PWC rule: Providers, CMS read reaction differently

Wednesday, May 31, 2006

YARMOUTH, Maine - CMS rubbed the rehab industry the wrong way when it included a sentence in its final rule for power mobility devices that implies providers had no problems with the agency's documentation changes.
The sentence, in section 17023, reads: "The industry response has been very positive."
In their comments to CMS, industry sources concede that they called a few of the final rule's requirements positive, namely the requirement that beneficiaries visit a physician for a face-to-face exam before receiving a power wheelchair or scooter.
But those same sources say their comments also reflected grave concerns over the lack of clarity in the rule's physician documentation requirements.
"CMS is lying," said one industry source. "They're trying to make it look like everything is rosy, when it's not."
Another source added: "It's disingenuous."
The final rule, which goes into effect June 5, 2006, replaces CMNs with prescriptions and medical records. While CMS has provided a seven-step process for filling out prescriptions and a nine-step algorithm for determining medical necessity, the industry argues both physicians and providers need further guidance on what should be included in medical records.
The only difference between the interim final rule, which went into effect Oct. 25, 2005, and the final rule, however, was a 15-day extension on the amount of time physicians have to supply providers with documentation, from 30 to 45 days.
To put it mildly, the industry was frustrated, and CMS's depiction of the response added salt to the wound.
"I think CMS could have more accurately reflected the situation," said Eric Sokol, spokesman for the Power Mobility Coalition. "The majority of our members came to me with concerns about documentation and that was certainly reflected in our comments."
Don Clayback, who heads up The Med Group's rehab network, took it up a notch, saying CMS's depiction of the industry's response has added to the "discomfort" felt by providers.
"CMS pushes this idea of a partnership, and we support that, but this doesn't give that partnership feeling," he said. "If we were really in this together, they wouldn't have distorted our position."
In all, CMS received 65 comments on its rule, including this recommendation from the American College of Physicians: "Work with the affected medical specialty organizations to develop a documentation template that would enable the physician to cogently capture the information that CMS determines necessary to justify the prescription."