DMERCs Issue Mobility Coverage Transition Article, But No Additional Documentation Guidance

BALTIMORE–HME providers will have to wait a bit longer for
documentation guidance on Medicare’s new mobility coverage
policy.

On Friday afternoon, the four durable medical equipment regional
carriers released a transition article following CMS’ May 5
National Coverage Determination for mobility that stated: “It is
expected that the patient’s medical records will reflect the need
for the care provided. The patient’s medical records include the
physician’s office records, hospital records, nursing home records,
home health agency records, records from other health care
professionals and test reports.”

The article said additional information related to documentation
of medical necessity will be included in the power mobility Local
Coverage Determination. A draft LCD is expected to be released
later this summer.

For now, the DMERCs reminded providers that “they may be asked
to provide information that corroborates the medical need for the
item provided … We encourage suppliers to work with their
referral sources to ensure the adequacy of the medical record.”

The transition article does match the current certificates of
medical necessity for power wheelchairs, scooters and manual
wheelchairs to the national coverage policy, telling clinicians
which questions to answer–and not answer–when prescribing
equipment under the new system. Some questions on the CMNs no
longer apply, the article said, because coverage is now based on a
patient’s ability to perform activities of daily living instead of
on previous “bed- or chair-confined” language. The new criteria
apply to all Medicare mobility claims with dates of service from
May 5 forward.

According to Seth Johnson, director of government relations for
Pride Mobility, Exeter, Pa., companion regulations to the
NCD–including a new wheelchair CMN, a revised POV policy and a
face-to-face physician exam requirement–“should include some
additional documentation guidance as well.

“We’re looking for clear instructions … that would not be open
to interpretation,” he added. “We just want to know the rules of
the road.”

Johnson, who met with CMS officials last week as chair of
AAHomecare’s Rehab and Assistive Technology Committee, said these
regulations have become “a top priority” at CMS headquarters in
Baltimore and their release is expected “very soon.”

Contact your DMERC for more information. Links to each DMERC are
available on HomeCare’s Web site by clicking
here.