DMERC doc clarifies PWC documentation

Sunday, July 17, 2005

2WASHINGTON --Providers who expect the DMERCs to specify exactly what type of documentation is necessary to prove medical necessity for a power wheelchair, should prepare to be "disappointed," said Region A Medical Director Dr. Paul Hughes.

In fact, Hughes added, while the DMERCs can -- and will later this year -- give guidance on what kind for information may be necessary to prove medical necessity for a PWC, the paperwork reduction act prevents them from asking for specific documents.

"I think suppliers would be better served by not using the word documentation," Hughes told HME News recently. "Documentation translates in their mind into what 'document' do I need to get. They would be better served thinking about it this way: 'What information do I need to have available to demonstrate that the (coverage) criteria are met?'"

That information could come from the doctor's notes, a PT evaluation, hospital notes, etc.. The "misconception" that a lot of people have, including some medical reviewers, Hughes said, is that "when we ask for medical records we are only asking for the physician's office records."

Providers and industry leaders have long complained that DMERC medical reviewers rely too heavily on the prescribing physician's progress notes, often to the exclusion of PT notes and other supporting documentation.

If, as Hughes said, the DMERCs will gladly accept other information to prove medical necessity, that suits the industry fine, said Cara Bachenheimer, Invacare's vice president of government relations.

"We're not looking for a formal document," Bachenhemier said. "But what types of information are going to be necessary. If there is valid clinical documentation and it doesn't contradict something in the progress notes, there is no reason to disregard it or downgrade it."