Medicare Compliance & Reimbursement

Recent reg does not mention rehab providers, but it still affects them.

Rehab providers that haven't kept in the loop on the Centers for Medicare and Medicaid Services' interim final rule on power mobility devices may be in for a rude awakening, because the rule affects those providers just as much as physicians.

Need help? Follow this expert advice to prepare for changes that could potentially limit rehab providers' original roles as a physical or occupational therapist in prescribing power mobility devices--and threaten their reimbursement.
 
The Medicare Modernization Act of 2003 included a review of how Medicare covers Power Mobility Devices. So, in April 2004, CMS created a  plan to review the coverage criteria for PMDs, develop new payment codes for PMDs reflecting specific types of equipment and develop quality standards for PMD suppliers.

In late August, CMS issued an interim final rule spelling out coverage, prescribing, coding, payment and claims documentation for these devices with an implementation date of Oct. 25, 2005. Now practitioners, insurers and reviewers are pleading for more adjustment time before some major changes take place.

This rule poses a problem for a rehab provider as a PT or OT. The rule now requires patients have a face-to-face visit with a doctor before obtaining a PMD.  

Snag: The rule doesn't mention the rehab provider--and that could threaten a rehab provider's long-established role in getting patients the devices they need and getting reimbursed for them. "Under the current system, physical [and occupational] therapists are clearly able to provide these services, but we need to clarify this in the final rule to allow therapists to do what they have been educated and clinically prepared to do," says Dave Mason, vice president of government affairs for the American Physical Therapy Association in Alexandria, VA.

"The rule as it stands can be interpreted to suggest a physician face-to-face assessment as the only service. There is a risk that patients will not get to a physical [or occupational] therapist to have the appropriate assessment and fitting," Mason says.

Also, certain areas of the country, particularly rural areas, are concerned about the availability of physicians and access to care. If gaining access to the correct device gets more difficult, it could potentially slow down a patient's functional progress, says Ellen Strunk, PT, clinical consultant for Restore Therapy Services, located in Pelham, AL.

Red Flag: CMS' new rule could also keep a rehab provider from a rightful reimbursement down the road because it doesn't mention the rehab provider's role.

To prepare for the interim final rule, providers should start by building relationships with physicians in their particular area. If the rule is going to require a face-to-face physician evaluation, then communication lines should be open with available physicians. [...]