Time on Our Side

After months of industry advocacy efforts with legislators raising awareness of the need for modifications to the Interim Final Rule, Congress passed language in the Labor, Health and Human Services and Education appropriations bill that “prevents CMS from using any resources to implement or enforce the IFR until April 1, 2006.”

The language instructs CMS to publish a proposed rule with comment period, and a final rule with a 45-day transition period, to be implemented no earlier than April 1, 2006. Since approval of the bill took more time than anticipated, CMS may not meet this timeframe; however, the agency is prevented from implementing or enforcing the IFR until at least that date.

The retraction of the IFR is positive in that it provides additional time for physician education and the development of documentation clarity, which will afford physicians and providers the understanding and acknowledgement of the level of documentation needed to substantiate medical necessity for power mobility devices.

While at this writing no official interim guidance has been issued by CMS, the retraction could also extend the 30-day timeframe between the face-to-face examination requirement and the provider's receiving the prescription and support documentation from the ordering physician.

We do not anticipate major changes with the retraction of the IFR since the National Coverage Determination and Local Coverage Determination remain in effect. The LCD outlines a nine-step examination, to be performed by the treating practitioner, which needs to be accompanied by supportive documentation. The LCD also outlines a seven-element prescription.

The industry now has a real opportunity to work with CMS on improving upon the status quo.

Although there is much in the IFR and LCD that is manageable for providers, physicians and the DMERCs, in order for this new rule to yield reasonable outcomes for the long term, the following is necessary.

• The DMERCs need to issue an official bulletin clarifying the documentation expectations. This would provide physicians with specific guidance as to their responsibilities regarding what constitutes a complete examination and documentation fulfillment that establishes medical necessity.