Ambiguous process needs overhaul

Wednesday, October 31, 2007

Q. A recent PMD probe indicates that documentation requirements are still confusing. What can be done to improve this?
A. It's time to take the guesswork out of the equation for physicians. CMS needs to develop a comprehensive clinical guide. When physicians are asked about the process for prescribing PMDs, they express frustration with the current documentation standard. Why? There is no standard process. Doctors are desperately trying to understand how to get Medicare to pay for PMDs. A recent probe in Regions A and B indicated that Medicare should have only paid for 10% of the PMDs billed for during the period reviewed. But the suppliers and doctors know that isn't the true picture. The reality is that the documentation rules are so vague that claim processors can deem any claim they want as unacceptable. Historically, CMS has developed clinical guides for physicians to use for nearly every product it reimburses under the Medicare program. The probe results point to the need for CMS to establish an objective and comprehensive clinical guide that helps establish medical necessity in such a way that it will be accepted as part of the medical record.
Two things need to be done immediately by the industry:
* Encourage physicians, hospitals and rehab specialists to voice their concerns to their state/national medical associations. Physician groups are now starting to weigh in on the industry's issues because the common goal is to provide quality healthcare solutions to the patient.
* Educate your member of Congress on the issue and encourage them to contact CMS to establish an objective, consistent clinical standard that helps everyone understand what documentation CMS wants. hme
Mark Leita is the director of public affairs for The Scooter Store. Reach him at 830-627-4717 or