For some, concerns over face-to-face proposal fizzle

Tuesday, August 31, 2004

WASHINGTON - A long-anticipated Medicare regulation requiring doctors to perform a face-to-face evaluation of a patient before prescribing a power wheelchair surprised many in the industry when the proposed rule failed to address power mobility specifically.

The Medicare Prescription Drug Act, which became law last December, mandated face-to-face evaluations as a means to combat fraud and reduce over utilization in the power mobility market. Wording in July’s Notice of Proposed Rulemaking, however, applied the regulation to all DME.

“We were not expecting [CMS] to apply it to all items of DME,” said Cara Bachenheimer, Invacare vice president of government relations. “It is pretty expansive.”

The implications of the regulation were still at issue, but some rehab providers said concern over its impact had fizzled.

“I have no problem with the concept that a doctor should only prescribe equipment for patients that he or she has seen and is familiar with their medical history,” said Phil Dilernia, president of Flemington, N.J.-based Cornell Healthcare. “It’s just that the devil is always in the details.”

The law originally had sparked a firestorm of concern about its practicality and the fact that the details of the requirement were not immediately spelled out. Questions included: What documentation is required to prove that exam has taken place; what is the allowable timeframe between the face to face and the equipment order; and what is required of a patient who can’t make it to their doctor’s office.

The proposed rule addressed some of the questions, including mandating a 30-day time limit between the face-to-face examination and when the equipment is ordered. It also requires proof that the exam took place, but CMS has yet to deem what is appropriate verification.

The 30-day requirement has garnered considerable rebuttals from rehab providers, who site scheduling and case complexity as some of the reasons why the 30-day time frame is inadequate.