Compliance: Empower physicians

Q. Why have PMD referrals from physicians declined?
Friday, April 24, 2015

A. Many physicians—as many as 60% nationwide—have stopped referring PMDs because of limited understanding about PMD documentation, lack of time and low reimbursement. 

A routine physical exam does not cover all the criteria CMS requires to be documented for a PMD referral. For example, a routine physical exam may not address the patient’s ability to maintain postural stability, which is necessary to address when prescribing a scooter. Many non-affirm decisions are a result of a physician not properly documenting a data point that CMS wants addressed during the patient encounter.

Completing paperwork doesn’t make money, but it does take time. CMS has attempted to reduce this burden by encouraging electronic templates to gather the necessary documentation. In addition, CMS provides reimbursement to physicians for completing the extra paperwork for prescribing PMDs. They may bill the G0372 code for providing the initial documentation and if the physician is located in a prior authorization demo state and they submit the PA request they can bill the G9156 code. The real question is “how can I get physicians to start referring PMDs again?”  

DME suppliers and referral sources are fast to adapt when specific objective criteria and standards are implemented and adhered to consistently. Empowering physicians to effectively do their part from a documentation standpoint requires readily available information during the patient encounter illustrating what CMS is looking to have substantiated. A standardized online documentation tool, with Medicare coverage criteria built into the program that is quick and easy to use during an exam, fills the documentation void.

Jamie Loper, ATP, chief compliance officer,, can be reached at or 800-986-9368.