CMS: No More Power Mobility CMNs

BALTIMORE–Years of wrangling over power mobility CMNs will soon
be moot according to a new process that eliminates the document
entirely.

Instead, under an interim final rule to take effect Oct. 25,
providers need only submit a physician’s prescription for
reimbursement of Medicare claims for power wheelchairs and
scooters. They will, however, be responsible for producing patient
records supplied by physicians that document medical necessity if
asked.

“This interim final rule is a critical step in ensuring that
people with Medicare have access to appropriate technology to
assist them with mobility,” CMS Administrator Mark McClellan said
at a Wednesday press conference announcing the new rule, calling it
“a comprehensive strategy to help Medicare beneficiaries get the
mobility assistance equipment they need while avoiding unnecessary
administrative burdens and inappropriate Medicare spending.”

According to CMS, the agency decided to drop the certificate of
medical necessity because it “did not work as well as originally
hoped. The CMN did not serve to help physicians better document
their patient’s clinical needs for a power wheelchair, it did not
serve to ensure that beneficiaries always received appropriate
equipment, nor did it serve as an effective deterrent to fraud and
abuse.”

Previously, only specialists in physical medicine, orthopedic
surgery, neurology or rheumatology could prescribe a power mobility
device, but McClellan told reporters the restriction was “out of
step with modern medical practice.”

The new rule allows physicians and treating practitioners to
prescribe PMDs, and also requires them to perform a face-to-face
exam before writing a prescription. According to Kimberly Brandt,
director of CMS’ Program Integrity Group, this will allow questions
to be asked about changes in the patient’s health or about
progression of the clinical condition that warrants the
equipment.

Under the new claims process, before billing Medicare, providers
must have a written prescription, signed and dated by the physician
or practitioner who performed the face-to-face exam, within 30 days
of the examination. Providers also are required to gather clinical
information supplied by the doctor or practitioner that proves
medical necessity before delivering a power wheelchair or scooter.
CMS reasons it is simpler for doctors to give providers copies of
existing documentation from the patient’s medical records rather
than having to transcribe that information onto a separate
form.

“The physician is in the best position to document and evaluate
clinical and medical need,” said McClellan, who called the power
wheelchair and scooter CMN “extra paperwork.”

While physicians already can file for payment for the office
visit to evaluate patients, he said CMS is authorizing an
additional physician payment of about $21 for 2005 for preparing
and providing the documentation to suppliers.

McClellan said the documentation does not need to be submitted
to the DMERCs with every claim, but suppliers should keep it on
file to supply upon request. According to CMS, the information
could include the patient’s history, physical examination,
diagnostic tests, summary of findings, diagnoses and treatment
plans. McClellan added that the DMERCs will later issue specific
guidance about what information is needed from the medical record
to document medical necessity.

He also said that he expects draft local coverage
determinations–which providers have been waiting on since the
release of the agency’s national coverage determination for
Medicare’s mobility benefit in May–will be “coming out very soon”
from the DMERCs.

CMS said it plans to issue billing instructions to suppliers
before the Oct. 25 implementation date, and will hold a special
Open Door Forum Sept. 13 to address power wheelchair and scooter
issues. The agency will accept comments on the interim rule until
Nov. 25. A final rule is expected to be issued shortly
thereafter.

To view the interim final rule, click
here.

To comment, click here.