Industry wrangles over forms

Wednesday, December 31, 2008

BALTIMORE--Industry stakeholders worry that providers may still be using standardized forms to collect power wheelchair documentation, despite a strong warning from CMS contractors.

In late 2008, the DME MACs cautioned providers and physicians that forms, though they’re not against the rules, aren’t sufficient documentation by themselves. It doesn’t matter if they’re created by providers, manufacturers or, in their latest reincarnation, physicians.

“I would hate to think providers are still using these forms now that they have clearly documented that, in an audit, if that’s all there is, they will ask for their money back,” said Rita Hostak, vice president of government relations for Sunrise Medical.

In 2005, CMS began requiring physician prescriptions and supporting documentation instead of CMNs for power wheelchairs. Since then, some providers have used simplified forms to help them and their physicians comply with the new requirements.

While the forms are most often associated with larger providers, some smaller providers and those in rural areas use them, too, because they and the physicians they work with are less familiar with the requirements, industry stakeholders pointed out.

“They’re thinking, ‘I have these physicians who do maybe five wheelchairs a year, and they don’t know how to document them,’” Hostak said. “So they use a form and it makes the lives of the physicians easier and, therefore, their lives easier.”

But the forms, in addition to putting providers at risk during audits, have created an un-level playing field between those who use them and those who don’t, industry stakeholders say.

“I’ve heard of many cases where the provider asks the physician for detailed documentation and the physician tells the provider that XYZ Medical down the street only requires a form with yes-and-no questions,” said Elizabeth Cole, director of clinical rehab services for U.S. Rehab. “Sometimes the physician refuses to do business with the provider who’s requesting the right paperwork.”

To resolve the issue, providers must spread the word about CMS’s “warning shot,” industry stakeholders say.

“We have to tell physicians and referral sources why the use of forms is insufficient,” said Cindi Petito, owner of Seating Solutions in Jacksonville, Fla. “We have to tell them that even if they use forms they still have to provide chart notes. Basically, it’s double the work.”