A Pause for Thought

Congress’ recent decision to delay implementation of the Interim Final Rule outlining documentation rules for Medicare purchases of power wheelchairs and other mobility equipment gives CMS an opportunity to establish rules, regulations — and an education process ensuring that beneficiaries with medical need have access to mobility products.

The Restore Access to Mobility Partnership has urged CMS to consider the recommendations proposed by clinicians, consumers, suppliers and manufacturers.

While CMS implemented the IFR on Oct. 25 last year (following the release of its new mobility coverage policy in May), on Dec. 30 President Bush signed a Labor/HHS appropriations bill including a provision that suspends enactment of the IFR until a new regulation is issued and implemented by April 1. The House and Senate included the provision after hearing concerns that the IFR was causing confusion among physicians, beneficiaries and suppliers.

That point was underscored in a recent Web survey conducted by HomeCare that sought to gauge how well CMS’ new mobility coverage policy and regulation changes are understood by suppliers. The survey asked: “Do you understand what is required for reimbursement of power mobility claims with dates of service on or after May 5, 2005?” (That is the date the new coverage policy became effective.)

The results show that a majority of suppliers who answered the question don’t understand how to deal with claims for power mobility equipment. The poll found that 62 percent of respondents said they either don’t understand or are “totally confused” about handling these claims now, and another 11 percent said they aren’t sure. Only 12 percent of the suppliers participating in the poll said that they definitely understand the process, while 15 percent said they think they understand.

Since suppliers make a concentrated effort to monitor regulatory changes, there are concerns that other stakeholders, such as physicians and the beneficiaries themselves, are even more confused about what has transpired since the coverage policy was changed last spring and new regulations were issued in the fall. Moreover, there are a few provisions in the rules and regulations that stakeholders agree must be changed if CMS hopes to achieve its goal of making the process more efficient.

Most in the industry are very supportive of many of the changes CMS has made, including the “face-to-face” exam rule requiring that a physician examine a Medicare beneficiary before power mobility equipment is prescribed. Continuing concerns, however, have been the lack of clarity CMS has provided to prescribing physicians and suppliers to enable a solid understanding of the respective parties’ new documentation responsibilities.

In a recent letter to CMS, RAMP recommended that CMS:

• Issue instructions clarifying that physicians may respond to a series of questions that are based upon the May 5, 2005, National Coverage Determination for mobility assistive equipment, as long as the physician provides all responding information. In many cases, physicians are not educated on the coverage criteria; suppliers typically are bearing the burden of providing that education to prescribing physicians.
• Work with national and state medical groups by providing articles explaining the new coverage policy and physician documentation responsibilities, as well as host seminars at their meetings.
• Create a Web-based education program to explain the new coverage policy, regulations and physician documentation responsibilities.
• Extend the requirement between the date of the face-to-face exam and the date that the physician provides the supplier with the supporting documentation from 30 to 60 days. Oftentimes, a 30-day time frame is not feasible.

RAMP also recommended that CMS affirm the documentation expectations outlined in the IFR will not be applied during a pre- or post-payment audit on claims for services provided during the transition period from Oct. 25, 2005, to the effective date of the new regulation.

A specialist in health care legislation, regulations and government relations, Cara C. Bachenheimer is vice president, government relations, for Invacare Corp., Elyria, Ohio. Bachenheimer previously worked at the law firm of Epstein, Becker & Green in Washington, D.C., and at the American Association for Homecare and the Health Industry Distributors Association. You can reach her by phone at 440/329-6226 or by e-mail at [email protected].