PMD Policy Puzzle

Events have been unfolding in the power mobility arena at lightning speed.

At press time, the Senate had approved an amendment to the Labor-HHS Appropriations bill that would delay CMS' interim final rule on face-to-face exams and new documentation rules. Previous to that, CMS announced the retraction of its second HCPCS code set for power mobility devices, issued Sept. 14, and said that it would start anew. In addition, CMS has announced changes to the Medicare national and regional coverage policies.

If you are confused, you are not alone.

It is primarily because these changes have been issued in a piecemeal fashion, and different policies have different effective dates. In addition, when CMS retracts one policy, it impacts another. All of this results in confusion among prescribing physicians, consumers, suppliers, manufacturers and other stakeholders regarding the fundamental issue: What does Medicare require for a beneficiary to receive a power wheelchair?

Following is a status update on the various PMD issues — at least for now.

• Documentation Issues: Through its “face-to-face exam” interim final rule issued Aug. 26, Medicare completely changed both the criteria for physicians to determine medical need for a PMD, how physicians are to document that need and how suppliers are to review and maintain the documentation. CMS is eliminating the “certificate of medical need” and instead is requiring physicians to provide suppliers with copies of medical records that are to contain information related to medical need.

  At the same time, CMS had not conducted any real physician education about these changes before the Oct. 25 effective date for the new documentation requirements. Additionally, the billing and claims payment software required to implement the payment of claims will not, according to Medicare, be in place and operational until April of 2006. At press time, we expected this regulation to be rescinded through an amendment to the Labor-HHS Appropriations bill.

• Delay of IFR: The Appropriations amendment would require CMS to publish a proposed rule Jan. 1, 2006, followed by a comment period and publication of a final rule, delaying the effective date for the face-to-face exam and new documentation rules for about six months.