Invacare, Pride Team Up to Change Mobility Policies

WASHINGTON–Two of HME’s largest manufacturers are working
together to persuade CMS to alter one of its recent controversial
power mobility policies.

In a Nov. 14 letter to CMS officials, Cara Bachenheimer, vice
president, government relations, for Invacare Corp., Elyria, Ohio,
and Dan Meuser, president of Pride-USA, Exeter, Pa., detailed their
concerns with the interim final rule for power mobility devices and
offered up suggestions that they said would help the industry serve
beneficiaries.

The IFR, which took effect Oct. 25, eliminated the certificate
of medical necessity for PMDs. Providers are now only required to
submit a physician’s prescription with their claims; however, they
are required to gather patient records from physicians documenting
medical necessity for the equipment (see HomeCare
Monday, Aug. 29).

While Invacare and Pride said they support aspects of the IFR,
such as a physician face-to-face examination and home assessment to
make sure the device is functional in the patient’s home, their
main concern is with physicians’ new documentation
responsibilities.

According to the letter, addressed to CMS Deputy Administrator
Leslie Norwalk and CMS Director Herb Kuhn, the companies are
concerned that physicians may provide weak supporting documentation
with their signed prescriptions, leaving providers unintentionally
non-compliant. If a review finds the equipment was not medically
necessary, the provider would be responsible for refunding
Medicare.

Also, certain inconsistencies between the IFR and local coverage
determination released by the DMERCs could cause further confusion,
the companies said.

“These inconsistencies between the IFR and LCD can lead the
DMERCs to a subjective interpretation of the patient’s medical
record and could ultimately give the DMERCs the ability to deny any
PMD claim in an audit,” the letter stated.

The companies also are asking CMS to extend the timeframe from
when the face-to-face exam takes place to the time a provider is
given a written prescription from 30 to 60 days. “We understand
from our customers that this timeframe may not provide adequate
time for the process to be completed. Under previous policy,
providers would routinely need to follow up with physicians on
numerous occasions just to obtain a prescription and completed
CMN,” the companies explained.

Another major concern with the IFR, according to Invacare and
Pride, is that it could be easier for unscrupulous suppliers to
defraud Medicare because a physician-signed document no longer
needs to be submitted with PMD claims.

“We strongly urge CMS to put an appropriate mechanism in place
on the front end of the claims system, which will strengthen
program integrity efforts and provide beneficiaries and providers
with some level of assurance that when a claim is paid, Medicare
has approved the claim,” the companies explained. This could
include a standardized series of questions that physicians use to
provide medical necessity information. A physician “attestation
statement” indicating the necessary information has been completed,
included in the medical record and provided to the supplier could
be submitted electronically with the PMD claim, the letter
suggested.

In the meantime, industry groups are divided over a proposed
amendment to the HHS spending bill that would rescind the IFR and
delay its implementation until April 2006 (see HomeCare
Monday, Oct. 31).

While many in the industry, including Pride and Invacare,
strongly support a delay, the National Coalition for Assistive and
Rehab Technology opposes rescinding the IFR, saying a delay would
only confuse the situation further.

Introduced by Sen. Arlen Specter, R-Pa., the amendment was
included in the most recent versions of the bill from both the
House of Representatives and the Senate. The original amendment
included a 1.5 percent reduction in power wheelchair reimbursement
as a way to pay for the delay–an estimated $10 million–but the
provision has been removed from the current version.

Although the bill was unexpectedly defeated last week by the
House and sent back to the negotiating table by the Senate, “we’ve
been given pretty strong assurances our amendment will be in final
bill,” said Seth Johnson, director of government affairs for Pride
Mobility.