Features
Charting the Changes
In order for an Advanced Determination of Medicare Coverage to be accepted for a wheelchair after Aug. 10, 2006, the following demographic items must be listed on the first page (if all of them are not, it will be rejected):
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Beneficiary information: name, HICN, address, date of birth
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Place of service
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ICD-9 diagnosis code (a narrative description is not acceptable)
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Supplier information: name, NSC number, address and phone number (I recommend you include your NPI number as well, though it is not required at this time.)
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Physician information: name, UPIN, address and phone number
If your ADMC is for a power wheelchair, the following items must be included:
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The order the supplier received within 45 days of the face-to-face evaluation, which must include the following:
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Beneficiary name
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General or specific description of the item (“power wheelchair” or “power mobility device” is acceptable, but I recommend being more specific.)
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Date of the face-to-face examination (this will be the last date seen if there were multiple visits)
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The conditions and diagnosis only that show why there is a need for a power wheelchair
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The length of need
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Physician's signature and date of signature
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The order must have a date stamp or some other type of equivalent means of showing when the provider received the order from the physician.
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A detailed product description of the information in the written order that lists the specific wheelchair base provided and each accessory or option that will be separately billed by the provider. Each item must have a specific HCPC code associated with it. The provider can enter this information and it must be signed and dated by the physician, although the physician signature does not have to be within the 45-day time limit of the face-to-face examination.
As of Aug. 24, 2006 a supplier's charge and fee schedule amount must be listed for each item as well. If an item does not have a fee schedule amount you are instructed to enter “not applicable.”
