RAC Approved to Audit Hospital Beds and Manual Wheelchairs

Published in Complex Rehab on February 07, 2020

The Recovery Audit Contractor (RAC) has been approved to audit hospital beds and manual wheelchairs.   

In this article, we focus on the manual wheelchairs K0001 and K0003 with DOS no more than 3 years ago through Dec. 31, 2019. Here is the low down on what you need to be prepared for an audit: 

  • Medical necessity for K0001 and K0003. Documentation must contain information as to why the patient can't use a least-costly alternative to the item, provided along with objective measurements (manual muscle test, ROM, pain scale, saturation, etc.) to support the reason stated. This must be in either the face to face exam OR the LCMP wheelchair evaluation AND 
  • Medical necessity for ALL accessories separately billed on the claim in either the face to face exam OR the LCMP wheelchair evaluation AND 
  • A face to face exam with the ordering practitioner that contains either the condition requiring the manual chair or noting the patient requires a manual chair. This must be have occurred within 6 months preceding the date of the order AND 
  • An initial order and a detailed written order (DWO) prior to the delivery date 
  • A home assessment documented prior to OR on the date of delivery 
  • A delivery ticket  

These are the main areas of focus, but it is not an all-inclusive list.  

If you have any questions regarding manual chair audits, please contact me at dan.fedor@vgm.com or 570-499-8459, and for hospital bed audits, please contact Ronda Buhrmester at ronda.buhrmester@vgm.com. 

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