Proposed PWC reg holds docs accountable

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Sunday, October 2, 2005

COLUMBIA, S.C. -- The HME industry may finally get something it's been demanding from CMS for years: increased accountability from doctors who order power wheelchairs.

CMS's proposal to pay doctors $21.60 for furnishing providers with medical records increases their stake in the process, Region A Medical Director Dr. Paul Hughes told HME News last week.

Hughes says he agrees with providers who say it's not fair that a doctor can write "crummy" progress notes and get away with it, while providers, who rely on those progress notes to prove medical necessity, get hit with gigantic overpayments.

Until now, however, Hughes has never had a way to hold the doctor responsible. Come Oct. 25, when the proposed rule goes into effect, he will. By matching up a provider overpayment with the doctor who provided the documentation, given it's inadequate, the DMERCs can report the doctor to his carrier. The carrier can then demand that he repay the $21.60 and possibly much more, if he's made the mistake multiple times, Hughes said.

"It's not a huge sum compared to what the provider has (to repay), but it will make an impact because the doctor hates to give back money," Hughes said. "This is just talk right now, but the potential exists for us now to, in our audits of providers, go back to the physicians and have some impact on modifying their behavior in a way that helps the provider."

A few overpayments assessed to doctors who keep inadequate records would go a long way toward changing physician behavior because "word gets out on the street real fast," Hughes said.

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