Clinician Task Force seeks relief

Tuesday, September 30, 2008

ATLANTA--The Clinician Task Force recently asked CMS to issue guidance to home health agencies (HHAs) about specialty wheelchair evaluations. Confusion over whether HHAs are responsible for evaluations has resulted in payment issues for therapists and significant delays for providers and patients, says Co-coordinator Laura Cohen.

“We want a FAQ-type document that we can use with home health agencies,” she said.

Often, HHAs are unaware that they’re responsible for specialty wheelchair evaluations. Even if they are aware, HHAs don’t feel that, under consolidated billing, CMS pays them enough to do the evaluations, or they feel their in-house therapists are ill equipped to conduct them, Cohen said.

The Clinician Task Force would like CMS to make it clearer that HHAs are responsible for evaluations and if they don’t have experienced therapists on staff, they’re responsible for establishing contracts with outpatient clinics or independent therapists who do.

Additionally, the task force would like CMS to make it clear that HHAs can’t discharge patients who need specialty wheelchair evaluations, just to avoid their therapy obligations, and then readmit them.

The Clinician Task Force sent suggested questions and answers, as well as case studies, to Laurence Wilson, director of CMS’s Chronic Care Policy Group. During a meeting last year, Wilson suggested the task force send him “hard data,” Cohen said.

“This is our follow-up to that,” she said.

The Clinician Task Force’s payment woes don’t begin and end with Medicare. The task force is also working to better educate Medicaid programs on CPT (current procedural terminology) codes.

Increasingly, Medicaid is denying the code for wheelchair management and training, which covers assessment and documentation.

“That means I get paid for 30 minutes for something that takes me three hours,” Cohen said.