CMS, industry agree on PWC documentation

Sunday, July 25, 2004

July 26, 2004

WASHINGTON - CMS agrees with industry leaders that physician progress notes should not be the sole documentation used to determine whether a beneficiary qualifies for a power wheelchair.
Medicare officials made that clear during a July 16 meeting with Restore Access to Mobility Partnership, a coalition of power wheelchair providers and manufacturers.
At the meeting with CMS, RAMP members discovered that a disconnect exists  between how CMS thinks medical review is being conducted and how the DMERCs are actually doing it.If a physician writes a customized letter of medical necessity describing a specific patient’s condition, that should be as credible as progress notes, RAMP members said during the meeting. CMS officials agreed, said Cara Bachenheimer, vice president of government relations for Invacare, a RAMP member.
By relying almost exclusively on progress notes, which industry watchers claim is the case, DMERC medical reviewers regularly deny claims that other documentation such as letters of medical necessity may support. Only by looking at physician-generated documents in addition to the progress notes, which are often sketchy and incomplete, can a medical reviewer get a true picture of medical necessity, say RAMP members.
At the July 16 meeting, CMS officials indicated a willingness to address the documentation issue during one of their weekly conference calls with the DMERCs.
“I think it is something they are going to raise,” said Seth Johnson, director of government affairs at Pride Mobility, another RAMP member. “I think there is a willingness at CMS to work through these issues.”