DMERCs Get Further Instructions on IFR

BALTIMORE–CMS will continue to give providers some leeway with
power mobility claims through the end of the month. In instructions
issued Friday to the Durable Medical Equipment Regional Carriers
and the new Program Safeguard Contractors, CMS explained that it
will not enforce some details of the Interim Final Rule for power
mobility devices until April 1.

Under the IFR–which eliminates the certificate of medical
necessity and replaces it with a face-to-face exam and a
prescription (see HomeCare
Monday, Aug. 29, 2005)–physicians are required to provide
medical records documenting a patient’s medical necessity for a
power wheelchair or scooter.

Although the IFR officially took effect Oct. 25, a subsequent
congressional directive put federal funds on hold for CMS to
implement or enforce the rule before April 1.

While claims must be supported by a face-to-face exam and a
written prescription, CMS said in the transmittal issued late
Friday afternoon, for claims received between Jan. 1, 2006, and
April 1, 2006, DMERCs, Regional Home Health Intermediaries and/or
DME PSCs will:

–Not require the details of the written prescription defined in
the IFR. The written prescription needs to be signed and dated by
the physician or treating practitioner who performed the
face-to-face exam.
–Not auto-deny PMD claims when the EY modifier has been used to
indicate that the written prescription with the elements specified
in the IFR was not received by the DME supplier within 30 days
after the face-to-face examination.
–Not require that the written prescription for the PMD be received
by the supplier within 30 days after the face-to-face exam.
–Continue to accept the partially completed unsigned CMN and not
edit on these partially completed CMNs.
–As defined in the Medicare Program Integrity Manual, if data
analysis indicates potentially aberrant billing, DMERCs and/or DME
PSCs shall continue to follow [this guidance] when performing
medical review on claims.

Last month, CMS announced that physicians and treating
practitioners who prescribe PMDs will not receive payment for
supplying medical records to HME providers until April (see
HomeCare
Monday, Feb. 27).

A Medlearn Matters article on the subject will be available by
clicking
here.