The path to better documentation
Q. Medicare has eliminated the CMN for power wheelchairs, and DMERC officials say that no one document -- including the doctor's progress notes--automatically justifies medical necessity. Are there documents that we can collect that will prove medical necessity 90% of the time or more?
A. The DMERCs have stated that the information required to support the medical necessity for a PMD (power wheelchair or scooter) must be found in the patient's medical record. This includes the patient's history (physician chart/progress notes, hospital records, nursing home records, etc.), physical examination (face-to-face exam and PT/OT wheelchair assessment), diagnostic tests and treatment plans.
Keep in mind that it is the content contained in the patient's medical record that is important and not the document itself. For example, if you obtain the ordering physician's chart notes and there is no information relevant to a mobility deficit, that would not be considered supporting documentation for the payment/audit of a PMD. As long as the document is considered part of the patient's medical record and it addresses the following information, you are well on your way to having what you need to support the medical necessity for a PMD:
- The mobility deficit that requires the use of a PMD;
- An explanation for why a least costly alternative (cane, walker and manual chair) cannot compensate for the mobility deficit to enable the patient to safely perform mobility related activities of daily living (MRADLs) in his/her home;
- The patient's home adequately accommodates a PMD (supplier documented home assessment); and
- The beneficiary's or caregiver's capability and willingness to operate the PMD.
The key is that you, as the equipment supplier, have available, in the event of a developed claim or an audit, the necessary information for the DMERCs to make a medical necessity determination.
Dan Fedor is general manager for education and compliance at Pride Mobility Products. Reach him at (800) 800-8586 or firstname.lastname@example.org.