Industry: PWC transmittal falls short

Sunday, March 19, 2006

WASHINGTON - CMS released a transmittal March 10 with some new guidance for power mobility device claims, but once again, the document failed to address the industry's biggest concern with the agency's new rule.

"This is helpful, but is it what we were looking for?" asked Cara Bachenheimer, vice president of government relations for Invacare. "No. We're really looking for more details on physician documentation requirements."

The industry has waited for guidance from CMS since late December, when it succeeded in stalling the interim final rule (IFR). The IFR, which went into effect Oct. 25, 2005, requires face-to-face exams and replaces CMNs with physician prescriptions and medical records. CMS must wait until April 1, 2006, to re-issue the rule.

The transmittal instructs the DMERCs on how to handle claims from Jan. 1, 2006 to April 1, 2006. While face-to-face exams and prescriptions are still needed to support claims, CMS instructed the DMERCs:
- Not to require the details of the written prescription as defined in the IFR;
- Not to auto-deny claims when the "EY" modifier has been used to indicate that prescriptions were written as defined in the IFR and were received by providers within 30 days of the face-to-face exam; and
- Not to require that providers receive prescriptions within 30 days of the face-to-face exam.

The transmittal also instructs the DMERCs to continue accepting the partially completed, unsigned CMN.

When CMS re-issues the IFR, it will likely extend the 30-day timeframe for supplying providers with documentation after the face-to-face exam, said Seth Johnson, chairman of AAHomecare's rehab council and vice president of government affairs for Pride Mobility Products.

"I'd say they're leaning more toward 60 days," he said of the industry's recommendation that CMS extend the timeframe to anywhere from 60 to 120 days.

The industry hopes CMS will follow-up with a program memo or other document to clarify the information that physicians need to include in their medical records, sources said.

In mid-February, CMS issued a document that provided instructions for physicians prescribing power mobility devices. The agency stated that the $21.60 payments for submitting medical records would be held until April 1, 2006.