Home Health & Hospice Week

CMS gets an earful from industry in special Open Door Forum.

The power mobility industry may not enter a brave new regulatory world next month after all.
 
Suppliers made a strong case for delaying implementation of the interim final rule on prescribing, supplying and receiving payment for power wheelchairs and scooters at a Sept. 13 special Open Door Forum. Chastened Centers for Medicare & Medicaid Services officials promised to carefully consider their concerns.
 
Held to gather feedback on the interim final rule unveiled last month, the three-hour discussion grew heated at times, as moderator Dr. Rich Lawlor engaged in spirited debate with suppliers and other stakeholders. Participants raised serious concerns about a lack of clarity in documentation requirements and insufficient phy-sician education, and they voiced repeated misgivings about the rushed rulemaking process.
 
CMS officials conceded that a piece of the puzzle was still missing, with local coverage determinations from the durable medical equipment regional carriers still to come. They expect the DMERCs to publish the LCD policy "within the next few days," to be followed by a 45-day comment period.
 
Suppliers are grappling with tremendous changes given the new codes, coverage rules, fee schedules and face-to-face exam and documentation requirements, noted Cara Bachenheimer of Elyria, OH-based Invacare Corp.
 
"We are truly entering a new paradigm, and I strongly encourage CMS to consider all the comments here and, instead of going forth with an effective date of Oct. 25, publish a final rule that gives all stakeholders a whole lot more information than we have available today," Bachenheimer urged.
 
CMS officials acknowledged they heard a lot of good comments and would give them consideration

Don't Make Us Play Doctor, Suppliers Say

The interim rule's documentation requirements came under sustained fire from suppliers.
 
"The rule claims simplification and elimination of a form -- the certificate of medical necessity," said Doug Harrison, CEO of The Scooter Store in New Braunfels, TX. "However, it creates two new forms -- the new prescription and a written [power mobility] evaluation, in addition to massive recordkeeping requirements for additional documentation."
 
A concern that provoked some of the most clamorous debate was whether the agency expects suppliers to make medical determinations based on their evaluation of the physician's documentation. The concern arises due to the requirement that suppliers gather and keep on file those parts of the patient's medical record that show necessity.
 
"We don't have the education," said one supplier. "What are we supposed to say? 'No, we don't think they need the machine ...quot; you didn't do your test right.'"
 
Eric Sokol of the Washington-based Power Mobility Coalition echoed those worries, arguing that CMS was asking suppliers to police physicians. "Do I need to make a medical judgment about documentation before I dispense the item?" he asked.
 
Lawlor called Sokol's point an "excellently challenging question," but insisted CMS was not asking suppliers to make medical decisions. "We're asking you to make a supplier decision," he said. "It is very close and bound to the medical information that you're getting from the doctor."
 
Many of the speakers also questioned the 30-day timeframe the rule establishes from the face-to-face exam to when the prescription must be written, pointing to situations involving multiple exams by various professionals. The clock does not necessarily start ticking at the time of the very first exam but when the decision to obtain mobility equipment is made, CMS clarified.

Coding changes ahead: Based on information gathered during LCD development and equipment testing, CMS has determined that it must make refinements to the HCPCS codes and the performance standards and testing requirements. The agency plans to post more information about those changes within a few days as well.