WASHINGTON--Two of HME's largest manufacturers are working together to persuade CMS to alter one of its recent controversial power mobility policies.

In a Nov. 14 letter to CMS officials, Cara Bachenheimer, vice president, government relations, for Invacare Corp., Elyria, Ohio, and Dan Meuser, president of Pride-USA, Exeter, Pa., detailed their concerns with the interim final rule for power mobility devices and offered up suggestions that they said would help the industry serve beneficiaries.

The IFR, which took effect Oct. 25, eliminated the certificate of medical necessity for PMDs. Providers are now only required to submit a physician's prescription with their claims; however, they are required to gather patient records from physicians documenting medical necessity for the equipment (see HomeCare Monday, Aug. 29).

While Invacare and Pride said they support aspects of the IFR, such as a physician face-to-face examination and home assessment to make sure the device is functional in the patient's home, their main concern is with physicians' new documentation responsibilities.

According to the letter, addressed to CMS Deputy Administrator Leslie Norwalk and CMS Director Herb Kuhn, the companies are concerned that physicians may provide weak supporting documentation with their signed prescriptions, leaving providers unintentionally non-compliant. If a review finds the equipment was not medically necessary, the provider would be responsible for refunding Medicare.

Also, certain inconsistencies between the IFR and local coverage determination released by the DMERCs could cause further confusion, the companies said.

"These inconsistencies between the IFR and LCD can lead the DMERCs to a subjective interpretation of the patient's medical record and could ultimately give the DMERCs the ability to deny any PMD claim in an audit," the letter stated.

The companies also are asking CMS to extend the timeframe from when the face-to-face exam takes place to the time a provider is given a written prescription from 30 to 60 days. "We understand from our customers that this timeframe may not provide adequate time for the process to be completed. Under previous policy, providers would routinely need to follow up with physicians on numerous occasions just to obtain a prescription and completed CMN," the companies explained.

Another major concern with the IFR, according to Invacare and Pride, is that it could be easier for unscrupulous suppliers to defraud Medicare because a physician-signed document no longer needs to be submitted with PMD claims.

"We strongly urge CMS to put an appropriate mechanism in place on the front end of the claims system, which will strengthen program integrity efforts and provide beneficiaries and providers with some level of assurance that when a claim is paid, Medicare has approved the claim," the companies explained. This could include a standardized series of questions that physicians use to provide medical necessity information. A physician "attestation statement" indicating the necessary information has been completed, included in the medical record and provided to the supplier could be submitted electronically with the PMD claim, the letter suggested.

In the meantime, industry groups are divided over a proposed amendment to the HHS spending bill that would rescind the IFR and delay its implementation until April 2006 (see HomeCare Monday, Oct. 31).

While many in the industry, including Pride and Invacare, strongly support a delay, the National Coalition for Assistive and Rehab Technology opposes rescinding the IFR, saying a delay would only confuse the situation further.

Introduced by Sen. Arlen Specter, R-Pa., the amendment was included in the most recent versions of the bill from both the House of Representatives and the Senate. The original amendment included a 1.5 percent reduction in power wheelchair reimbursement as a way to pay for the delay--an estimated $10 million--but the provision has been removed from the current version.

Although the bill was unexpectedly defeated last week by the House and sent back to the negotiating table by the Senate, "we've been given pretty strong assurances our amendment will be in final bill," said Seth Johnson, director of government affairs for Pride Mobility.