New rule: Providers are still in the dark

Friday, March 31, 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, 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 partially completed, unsigned CMNs.
When CMS re-issues the IFR, it will likely extend the 30-day timeframe for supplying providers with documentation, said Seth Johnson, vice president of government affairs for Pride Mobility Products.
"I'd say they're leaning 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 what physicians need to include in their medical records.