Avoid catastrophe in an uncertain time

Monday, October 31, 2005

Q. On Oct. 25, CMS eliminated the certificate of medical necessity for power wheelchairs. Providers now must keep on file information that documents medical necessity. How do we handle this? What kind of information do we need?

A.The first thing that a supplier should do is to work with his physicians and educate them regarding the change in policy. This education should include a lesson on what the DMERCs expect to see in progress notes. The DMERCs have issued a "Dear Physician" letter that details the type of information it expects to see in progress notes.
A supplier should carefully review all progress notes received from the physician. The notes should contain information related to the patient's mobility limitation and its interference with the patient's ability to perform activities of daily living. The notes should also show the progressive consideration of equipment in the following order: a cane, walker, manual wheelchair, scooter and ending with a decision to order a power chair. If the progress notes do not contain the necessary information, the supplier is at risk for non-payment and should contact the physician again.
In addition to making sure a supplier has good physician progress notes, the supplier should perform a home assessment at the time of delivery and thoroughly document the beneficiary's ability to use the equipment in his/her home. This should include measuring the width of doorways and room sizes. It is also helpful to take pictures.
This is a very uncertain time for power chair suppliers and the failure to obtain good documentation can be catastrophic.


Denise Fletcher is an attorney with the Health Care Group of Brown & Fortunato, an Amarillo, Texas-based law firm. She can be reached at dfletcher@bf-law.com.