Final Power Mobility Rule Extends Exam-to-Provider Timeframe

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 rule, published last month, 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 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.

After the release of the interim final rule in August 2005, many stakeholders argued that 30 days is not enough time to obtain required documentation, especially if the patient has a complex condition and requires an additional evaluation for fitting.

Other major elements of the IFR — 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, 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.”