PMD documentation: State, providers form workgroup

Saturday, September 30, 2006

TALLAHASSEE, Fla. - Florida rehab providers hope a new custom wheelchair workgroup will help make the documentation requirements that have dogged them for nearly two years a thing of the past. But some aren't holding their breath.
The workgroup, whose members include providers, clinicians, therapists and Medicaid officials, meet for conference calls every two or three weeks. The main topic of conversation: How to streamline requirements to decrease two things--the number of denials providers receive and the amount of time it takes for them to get paid.
"It's a positive development," said Tom McEnany, owner of Jacksonville, Fla.-based Wheelchairs Plus, who's a member of the workgroup. "We want to better define the parameters of medical necessity, so we provide the right information from the get-go and there's not so much back-and-forth. Right now, everything's misunderstood."
Providers blame several factors--some concrete, others speculation--for the problems they've experienced: The state's decision to replace local review nurses with two full-time PTs and one part-time PT working out of Tallahassee; a new 11-page evaluation form that they call "laborious"; and delays in the prior authorization process.
That last factor is the "meat and potatoes of all of this," according to Craig Kraft, the director of the seating program at Shriners Hospital for Children in Tampa, Fla. He's also a member of the workgroup.
"Getting prior authorization for special equipment for people with disabilities has become a nightmare," Kraft said. "There are delays due to semantics--not saying the correct word."
Laura Cohen, co-coordinator for The Clinician Task Force, who was asked to join the workgroup, agreed that the wires between the industry and the state are crossed.
"There's concern from therapists that the documentation they submit, in their perspective, clearly defines medical necessity, but they're receiving denials saying there's no medical necessity," she said. "There's a discrepancy in how (medical necessity) is being defined."