Medicare Compliance & Reimbursement

LCDs make rules are even more restrictive.

Rehab providers that employ physical or occupational therapists probably weren't very happy with the Centers for Medicare and Medicaid Services' new interim final rule on power mobility devices.
 
But they won't be much happier with the resulting local coverage determinations, which add an extra twist that could exclude rehab providers and their therapists from the process even more.

Providers may have hoped the LCDs would be a good opportunity for the regional carriers to mention their role in establishing medical necessity for patients needing power mobility devices--but just like the national coverage determination, they don't. The LCDs still hold that beneficiaries receive a face-to-face evaluation from a physician--so it's still up to the physician's discretion to utilize a physical or occupational therapist in the process.
 
Here's the snag: When dealing with power-tilt or other specialized-use, high-activity power chairs, unless the therapist holds a Rehabilitation Engineering and Assistive Technology Society of North America-certified Assistive Technology Practitioner credential, a provider doesn't have a chance of participating.

Important: Don't be confused by a generalized discussion of four different DMERC's LCDs. In this special case, the four LCDs are virtually the same because the DMERCs collaborated in their creation, explains Leslie Stein Lloyd, Esq., director of the Reimbursement and Regulatory Policy Department for the American Occupational Therapy Association in Bethesda, MD.
 
The LCDs create a major problem for providers used to getting reimbursed for these services. But patients may suffer even more if they can't access a certified ATP. 

"There are very few physicians who hold the ATP certification as a practitioner," warns Barbara Crane, co-coordinator of Clinician Task Force and assistant professor at University of Hartford Physical Therapy Department in West Hartford, CT. "In many states there are only one or two ATPs."