CMS: PWC guidance for providers on its way

Sunday, February 19, 2006

WASHINGTON - A fact sheet released last week by CMS contained guidance for physicians prescribing power mobility devices, but it left providers still in the dark.

The industry has anticipated guidance from CMS since late December, when it succeeded in stalling a new power mobility rule on the grounds that the agency needed to improve physician education efforts and clarify documentation requirements. The rule, which went into effect Oct. 25, 2005, requires face-to-face exams and replaces CMNs with prescriptions and medical records.

In the fact sheet, CMS notified physicians that the $21.60 payments for submitting medical records would be held until April 1, 2006, when the agency expects to re-issue the rule.

The fact sheet did contain, however, a hint that clarification for providers could be on its way, said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility.

In the last paragraph, CMS indicated that it would instruct the DMERCs to provide guidance to providers on the documentation needed to establish medical necessity.

"Now that they've issued this fact sheet clearing up physician issues, we hope they can get on to the issues that the industry has with this rule, so there's equivalent understanding in the physician and supplier communities as to what the documentation requirements are," Johnson said.

CMS also indicated that it would instruct the DMERCS to "promote consistent claims processing during this time period."

Physicians aren't expected to withhold documentation, even though their payments will be delayed, industry sources said.

"If the reimbursement amount were significantly more, then I would think that would be an issue," said Cara Bachenheimer, vice president of government relations for Invacare.

The industry succeeded in stalling the rule late last year by attaching an amendment to a bill that set spending for Medicare. The amendment precluded CMS from using funds made available by the bill to implement the rule.