PMD Rule to be Released Wednesday

BALTIMORE–The long-awaited final rule on documentation and
payment procedures for Medicare power mobility devices is scheduled
to be published this Wednesday, CMS announced.

In a fact sheet issued Friday evening, CMS said one major change
in the final rule is that it gives physicians and treating
practitioners 45 days, rather than 30 days, after the date of a
face-to-face patient examination to supply medical records to HME
providers. Industry stakeholders had been pushing for a 60-day
timeframe.

In August, CMS released an interim final rule on power mobility
devices (see HomeCare
Monday, Aug. 29, 2005) that eliminated the power mobility
certificate of medical necessity and replaced it with a doctor’s
prescription and a face-to-face exam. The rule also requires
doctors to supply providers with patient records documenting
medical necessity. The IFR originally took effect Oct. 25, but an
HME industry effort, including the Restore Access to Mobility
Partnership, with members Pride Mobility, Invacare Corp. and the
American Association for Homecare, succeeded in delaying the rule
until at least April 1.

Since the release of the IFR, stakeholders have been anxiously
seeking further instructions on exactly what documentation should
be included with reimbursement claims.

According to CMS, the final rule “gives physicians, other
treating practitioners and suppliers greater certainty regarding
Medicare payment by providing more extensive guidance for how PMD
claims can be supported with well-documented findings by physicians
and other treating practitioners.”

The new process also “eliminates the burden for physicians to
provide potentially duplicative information on multiple forms,” the
agency said.

The pertinent parts of the medical record should include
documentation of the face-to-face exam, including information such
as the history, physical examination, diagnostic tests, summary of
findings, diagnoses and treatment plans, CMS stated.

In an appendix titled “Documenting Medical Necessity: Pointers
for Physicians and Other Treating Practitioners,” CMS said the
parts of the medical record selected “should be sufficient to:

–delineate the history of events that led to the request for
the PMD;
–identify the mobility deficits to be corrected by the PMD;
–establish that other treatments do not obviate the need for the
PMD,
–establish that the beneficiary lives in an environment that
supports the use of the PMD; and
–establish that the beneficiary or caregiver is capable of
operating the PMD.”

Although information recorded at the face-to-face examination
will be sufficient in most cases, CMS said there may be some cases
where the physician has treated a patient for an extended period of
time so previous notes also should be included.

On Saturday, CMS began paying physicians an add-on fee of $21.60
for the work involved in compiling and transmitting documentation
to suppliers. Until now, CMS had been not been able to make these
payments because funds to implement or enforce the rule were on
hold.

To view the fact sheet, click
here.

To view the rule after it is published in Wednesday’s Federal
Register, click
here.