Home Health & Hospice Week

Beneficiaries no longer need a medical specialist's OK.

It may be bad news for physiatrists, orthopedic surgeons, rheumatologists and neurologists, but a policy change implemented recently by the durable medical equipment regional carriers has pleased suppliers of power-operated vehicles.

The DMERCs have begun notifying suppliers that they are eliminating the physician specialist requirement for prescribing scooters and other POVs. Suppliers have been anticipating the policy revision, which the Centers for Medicare & Medicaid Services worked on for the past several months.

DME industry leaders praise the change. "We believed all along that [all]physicians should be able to prescribe this equipment and not just specialists," says Tim Zipp, head of government relations for the New Braunfels, TX-based The Scooter Store.

When Medicare imposed restrictions on scooter prescriptions, it led to an increase in the use of costlier power chairs simply because they were easier to obtain, suppliers observe. The cancellation of the specialist requirement should make it easier for beneficiaries to get the most appropriate equipment to meet their needs.

However, don't expect to see a dramatic shift in utilization away from power wheelchairs and toward scooters and other POVs, Zipp cautions. That's because most POVs simply can't maneuver as well as more technologically sophisticated equipment in ordinary homes.

"Power wheelchairs still will be a better product in that setting," Zipp observes.

MMA Mandated the Policy Change

The new policy has sparked worries among some suppliers who note that CMS did not undertake any sort of regulatory process to codify the revision.

"What I'm concerned about is that claims get submitted without a specialist, yet the regs on the book still require one," one source confides. "Two years down the road when they audit, could there be a problem?"

The answer to that question is no, according to CMS. "This change was included in a self-implementing provision of the [Medicare Modernization Act]," a CMS spokesperson tells Eli.

The change is due to the new national coverage determination for mobility assistive equipment released earlier this year, the DMERCs point out in the notices about the new policy. In releasing the new NCD, CMS officially eliminated the old POV/scooter NCD, which contained the specialist requirement.

Educate docs: The American Association for Homecare urges providers to get busy informing physicians and other referral sources about the policy revision.

The new policy is effective retroactively for dates of service on or after May 5 when the new mobility NCD took effect. Meanwhile, suppliers must continue to wait for new instructions on the face-to-face physician exam, certificate of medical necessity revisions and documentation guidance for claims reimbursement.