New rule also details face-to-face exam. Suppliers will no longer have to submit certificates of medical necessity when billing for power mobility equipment, ending years of wrangling with regulators over the requirement.
The Centers for Medicare & Medicaid Services on Aug. 24 announced an interim final rule clarifying requirements for prescribing, supplying and receiving payment for power-operated vehicles such as power wheelchairs and scooters. Part of the agency's ongoing Power Wheelchair Initiative, the rule eliminates the requirement that a CMN signed by the prescribing physician or other treating practitioner accompany all POV claims.
In lieu of the CMN, the new rule requires suppliers to submit a physician's prescription. However, providers will also be responsible for maintaining patient records documenting medical necessity and turning them over if requested by Medicare contractors. The rule is set to take effect Oct. 25.
"The CMN was designed for the earlier coverage standard, which is not the one we're using now," CMS Administrator Mark McClellan said in a press conference discussing the changes. "We have now a clinical functional standard, and that functional standard is best reflected by the information in the medical record." Docs Get Extra Payment for Paperwork The interim final rule also implements a Medicare Modernization Act provision requiring physicians or other treating practitioners such as physician assistants, nurse practitioners or clinical nurse specialists to conduct a face-to-face examination before prescribing a POV.
And the rule eliminates a restriction that allowed only specialists in physical medicine, orthopedic surgery, neurology or rheumatology to prescribe a power scooter. The new rule permits both physicians and treating practitioners to prescribe POVs.
Before billing Medicare, suppliers must obtain a written prescription - signed and dated by the physician or treating practitioner who performed the face-to-face exam - within 30 days of that exam.
Medicare already pays for beneficiaries' evaluations under the physician fee schedule. But to compensate for more demanding documentation requirements, CMS is giving an additional payment to physicians and treating practitioners for providing that documentation to suppliers. The basic payment amount will be $21.66, adjusted by the usual geographic factors applied to the physician fee schedule.
The interim rule appeared in the Aug. 26 Federal Register. CMS will accept comments until Nov. 25 and will publish a final rule at a later date.
The agency also plans to issue more detailed billing instructions to suppliers before the Oct. 25 implementation date, and it will hold a special Open Door Forum Sept. 13 to address power mobility issues. CMS officials in the Aug. 25 Open Door Forum for home care providers urged suppliers to continue using CMNs until the new policy takes effect.
Note: The interim rule and a fact sheet will be at
www.cms.hhs.gov/coverage/wheelchairs.asp.
