[TGlenn]

Attempting to assist a double amputee Medicare patient that has a broken POV. The original Provider has gone out of business and after checking the IVR, find that the supplier of the POV billed for a K0823 PWC. Repairs to the scooter would be denied since the model and serial no. does not match the IVR record. the Pt's medical conditon has not changed so a new PWC would not be covered.
Has anyone had any similar experiences or have any suggestions how to get a repair claim paid in this situation?
Thank you,

[Regina]

This is a tough one. I don't think you, as the provider, are going to get anywhere with Medicare on this one. I would deny service to the patient, and tell them to contact their congressperson to get help with this. If they're lucky, they'll have the delivery ticket from the chair. That's just my opinion. I will be interested to hear what others think!

[SimplyLori]

We lost a lot of money in the past trying to be the good guys but especially with the Scooter store and all the other "800 #" sales out there it got too crazy. We will work on equipment we didn't originally sell but non-assigned only!

[serina.breen@comcast.net]

SimplyLori: How exactly did your company lose money doing repairs? What were
the specifics surrounding those cases?

[SimplyLori]

We couldn't get the documentation to prove the base was covered mostly. I recall a couple times at least the repairs were rejected and we needed to prove no warranty. Also on power we never get the amount of labor we need for diagnostics and the repair itself. The biggest problem overall is that if you didn't do the base you can't be sure if the initial paperwork was done right unless you get it all before the repair. Most people that rely on their power mobility don't want to wait and there are far too many companies out there that still do a shoddy job at documenting their base coverage. It blows my mind that they can get away with it but we'll get rejected and have to appeal a lousy pair of armrests! That's when the entire packet of info has to be submitted or they reject the repair itself so you're being paid or rejected based on another companies documents....

[serina.breen@comcast.net]

Hi SimplyLori,

I'm still curious. Did Medicare ask you for the documentation up front
before paying the claim? Or was this a post audit where they took the money
back? Also what jurisdiction was this?

[SimplyLori]

I honestly don't remember how many were before or after because we stopped trying a couple years ago but are region b. Bottom line is that we,ve had so many pre and post pay audits we don't even wait for Medicare to ask for the docs anymore...we get them up front.