Medicare Compliance & Reimbursement

Documentation demands will up reimbursement rate, though.

As of Oct. 25, doctors will have to see patients face-to-face before they prescribe either a power wheelchair or a scooter.

The Centers for Medicare and Medicaid Services implemented the face-to-face requirement in an interim final rule on power mobility devices such as power wheelchairs and scooters. Unlike an earlier rule, which would have applied to all durable medical equipment, this requirement only applies to PMDs, however.

Good news: Doctors will no longer have to fill out and sign the certificate of medical necessity for PMDs. Also, CMS is deleting the requirement that only specialists in physical medicine, orthopedic surgery, neurology or rhematology can prescribe power scooters.

Not-so-good news: Physicians will have to provide written prescriptions for PMDs, plus copies of any relevant documentation from the patients' files, to wheelchair suppliers. The suppliers must have that documentation in their files when they bill Medicare.

New code: CMS is creating a new add-on "G" code for providing wheelchair documentation to suppliers, and it'll reimburse around $21.60 in 2005.

A fact sheet on the CMS Web site spells out the documentation that physicians must provide to suppliers to prove the necessity for wheelchairs. The documentation must show the history of events that led to the order for a PMD, identify the mobility problems that the PMD will correct, show that other treatments haven't worked, and prove that the patient lives in an environment that will support the PMD and that he or she knows how to use it. (The fact sheet is at www.cms.gov/coverage/wheelchairs.asp).

CMS has changed its coverage policies for PMDs to reflect a "functional standard," CMS administrator Mark McClellan said in an Aug 24 conference call with reporters. The new physician documentation requirement is "the least burdensome and most effective" way to make sure patients meet the new standards, McClellan argued.  

"The point isn't to create new burdens for physicians  and health professionals," McClellan insisted. "We want to make sure we're supporting them effectively in their responsibility." But some experts predict physicians will find the new requirement more challenging.

The overall number of patients receiving PMDs may actually go up, now that all physicians can prescribe them, McClellan said. But the new documentation requirements should ensure that patients don't receive any equipment they don't actually need, he added.

CMS is accepting comments on the new regulation until Nov. 25. CMS will hold an Open Door Forum on the new regulation on Sept. 13 and will provide more guidance to physicians soon.