BALTIMORE--Years of wrangling over power mobility CMNs will soon be moot according to a new process that eliminates the document entirely.

Instead, under an interim final rule to take effect Oct. 25, providers need only submit a physician's prescription for reimbursement of Medicare claims for power wheelchairs and scooters. They will, however, be responsible for producing patient records supplied by physicians that document medical necessity if asked.

"This interim final rule is a critical step in ensuring that people with Medicare have access to appropriate technology to assist them with mobility," CMS Administrator Mark McClellan said at a Wednesday press conference announcing the new rule, calling it "a comprehensive strategy to help Medicare beneficiaries get the mobility assistance equipment they need while avoiding unnecessary administrative burdens and inappropriate Medicare spending."

According to CMS, the agency decided to drop the certificate of medical necessity because it "did not work as well as originally hoped. The CMN did not serve to help physicians better document their patient's clinical needs for a power wheelchair, it did not serve to ensure that beneficiaries always received appropriate equipment, nor did it serve as an effective deterrent to fraud and abuse."

Previously, only specialists in physical medicine, orthopedic surgery, neurology or rheumatology could prescribe a power mobility device, but McClellan told reporters the restriction was "out of step with modern medical practice."

The new rule allows physicians and treating practitioners to prescribe PMDs, and also requires them to perform a face-to-face exam before writing a prescription. According to Kimberly Brandt, director of CMS' Program Integrity Group, this will allow questions to be asked about changes in the patient's health or about progression of the clinical condition that warrants the equipment.

Under the new claims process, before billing Medicare, providers must have a written prescription, signed and dated by the physician or practitioner who performed the face-to-face exam, within 30 days of the examination. Providers also are required to gather clinical information supplied by the doctor or practitioner that proves medical necessity before delivering a power wheelchair or scooter. CMS reasons it is simpler for doctors to give providers copies of existing documentation from the patient's medical records rather than having to transcribe that information onto a separate form.

"The physician is in the best position to document and evaluate clinical and medical need," said McClellan, who called the power wheelchair and scooter CMN "extra paperwork."

While physicians already can file for payment for the office visit to evaluate patients, he said CMS is authorizing an additional physician payment of about $21 for 2005 for preparing and providing the documentation to suppliers.

McClellan said the documentation does not need to be submitted to the DMERCs with every claim, but suppliers should keep it on file to supply upon request. According to CMS, the information could include the patient's history, physical examination, diagnostic tests, summary of findings, diagnoses and treatment plans. McClellan added that the DMERCs will later issue specific guidance about what information is needed from the medical record to document medical necessity.

He also said that he expects draft local coverage determinations--which providers have been waiting on since the release of the agency's national coverage determination for Medicare's mobility benefit in May--will be "coming out very soon" from the DMERCs.

CMS said it plans to issue billing instructions to suppliers before the Oct. 25 implementation date, and will hold a special Open Door Forum Sept. 13 to address power wheelchair and scooter issues. The agency will accept comments on the interim rule until Nov. 25. A final rule is expected to be issued shortly thereafter.

To view the interim final rule, click here.

To comment, click here.