Medicare Compliance & Reimbursement

Providers let CMS have it at 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 and 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 physician 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

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--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.