New PMD Guidance Concerns Stakeholders

Washington

Following the DMERCs' and Medicare Administrative Contractors' release of the latest power mobility device guidance, some stakeholders say they still are not exactly clear on what medical documentation providers should request and keep in their patients' files to support claims.

“We think it's a missed opportunity to provide some objectivity and clarity in the process,” said Eric Sokol, director of the Power Mobility Coalition, adding that a template or guidelines would be helpful in assuring providers that “if x, y and z is done,” they will be reimbursed.

While the guidance mainly repeats information that has already been published, the new requirement that concerns some stakeholders is that the diagnosis of certain conditions will be emphasized over the face-to-face exam in the patient's medical record.

“For example, for patients with [chronic obstructive pulmonary disease], heart failure or arthritis, the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination,” according to the new guidance.

“Singling out certain diagnosis codes and treating them differently de-emphasizes the face-to-face [exam],” Sokol said. “It's totally subjective.”

Seth Johnson, vice president, government affairs, for Exeter, Pa.-based Pride Mobility Products, also said he is concerned about what appears to be a “two-tier standard” based on condition. “This is almost counter to congressional intent,” he said. “Congress mandated that the face-to-face exam occur to justify medical necessity for an item.”

Another new requirement is that the PMD delivery must occur within 120 days of the face-to-face exam. And prior to delivery, providers must have the prescribing physician sign a detailed product description that lists the specific HCPCS code for the equipment along with the manufacturer name and model, options and accessories.

Because providers must receive all documentation from the physician within 45 days of the patient exam, this additional requirement compounds paperwork and probably means another contact with the physician's office, Johnson said, adding that getting all that done within the timeframe required could prove difficult.

“It's going to require suppliers to have to go back to the physician [for another] signed and dated document. It's an additional burden on physicians and an additional burden on suppliers,” Johnson said.

For more, see “Washington Wit & Wisdom” on page 48.