BALTIMORE--While stakeholders applauded CMS for remedying one major point of contention in the final rule on power mobility, the industry is still awaiting further clarification on exactly what documentation is required for reimbursement of power mobility claims.
In the final power mobility rule, published in Wednesday's Federal Register, CMS said physicians and treating practitioners will have 45 days, rather than 30 days, after the date of a face-to-face patient examination to supply medical records to HME providers. Providers also must receive a prescription for the equipment within 45 days of the exam or 45 days after the patient has been discharged from the hospital. The final rule takes effect June 5.
Even though many in the industry were pushing for a 60-day timeframe, "45 days is certainly an improvement over 30 days, and something that we welcome. I really think that's going to take care of most of the claims that were an issue," said Seth Johnson, director of government affairs for Exeter, Pa.-based Pride Mobility.
Following the release of the interim final rule in August (see HomeCare Monday, Aug. 29, 2005), many stakeholders argued that 30 days was not enough time to obtain all of the necessary documentation, especially if the patient has a complex condition and requires an additional evaluation for fitting.
Other major elements of the interim final rule--which eliminated the power mobility certificate of medical necessity and replaced it with a doctor's prescription, face-to-face exam and patient records documenting medical necessity--remain intact.
But providers hoping for further instructions on exactly what documentation should be included with reimbursement claims came up empty-handed. In a fact sheet issued last week (see HomeCare Monday, April 3), CMS stated that prescribing physicians should include documentation of the beneficiary's need for the device in the home, including the face-to-face exam, information such as the history, physical examination, diagnostic tests, summary of findings, diagnoses and treatment plans.
But the Washington, D.C.-based Power Mobility Coalition said it was disappointed that CMS did not include objective criteria or a clear documentation requirement.
"By eliminating any objectivity in the PMD claims process, CMS contractors now have the discretionary authority to deny any and all claims," said PMC Director Eric Sokol. "Our goal is to achieve some balance and work toward a system that has some objective criteria in which lawful suppliers can comply and have a reasonable expectation of reimbursement."
The PMC said it is also concerned that many physicians and health practitioners still are unaware of the rule changes. "Despite its intent, this rule will ultimately place suppliers, not physicians, in the role of determining what documentation supports the claim and if the physician's prescription is valid," said PMC Counsel Stephen Azia. "This would be like allowing your pharmacist to determine whether you really need a prescribed medication."
CMS stated in the final rule that it "cannot develop an all-inclusive list of documents or information that Medicare contractors may request during audits." The agency added that "there is no type of document that, taken alone without regard to substantive content, will guarantee that the beneficiary's clinical condition meets the conditions for payment. It would be misleading to suggest otherwise."
Cara Bachenheimer, vice president, government relations, for Elyria, Ohio-based Invacare Corp., said she was not expecting clarification in the final rule because the agency had indicated earlier that the document was not the appropriate place for that information. But, she said she remains hopeful that further details will be published soon. "[The release of the final rule] opens the door to CMS putting out documentation clarification," she said. "Our No. 1 objective is clarity, and we're hoping that's what CMS and the DMERCs will provide."
CMS said it received approximately 65 comments on the interim final rule, adding that "the industry response has been very positive. As a result of the educational outreach to physicians and treating practitioners, suppliers have noted a significant improvement in the timeliness, completeness and substantive content of medical record documentation submitted in support of PMD prescriptions."
This statement, which was published in the final rule, puzzled Bachenheimer. "It's 100 percent contrary to the comments we hear every single day from our customers," she said. "I am wondering who they were talking to."
To view the final power mobility rule, click here.
