation cannot be sufficiently and safely resolved using an appropriately fitted cane or walker. 4.08%
9. The treating practitioner's order, supplier prepared statement, or the practitioner's attestation, by itself, does not show enough documentation of medical necessity. 3.74%
10. The home assessment did not address the physical layout of the home, surfaces to be traversed and/or obstacles. 3.40%

*The total percentage will be greater than 100% because some claims denied for multiple reasons.

**The error rate included is an overall average for the supplier specific reviews as a part of the Targeted Probe and Educate program. This is not meant to be an overall error rate for the HCPCS code or policy under medical record review.

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Updated: May 21, 2024

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