'There's still a sense of frustration'

Even after a year and a half, when it comes to physicians writing prescriptions and compiling chart notes for power mobility devices, there's still room for improvement, numerous providers report. "We're still facing documentation issues--definitely," said Dan Lipka, an ATS with Miller's Rental & Sales in Akron, Ohio. "Even though we've done a lot of education, there are physicians that, if they're not one of our regular referral sources, they don't know. They still don't know." CMS replaced certificates of medical necessity (CMNs) with physician prescriptions and supporting documentation Oct. 25, 2005 (See HME News December 2005). At that time, the agency also began requiring physicians to conduct face-to-face evaluations. Like Miller's, numerous providers launched massive campaigns to educate physicians on the change. A three-person team at Metrocare Home Medical in Germantown, Wis., has conducted more than 50 in-services with area physicians, said owner Jim Poteet. "Educating physicians has been an added cost--we have three individuals doing the road shows," he said. "But it has made the transition OK." Still, getting appropriate documentation, even from regular referral sources, can take two or three follow-ups, said Tim Barrett, operations manager for Rehab Designs in Louisville, Ky. "It's just persistence," he said. "It hasn't gotten any better (over time). We understand physicians are busy, but we still need them to do a better job." Providers often don't find what they need, especially in chart notes, because physicians are pre-occupied with blood chemistry levels, organ functions and skin integrity. "The information we need just isn't there," Lipka said. "We're fortunate, in many situations, because we work with a few therapists who can conduct the face-to-face evaluations and put notes in the chart. But even then, most insurers want a pattern of evidence, and one therapist's notes doesn't guarantee that." From his perch at The MED Group, Don Clayback said providers, while seeing some improvement, continue to struggle. "They're doing a good job of continually getting the message out there, but there's still a sense of frustration that it takes such a great deal of effort to get things done," said Clayback, who heads up MED's rehab network.