BALTIMORE--On Friday, CMS sent formal instruction to the durable medical equipment regional carriers to implement Medicare's new mobility coverage policy, paving the way for the four DMERCs to issue interim guidance for equipment providers and work on local medical review policy.

In its Change Request, the agency told the DMERCs to disregard the "bed- or chair-confined" criterion--historically used to determine medical necessity--and instead use the functional approach outlined in the National Coverage Determination released May 5, which bases coverage on a beneficiary's ability to perform activities of daily living.

The new policy is effective for mobility claims with dates of service from May 5 forward, according to the CMS instruction, which adds that the DMERCs "may adjust claims back to May 5, 2005, if brought to their attention."

This means that if a provider brings up a claim--with a date of service on or after May 5--that was denied under the old bed- or chair-confined language, the DMERCs "are required to review the case under the new policy," a CMS spokesperson told HomeCare Monday. The spokesperson added that providers should contact their carrier "to find out how the DMERC wants [the claim] resubmitted under the new coverage standard."

According to Dr. Robert Hoover, medical director for Region D, the DMERCs plan to post a "transition article" on their Web sites to serve as interim guidance while they draft the LMRP.

What's lacking is documentation guidance, said Cara Bachenheimer, vice president of government relations for Elyria, Ohio-based Invacare Corp. She said the Restore Access to Mobility Partnership--a coalition that includes the American Association for Homecare, Invacare, The Med Group, Mobility Products Unlimited, Pride Mobility and Sunrise Medical--"has been pressing CMS and the DMERCs to issue detailed documentation requirements. We don't yet have a response on exactly what direction CMS may be going."

The new coverage policy is part of a larger effort to revamp Medicare's mobility benefit. Earlier this year, CMS introduced 49 new power chair and scooter codes that will take effect Jan. 1. The agency is also working through a regulation requiring a face-to-face physician exam for the equipment, a revision of the POV policy and is considering a new wheelchair CMN.