'Let's not keep things a mystery'

Tuesday, February 28, 2006

YARMOUTH, Maine - With CMS's power mobility rule on hold, the rehab industry has crossed its fingers that, the second time around, the agency will do a better job spelling out what it expects from physicians and suppliers.
"Let's not keep things such a mystery," said Don Clayback, who heads up The Med Group's rehab network. "We want to make sure there are safeguards, so only appropriate equipment is given to appropriate people. But the requirements can't be so nebulous that providers are hesitant to provide equipment and physicians are shaking their heads saying, 'This is so confusing.'"
The rule replaced CMNs with prescriptions and physicians notes, beginning Oct. 25, 2005. A legislative effort led by Invacare and Pride Mobility, however, succeeded in halting the rule in late December, on the grounds that CMS needed to improve physician education efforts and clarify documentation requirements.
The industry expects CMS to issue a new rule no sooner than April 1, 2006.
In an ideal world, the agency would introduce a form, including a set of questions, that would help physicians incorporate appropriate information in their notes, industry sources say.
While providers are comfortable with the prescription requirement, they say they're wary of having to use notes--notes that may or may not include the information CMS is looking for--to back up determinations of medical necessity.
"For me, the biggest issue is who bears the responsibility for the documentation," said Rick Perrotta, president of Network Medical Supply in Charlotte, N.C. "The way things stand with the current rule, we get all the documentation from the doctor, and if the notes are inadequate, we get audited. It's not fair."
Jim Travis, president of Buffalo Wheelchair in West Seneca, N.Y., agreed. If he had his way, CMS would introduce prior authorization for K0011 chairs.
"I think that's the simple solution," Travis said. "With prior authorization, we would know within 30 days (if a wheelchair is approved or not). It would put the liability on them, when right now, they're telling us: 'Go ahead and order it, and we'll tell you in two years whether or not you owe us any money.'"