CMS applies ‘logic’ to documentation requirements for repairs

'It's a home run; it's not a grand slam'
Friday, August 29, 2014

WASHINGTON – In the face of mounting pressure from industry stakeholders and advocacy groups, CMS has changed its tune about documentation requirements for wheelchair repairs.

In an Aug. 1 notice, the agency states that the initial purchase of equipment by Medicare is enough to establish medical necessity, so when reviewing claims for repairs, contractors only have to review for continued medical necessity of the item and necessity of the repair.

“It encouraged me that it’s the first thing I’ve seen in a long time that looked like they might be trying to apply logic here,” said Weesie Walker, executive director of NRRTS.

Stakeholders interpret the change to mean that providers will be able to repair wheelchairs without having to find the original documentation from the original provider, which is often, like in the case of The Scooter Store, no longer in business.

While stakeholders say the change is a “good first step” on paper, they’re anxious about how it will be implemented in practice.

“The only concern I have is when they make those changes, like not having to have the documentation for the original purchase of the chair, is it going to come back to haunt the provider during an audit?” Walker said. “I guess time will tell.”

By way of additional guidance, CSM states in the notice: “Even though a face-to-face encounter is required for the initial provision of certain wheelchairs, it is not needed for the repair of a wheelchair already covered and paid for by Medicare. However, documentation from the physician or treating practitioner that indicates the wheelchair being repaired continues to be medical necessary is required.”

“It’s an acknowledgement by CMS that there’s a more efficient way to do this and that they need to listen to the beneficiaries,” said Peter Rankin, government affairs manager at AAHomecare. “If you got the chair in the first place and it breaks, then you should probably get the chair fixed.”

Regardless of the change, until stakeholders receive additional clarification on the impact on audits and other issues, The VGM Group’s U.S. Rehab is advising its members to still obtain medical records when repairing items they didn’t initially provide, says Dan Fedor, compliance director.

“Proceed with caution is a good way to say it,” he said.

What the change doesn’t help with at all is reimbursement.

“Although this is a big step forward in terms of helping beneficiaries get service, the other half is the competitive bid single payment amount rates that providers have to accept for these repairs,” said Martin Szmal, founder of The Mobility Consultants. “It’s a home run; it’s not a grand slam."