Physicians often unaware of rules

Saturday, March 31, 2007

ATLANTA - When rehab providers complain that physicians still aren't providing them with the right documentation for power wheelchair claims, they're not kidding, says Laura Cohen, co-coordinator of The Clinician Task Force.
Last year, the task force recruited about 50 physicians to complete a four-page survey about the required seven-step process for filling out prescriptions and the nine-step algorithm for determining medical necessity. The survey's recently compiled results confirm that confusion still reigns.
"It was shocking," Cohen said.
Only 15% of the physicians who took the survey said that they were familiar with the national coverage determination that outlined the documentation requirements. Only 11% said they had used the algorithm for determining medical necessity.
Additionally, physicians reported that putting together the appropriate paperwork for a power wheelchair claim--prescription and supporting documentation--doesn't take 2 minutes, as CMS alleges, but, on average, more than 1 hour.
Cohen noted that most of the physicians who took the survey were physiatrists, physicians who specialize in physical medicine and rehabilitation, making the results even more astounding.
"These are not your general practitioners," Cohen said. "These are the gate keepers to getting these folks equipment."
The task force plans to publish the results in a journal and share them with CMS.
Other findings from the survey:
* Physicians rely on therapists and providers to notify them of policy changes--not CMS.
* 66% of physicians said they weren't aware that they could collect $21 and change for conducting face-to-face exams;
* 60% of physicians said they weren't familiar with MRADLs (mobility-related activities of daily living), a criteria used to determine medical necessity; and
* 62% of physicians said they thought they still had to complete CMNs for power wheelchair claims.