CMS forum address PWC billing, provider satisfaction

Sunday, November 20, 2005

BALTIMORE - CMS officials did their best at an Open Door Forum last week to clear up some confusion regarding power wheelchair billing.

On Oct. 25, CMS implemented an interim final rule that replaced the CMN for power mobility devices with a doctor's prescription; the IFR also requires the provider to obtain the patient's medical records prior to billing for the product.

According to CMS officials: If a supplier has a written, detailed order for a power mobility device that was signed and dated by the treating physician prior to Oct. 25, but the wheelchair wasn't delivered and billed for until after Oct. 25, the DMERCs will not apply the requirements of the interim final rule if that claim is subjected to manual medical review.

Instead, the prior documentation requirement will apply. That is, the device must be ordered prior to delivery; the provider must have a detailed written order on file prior to billing for the device; there must be documentation in the patients medical record indicating that the coverage criteria for the device has been met; and finally, all of the documentation must be available to the DMERC upon request.

Also at the Open Door Forum: CMS officials revealed that Medicare will randomly survey 25,000 providers in January to determine their level of satisfaction with the DMERCs and other fee-for-service contractors.

The survey will focus on seven key areas: provider communication, provider inquiries, claims processing, appeals, provider enrollment, medical review and provider audit and reimbursement.

The Center for Medicare Management will analyze the surveys in April and publish the results in July.

The surveys include 76 questions and can be completed in about 20 minutes. They will be mailed out the third week of January and must be returned by January 25. The survey's can be completed online or providers can request a paper copy that can be return via mail or fax.