Medicare finalizes PWC rule

Sunday, April 30, 2006

By Liz Beaulieu, Managing Editor
WASHINGTON - CMS published its final rule for power mobility devices in the Federal Register April 5, and the elements of its interim final rule (IFR) remained largely intact--with one exception.
CMS extended the amount of time physicians have to supply providers with documentation after the required face-to-face exam from 30 to 45 days. Although industry groups lobbied for 60 days or more, "we'll take it," said Tim Pedersen, a member of AAHomecare's rehab council, and owner of WestMed Rehab in South Dakota.
Many providers, especially those providing high-end rehab, have grown accustomed to chasing down documentation within 30 days, anyway. Still, they welcome the extra two weeks.
"Whenever you can get more time, it's a good thing," said Nancy Lansing, vice president of compliance and marketing for Assistive Technology Group (ATG), which operates seven rehab companies. "Physicians are busy. Sometimes it takes several phone calls to get the information we need."
The final rule doesn't go into effect until June 5, 2006. That means providers must abide by the IFR, including the 30-day requirement, for several more weeks, according to Seth Johnson, chairman of RATC, AAHomecare's rehab council, and vice president of government affairs for Pride Mobility.
Because the final rule, like the IFR, replaces CMNs with prescriptions and physician notes, the industry's real work may still lie ahead. It has been lobbying CMS and the medical carriers to issue further guidance on physician documentation requirements through a DMERC Bulletin or some other document.
"Clarification is still our overriding goal," said Cara Bachenheimer, vice president of government relations for Invacare. "What kind of documentation do physicians need to provide?"
The final rule did mention SOAP, which refers to the four major parts of a physician's medical record documentation: subjective, objective, assessment and plan. But SOAP refers only to a process, industry sources said.
"We're not asking to be spoon-fed information," Pedersen said. "We're just asking for a little more guidance on the algorithmic approach--what conditions qualify for what equipment, and how that should be documented."
Without further guidance, the final rule may put providers in the unfair position of determining medical necessity, according to a statement from the Power Mobility Coalition (PMC).
"Despite its intent, this rule will ultimately place suppliers, not physicians, in the role of determining what documentation supports the claim and if the physician's prescription is valid," stated Stephen Azia, legal counsel for the PMC. "This would be like allowing your pharmacist to determine whether you really need prescribed medication."


CMS's response to comments that it should clarify physician documentation requirements:
"There is no set volume of documentation (for example, number of pages or number of sections from a record) that, taken alone without regard to substantive content, will guarantee that the beneficiary's clinical condition meets the conditions for payment. Similarly, there is no type of document that, taken alone without regard to substantive content, will guarantee that the beneficiary's clinical condition meets the conditions for payment. It would be misleading to suggest otherwise."
CMS's take on the industry's response to the changes:
"The industry's response has been very positive. As a result of the educational outreach to physicians and treating practitioners, suppliers have noted a significant improvement in the timeliness, completeness and substantive content of medical record documentation submitted in support of PMD prescriptions."