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Medicare Moves to Streamline Access to Power
Vehicles
Aug. 24, 2005 - The Centers for Medicare & Medicaid
Services (CMS) today took another step to streamline and ensure
appropriate access for people with Medicare to power operated vehicles –
commonly called “scooters” and power wheelchairs. In an interim final
rule with opportunity to comment that went on display today at the
Federal Register, CMS clarified the requirements for prescribing,
supplying, and receiving payment for these vehicles. The interim final
rule builds on current clinical standards of care.
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Just two days ago, citing concerns regarding
implementation of the new Medicare coverage policy for power mobility
equipment, Senators Arlen Specter and Rick Santorum of Pennsylvania have
implored the Centers for Medicare and Medicaid Services (CMS) to quickly
issue "clear instructions'' on the information that providers must
maintain to establish medical necessity for mobility products.
Sens. Specter and Santorum, both Republicans,
echoed concerns recently raised by providers that it is difficult to
implement the new coverage policy that CMS issued in May without clearer
guidelines on documentation.
Although not addressing these concerns, the move by
Medicare is seen as an effort to clarify the rules.
“This interim final rule is a critical step in
ensuring that people with Medicare have access to appropriate technology
to assist them with mobility,” said CMS Administrator Mark B. McClellan,
M.D., Ph.D.
“Along with Medicare’s decision earlier this year
to replace the old ‘bed or chair confined’ standard with new functional
criteria for eligibility, this interim final rule is part of a
comprehensive strategy to help Medicare beneficiaries get the mobility
assistance equipment they need while avoiding unnecessary administrative
burdens and inappropriate Medicare spending. An appropriate
professional evaluation and its documentation in the patient’s record
are the key to the effective use of mobility devices and the quality and
continuity of care for our beneficiaries.”
CMS is eliminating the requirement that a
Certificate of Medical Necessity (CMN) signed by the prescribing
physician or other treating practitioner accompany claims for power
wheelchairs and scooters. In place of the CMN, the interim final rule
describes the clinical documentation from a patient’s medical record
that must be submitted along with a written prescription to the supplier
before the supplier delivers a power wheelchair or scooter to the
beneficiary.
“Under the Medicare system, the provider customizes
or ‘fits’ a chair for the patient after the physician has prescribed the
mobility equipment, which must actually be provided to the patient
before they submit a claim for payment. In December 2003, CMS changed
the interpretation of the old coverage criteria and the DMERCs began
rejecting claims that previously were being approved. As a result, more
than $100 million in claims across the industry have been rejected for
equipment that providers have already provided to patients. Providers
must avoid a costly recurrence,” according to a news release issued
earlier by Restore Access to Mobility Partnership, a coalition
representing power wheelchair providers and manufacturers..
“Documentation in the medical record of the
beneficiary’s need for assistance with mobility in the home, as well as
the type of technology needed, not only is the best evidence of medical
necessity – it also helps to promote continuity of care for our
beneficiaries,” said CMS Acting Chief Medical Officer, Barry Straube,
M.D. “And we are recognizing this in our payments to providers.”
Medicare already pays under the Physician Fee
Schedule for the office visit required to evaluate the beneficiary.
Because of the changes in the documentation suppliers will need before
delivering a power wheelchair or scooter, CMS is authorizing an
additional payment to physicians and treating practitioners for
preparing and providing the required documentation to the equipment
supplier. To receive this payment, the physician or treating
practitioner will include a special billing code on the claim for the
office visit.
CMS is today notifying physicians and other
treating professionals, as well as PMD suppliers, of this interim final
rule through its Medicare listserves. In addition, between the issuance
of this interim final rule and its effective date in 60 days, CMS will
target educational efforts to physicians and other practitioners who
prescribe power wheelchairs and power scooters as well as to suppliers
of PMD, to help them understand the new criteria and new documentation
requirements. CMS will also provide billing instructions for suppliers
before the implementation date.
To help suppliers evaluate and document the
patient’s need for a particular type of technology, the contractors who
process durable medical equipment claims will issue specific guidance
about what information from the beneficiary's medical record is needed
to demonstrate the medical necessity of the equipment. This guidance
will underscore that an appropriate coverage determination for these
products will take into account the patient’s medical history, elements
of a physical assessment such as strength and range of motion, a
functional needs assessment as documented in the medical record, as well
as the availability of other types of devices.
In early September, CMS will hold a special Open
Door Forum to address power wheelchair and power scooter issues. Open
Door Forums offer physicians, suppliers and other stakeholders the
opportunity to participate in person or by conference call in a
discussion with senior staff about Medicare policies.
The interim final rule issued today is the latest
action CMS is taking to implement a Power Wheelchair Initiative first
announced in April 2004. That multi-pronged initiative is focused on
improving coverage, payment policies, and quality of suppliers of power
wheelchairs and power scooters. In addition to developing new,
functional criteria for coverage, CMS is adopting new billing codes for
power wheelchairs and power scooters that will allow Medicare to
differentiate among types of equipment with different features and pay
more accurately depending on the characteristics of the particular
chair.
The interim final rule also implements provisions
in the Medicare Modernization Act of 2003 (MMA) affecting power
wheelchairs and power scooters, including a provision requiring a
physician or treating practitioner (who can be a physician assistant,
nurse practitioner, or clinical nurse specialist) to conduct a
face-to-face examination of the beneficiary before prescribing a power
wheelchair or power scooter.
The interim final rule also eliminates a
restriction that allows only a specialist in physical medicine,
orthopedic surgery, neurology or rheumatology to prescribe a power
scooter. This restriction, which no longer reflects current standards
of care, has created barriers to appropriate prescribing of equipment to
meet a patient’s needs. The new rule allows both physicians and
treating practitioners to prescribe a power wheelchair or power
scooter. Finally, the interim final rule requires a supplier, before
billing Medicare, to obtain a written prescription, signed and dated by
the physician or treating practitioner who performed the face-to-face
examination, within 30 days of the examination.
The actions CMS is taking today underscore the
principle that the beneficiary’s physician or treating practitioner is
in the best position to evaluate and document the beneficiary’s clinical
condition and medical needs. Good medical practice requires that this
evaluation be adequately documented. Thus, to minimize the
documentation requirements for providers while assuring that
documentation is adequate, physicians and treating practitioners will
now submit copies of relevant existing documentation from the
beneficiary’s medical record, rather than having to transcribe medical
record information onto a separate form such as a CMN.
The interim final rule will be published in the
August 26 Federal Register, and will become effective for services on or
after October 25. Comments will be accepted until November 25, and a
final rule will be published at a later date.
Note: The Interim Final Rule and a Fact Sheet
will be posted on the CMS Website at:
www.cms.hhs.gov/coverage/wheelchairs.asp
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