Senators Ask for Clarification on Mobility Coverage

Washington

Pennsylvania Sens. Rick Santorum and Arlen Specter are urging CMS to issue clear documentation requirements for Medicare coverage of mobility equipment.

In a letter dated Aug. 5 to CMS Administrator Mark McClellan, the senators said they “remain concerned with the lack of clear instructions to [DMERCs] and for providers as to how they are to document the medical necessity of power mobility products under the coverage policy.”

Since CMS released a new mobility coverage policy on May 5, providers, manufacturers and others have argued that the agency has not provided enough guidance on required claims documentation under the new policy.

The senators pointed out that “providers regularly encounter inconsistencies within the four DMERC regions on how documentation is interpreted. In addition, providers are faced with the DMERCs’ placing extreme emphasis on a physician’s chart notes to justify medical necessity, even though physicians do not routinely document medical information in their charts to the level of specificity that the DMERCs are requiring.” According to the senators, evaluations from clinicians or letters of medical necessity should be used by claims processors if there is an audit.

As of press time, a revised wheelchair certificate of medical necessity and final face-to-face examination rule were expected, had not yet been issued.