Smart Talk: How much info do we collect?

Wednesday, August 31, 2005

Q. If the DMERCs don't plan to tell providers exactly what documents are needed to prove medical necessity for a power wheelchair -- but only suggest what information may be needed -- what's to stop a provider from having to collect volumes of unnecessary documentation?
A. The DMERCs are being intentionally vague with these instructions for a reason: Every Medicare patient has a different set of circumstances and physical limitations, and while the algorithmic approach seems complicated, it is basically preaching common sense. In my opinion, we keep trying to read more into the approach than is intended by the DMERCs or CMS.
We do not want them to specify a mountain of paperwork to be collected on every patient. You will need to provide more documentation for a patient who has a mild to moderate limitation than you would for a severe limitation. If the condition is not clear-cut to warrant powered mobility to the average clinician, then you would need to worry about collecting additional documentation to make the case that the patient could not use a scooter, manual chair, walker, etc.
For your clear cut cases, not much has changed: Ensure that you have access to clinical progress notes that establish the functional limitations/capabilities and diagnosis. If a caregiver will be assisting the patient with most activities, there needs to be mention of their availability and capabilities to assist the patient. Additionally, you must perform a home assessment.
For the grey area patients I would advise that you collect PT evaluations, hospital records, home health assessments and any other independent document that proves the need for power over other modes of mobility.

Andrea Stark is is a Medicare consultant/billing specialist at MiraVista. Reach her at (803) 462-9959 or