Final Power Mobility Rule Published; Providers Still Waiting for Documentation Clarification

BALTIMORE–While stakeholders applauded CMS for remedying one
major point of contention in the final rule on power mobility, the
industry is still awaiting further clarification on exactly what
documentation is required for reimbursement of power mobility
claims.

In the final power mobility rule, published in Wednesday’s
Federal Register, CMS said physicians and treating
practitioners will have 45 days, rather than 30 days, after the
date of a face-to-face patient examination to supply medical
records to HME providers. Providers also must receive a
prescription for the equipment within 45 days of the exam or 45
days after the patient has been discharged from the hospital. The
final rule takes effect June 5.

Even though many in the industry were pushing for a 60-day
timeframe, “45 days is certainly an improvement over 30 days, and
something that we welcome. I really think that’s going to take care
of most of the claims that were an issue,” said Seth Johnson,
director of government affairs for Exeter, Pa.-based Pride
Mobility.

Following the release of the interim final rule in August (see
HomeCare
Monday, Aug. 29, 2005), many stakeholders argued that 30
days was not enough time to obtain all of the necessary
documentation, especially if the patient has a complex condition
and requires an additional evaluation for fitting.

Other major elements of the interim final rule–which eliminated
the power mobility certificate of medical necessity and replaced it
with a doctor’s prescription, face-to-face exam and patient records
documenting medical necessity–remain intact.

But providers hoping for further instructions on exactly what
documentation should be included with reimbursement claims came up
empty-handed. In a fact sheet issued last week (see
HomeCare Monday, April 3), CMS stated that prescribing
physicians should include documentation of the beneficiary’s need
for the device in the home, including the face-to-face exam,
information such as the history, physical examination, diagnostic
tests, summary of findings, diagnoses and treatment plans.

But the Washington, D.C.-based Power Mobility Coalition said it
was disappointed that CMS did not include objective criteria or a
clear documentation requirement.

“By eliminating any objectivity in the PMD claims process, CMS
contractors now have the discretionary authority to deny any and
all claims,” said PMC Director Eric Sokol. “Our goal is to achieve
some balance and work toward a system that has some objective
criteria in which lawful suppliers can comply and have a reasonable
expectation of reimbursement.”

The PMC said it is also concerned that many physicians and
health practitioners still are unaware of the rule changes.
“Despite its intent, this rule will ultimately place suppliers, not
physicians, in the role of determining what documentation supports
the claim and if the physician’s prescription is valid,” said PMC
Counsel Stephen Azia. “This would be like allowing your pharmacist
to determine whether you really need a prescribed medication.”

CMS stated in the final rule that it “cannot develop an
all-inclusive list of documents or information that Medicare
contractors may request during audits.” The agency added that
“there is no type of document that, taken alone without regard to
substantive content, will guarantee that the beneficiary’s clinical
condition meets the conditions for payment. It would be misleading
to suggest otherwise.”

Cara Bachenheimer, vice president, government relations, for
Elyria, Ohio-based Invacare Corp., said she was not expecting
clarification in the final rule because the agency had indicated
earlier that the document was not the appropriate place for that
information. But, she said she remains hopeful that further details
will be published soon. “[The release of the final rule] opens the
door to CMS putting out documentation clarification,” she said.
“Our No. 1 objective is clarity, and we’re hoping that’s what CMS
and the DMERCs will provide.”

CMS said it received approximately 65 comments on the interim
final rule, adding that “the industry response has been very
positive. As a result of the educational outreach to physicians and
treating practitioners, suppliers have noted a significant
improvement in the timeliness, completeness and substantive content
of medical record documentation submitted in support of PMD
prescriptions.”

This statement, which was published in the final rule, puzzled
Bachenheimer. “It’s 100 percent contrary to the comments we hear
every single day from our customers,” she said. “I am wondering who
they were talking to.”

To view the final power mobility rule,
click here.