Ask the DMERC MDs

Friday, September 30, 2005

Over the last few months, the DMERC Medical Directors reviewed some of the common questions that have arisen about the Mobility Assistive Equipment NCD (NCD 280.3). Recently CMS released a regulation addressing additional power mobility issues
The regulation, Conditions for Payment of Power Mobility Devices, Including Power Wheelchairs and Power-Operated Vehicles; Interim Final Rule (PMD regulation), addresses several important issues, including the elimination of the certificate of medical necessity for these items and the creation of a requirement for a face-to-face physician evaluation.
We continue with some additional questions on the recently released CMS regulation this month.
Q. What provisions in the PMD regulation were required by the MedicareModernization Act?
A. There are two provisions required by the MMA:
n Expanding the category of treating practitioners who may order power mobility devices to include some non-physician practitioners. Treating practitioners include physician assistants, clinical nurse practitioners or nurse specialists.
n The physician or treating practitioner must conduct a face-to-face examination before prescribing a PMD.
Q. Apart from MMA requirements, what other key change is made by this regulation?
A. This regulation removes the current requirement that in order to get a motorized scooter (power operated vehicle or POV), a beneficiary must be seen by a specialist in physical medicine, orthopedic surgery, neurology, or rheumatology. The regulation allows the beneficiary's physician or treating practitioner to prescribe either a power wheelchair or a power-operated vehicle.
Q. How do the provisions of this regulation benefit physicians?
A. The importance of the treating physician's role in the assessment and treatment of the beneficiary is reinforced by the requirement of a face-to-face examination. The recently published national coverage determination on Mobility Assistive Equipment provides greater transparency on how CMS contractors make coverage determinations. At the time of the examination, physicians who are familiar with these coverage guidelines can prescribe with greater certainty that the beneficiary will indeed receive the appropriate mobility device. We anticipate that physicians will find it simpler to provide supporting documentation from the medical record at the time the patient is seen, rather than having to complete a CMN.
Q. Why did CMS eliminate the CMN?
A. CMS's experience has been that the CMN did not work as well as originally hoped. The CMN did not serve to help physicians better document their patient's clinical needs for a power wheelchair. It did not serve to ensure that beneficiaries always received appropriate equipment, nor did it serve as an effective deterrent to fraud and abuse.
Q. Why is CMS relying on supplemental documentation from the medical record instead of using the CMN?
A. CMS believes 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. Thus this regulation supports this important role, and it is simpler for physicians and treating practitioners to submit copies of existing documentation from the medical record, rather than having to transcribe medical record information onto a separate form.