Senators Ask McClellan For Mobility Policy Clarification

WASHINGTON–Pennsylvania Sens. Rick Santorum and Arlen Specter
are urging CMS to issue clear documentation requirements for
Medicare coverage of mobility equipment.

In a letter dated Aug. 5 to CMS Administrator Mark McClellan,
the senators said they “remain concerned with the lack of clear
instructions to [DMERCs] and for providers as to how they are to
document the medical necessity of power mobility products under the
coverage policy.”

Since CMS released a new mobility coverage policy on May 5,
providers, manufacturers and others have argued that the agency has
not provided enough guidance on required claims documentation under
the new policy.

The senators pointed out that “providers regularly encounter
inconsistencies within the four DMERC regions on how documentation
is interpreted. In addition, providers are faced with the DMERCs’
placing extreme emphasis on a physician’s chart notes to justify
medical necessity, even though physicians do not routinely document
medical information in their charts to the level of specificity
that the DMERCs are requiring.” According to the senators,
evaluations from clinicians or letters of medical necessity should
be used by claims processors if there is an audit.

The senators also raised concerns that a revised wheelchair
certificate of medical necessity, power operated vehicle policy and
final face-to-face examination rule–all expected to be released by
CMS–may not be adequate to determine medical necessity.

The mobility policy also has caught the attention of Ohio Sen.
George Voinovich, who last month sent a letter to HHS Secretary
Michael Leavitt asking that the companion regulations be released
soon.

“I think these letters have a significant impact,” said Seth
Johnson, director of government affairs for Exeter, Pa.-based Pride
Mobility. “We really want to know what the rules of the road are.
And providers want to know so they know with certainty when they
submit a claim they are going to get paid.”