CMS modifies repair policy
WASHINGTON – It appears HME providers will now be able to repair equipment, such as power wheelchairs, without having to find the original medical necessity documentation from the original provider, AAHomecare reports.
If Medicare paid for the base equipment initially, medical necessity for the equipment has been established, according to the association’s initial reading of new guidance from CMS on the matter.
“When reviewing DMEPOS claims for repairs, contractors shall only review for continued medical necessity of the item and necessity of the repair,” CMS states. “Contractors shall not expend resources to determine if the requirements for the initial provision of the DMEPOS item as/when it was originally ordered were met.”
The guidance applies to all DME equipment owned by Medicare beneficiaries as of Nov. 4, 2014.
CMS offered the following example in its guidance: “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. For this purpose, documentation is considered timely when it is on record in the preceding 12 months, unless otherwise specified in relevant Medicare policy.”
AAHomecare heralded the guidance as a “step in the right direction toward fixing the convoluted and confusing documentation requirements.”
“From patient complaints to members of Congress, it has taken many voices to help CMS understand that the current state of medical equipment repair is unacceptable,” stated President and CEO Tom Ryan in a release.
Issues with repairs, especially for power wheelchairs and especially in the wake of competitive bidding, have been well documented by AAHomecare, People for Quality Care and even the mainstream press.