Medicare is taking action regarding questionable medical claims by demanding pre-approval for medical devices. Beginning February 28, patients will need pre-authorization for common medical supplies such as power wheelchairs, hospital beds, oxygen and other essential equipment. This change in rules is due to years of abuse in the industry from inflated claims costing millions.
Stolen physician and beneficiary identification numbers were used in the past to abuse the system. One incident billed the government $5.5 million from three separate medical equipment offices. After further investigation, these offices were just a utility closet that had buckets of road tar, tools and sand mix. There wasn’t any office equipment or signs or even enough space for an office to run from the location.
Who is affected?
Senior citizens with Medicare Advantage health coverage need not to worry since their plans are independently contracted directly with providers. However, those who will be affected by the new policy are seniors with traditional Medicare fee-for-service.
The Rules and Regulations
Patients will now be required to get the approval from their physician for essential and necessary medical equipment. Doctor’s will have to sign-off on any medical supplies and equipment, which can lead to a variety of issues for patients. There are two scenarios that most people have in mind regarding these new rules.
First is the delay in getting the doctor’s approval. Most equipment and supply approval requires patients to see the doctor in person to determine which equipment is necessary and suitable for the patient’s needs. If the patient is not able to get to the doctor's office when needed due to health or mobility restrictions, they may experience a delay in receiving approved supplies and equipment.
The second concern in this matter is some doctors may not feel the patient needs specific equipment or supplies when they really do. This means a patient may never receive what they need. The new rules seem like it is hindering patients more than it is restricting those who abuse the system for monetary gain.
Liz Harrington who is a Washington Free Beacon reporter appeared on Fox Business Network to discuss the matter further. She specifically mentioned the Hoveround wheelchair company that had billed the federal government for power wheelchairs numbering in the thousands. While this may not sound unusual to many, the issue was they did not prove that the wheelchairs were medically necessary to the patient, which is a requirement.
An audit was conducted by the federal government which revealed Hoveround had billed taxpayers more than $27 million for medically unnecessary wheelchairs within one year. This large amount of taxpayers money has many wondering how this happened.
The required procedure involves the patient getting approval from their physician that a power wheelchair is necessary to live a productive life. This means the patient is not physically capable of using a standard wheelchair or a walker. The audit revealed that Hoveround claims that nine out of ten of their customers pay nothing or a small amount for their wheelchairs.
New Regulation Pros
- Protects taxpayers money
- Lessens the possibility of fraud
- Helps get the equipment to patient’s who really need it
- Cuts-down abuse claims
New Regulations Cons
- Delays patients receiving medical supplies and equipment
- Inconveniences patients, doctors and hospitals
- Patient’s may not get what they truly need to maintain their health and recovery
- Requires unnecessary visits to the doctor’s office
What does this mean for healthcare providers?
The new regulations require doctors to approve specific medical supplies and equipment for patients. Doctor’s will have to feel confident that the patient absolutely needs the items to maintain a healthy lifestyle. Doctor office visits will increase, the staff will become overwhelmed and the patient is inconvenienced. Healthcare providers will have to adjust their schedules to meet the demands for their patient’s needs.
What should consumers do?
If you are a patient that has an illness or injury that requires you to have specific medical supplies and equipment you will want to discuss the matter with your physician. It is wise to keep a notebook of your ailments and limitations to discuss with your doctor. This will allow your physician to have a clear view of your needs so he or she can determine what items are specifically suited for you.
If you require supplies that are needed on a weekly or monthly basis, you will want to discuss the steps you need to take with your doctor. You want to be assured that you will have a continuous supply of your mandatory essentials. This may require scheduling doctor appointments so your doctor can examine your progress and determine if certain supplies are still needed or if new ones are necessary.
The key for consumers is to stay in contact with your doctor and show up for appointments. This will lessen the risk of experiencing a gap in time from receiving much needed medical supplies and equipment. In this situation planning ahead with your doctor and staying on schedule is in the best interest of the patient and the doctor.
Remember as of February 28 this new rule goes into effect. You will want to speak to your doctor ahead of time to avoid any inconvenience the new regulations can cause. While this may feel inconvenient to patients, doctors and hospitals, the new regulations capable of having a positive impact in relation to preventing fraud in the industry.