Home Health & Hospice Week

Suppliers' forms won't fly, contractors warn.

For power mobility suppliers, there's a lot riding on how doctors document the "face-to-face" visit that's now required for clean claims. Here's how to keep your cash flow on track:

• Know how the physician visit should be defined. The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) now say that medical records must state that the main reason for the face-to-face exam was to evaluate mobility needs, reports Eric Sokol, director of the Power Mobility Coalition.

About face: "That's a 180 degree change," says Sokol, adding that it is a welcome change from CMS' original stand that the exam not focus solely or mainly on mobility needs.

• Physicians must document the evaluation in "a detailed narrative note in their charts," say the contractors, using the format that they use for other entries. By doing so, the DME MACs have nixed the use of supplier-created forms, contends Sokol. "Physicians need guidance from suppliers" regarding what the contractors expect to see in the medical record, he explains--a need that the supplier generated forms aimed to fill.

• Physicians must file an actual "report" on the mobility exam. This report should cover a lot of ground, direct the MACs, including a patient's symptoms, related diagnoses, history, clinical progression, interventions and the result, physical exam and functional assessment.

"The elements addressed will depend on the diagnoses that are responsible for the mobility deficit,"  notes the MACs' guidance, an addendum that concerns Sokol and others.

Here's why: The MACs specifically address COPD, heart failure and arthritis, noting that in these diagnoses "symptoms and history of the progression of their condition" will trump the physical examination in determining the need for a PMD. "We feel that this assertion discounts the face-to-face examination," says Sokol, making the claims documentation process even more subjective.

"Our concern remains that the PMD claims process is so subjective at this point that the contractors will find it very easy to deny claims," says Sokol. "Ultimately, that could make it more difficult for those who need power mobility devices to obtain them."