DMERCS wait on NCD instructions from CMS

Sunday, May 15, 2005

BALTIMORE -- Although CMS issued its national coverage determination for wheelchairs, "effective immediately," April 28, effective immediately means one thing to suppliers and another thing to the DMERCs.

Until the DMERCs receive implementation instructions from CMS, the DMERCs are likely to keep adjudicating claims under the old policy.

Although providers bemoaned CMS's decision to retain the in-the-home criteria, they cheered the removal of the bed-or-chair confined criteria that caused so much confusion. Especially welcome has been additional coverage criteria that qualifies people for coverage based on their ability to accomplish mobility-related activities of daily living, including toileting, eating, dressing, grooming and bathing.

But that criteria won't go into effect until the CMS issues a practical set of instructions to the DMERCs in a week or two, maybe a month, maybe two months, say insiders.

In the wake of the NCD announcement last week, some providers were scratching their heads over whether the national coverage determination had been issued at all. Or was it a decision memorandum? And what's the difference?

Part of the confusion goes back to the MMA, which made changes to terminology that CMS and the DMERCS are still getting used to. In other words, what looks like an NCD to the CMS looks like a decision memo to the DMERCs.