DMERC: Don't expect less PWC documentation

Sunday, June 30, 2002

YARMOUTH, Maine - A month after the rehab industry hailed a program memo from CMS that says the DMERCs can't require providers to submit additional documentation for all POV and power wheelchair claims, a medical director is saying "it will not make a major difference in the way we do things."

"Immediately, it won't have any noticeable affects on our review of claims," said Region B Medical Director Adrian Oleck, M.D. "It could have some affect on POVs but not on power wheelchairs."

The rehab industry had hoped the May 1 memo would result in providers receiving fewer denials. The industry had also hoped the memo would result in providers saving money, as the DMERCs wouldn't make as many requests for additional documentation, which, in the form of an evaluation from a physical therapist, can be costly.

Oleck said Region B did reverse a March 1998 decision requiring additional documentation for all POV claims last month. But the DMERC will continue to make the requirement for certain POV claims, he said.

"There was some interpretation that the memo meant we no longer had the ability to ask for information beyond the CMN for any of those claims," Oleck said. "That's not the case. The principle is that we can't ask for additional documentation in every case."

The Region B DMERC has released a statement saying it will stop requiring additional documentation for all POV claims for patients with significant neuromuscular disorders (i.e. mulitple sclerosis, muscular dystrophy, stroke). HME