Power Mobility Final Rule Published
The final rule on conditions of coverage for payment of Power Mobility Devices (PMD) was published April 5 in the Federal Register and will go into effect June 5, 2006.
The biggest change in the PMD Final Rule is the timeframe requirement between the date of the face-to-face examination and receipt of the prescription and supporting documentation by the provider. The change extends the 30-day timeframe to 45 days in the Final Rule. Specifically, the CMS Fact Sheet on the Final Rule states:
"Beginning April 1, 2006, for claims submitted to the DMERCs, providers should follow the requirements outlined in the IFR until implementation of the PMD Final Rule on June 5, 2006. The CMS Fact Sheet issued on March 31 outlines changes made to the Final Rule as well as the implementation schedule for the Final Rule."
Written Prescription: The physician or treating practitioner must submit a written prescription for the PMD to the supplier. This prescription must be received by the supplier within 45 days after the face-to-face examination, or in the case of a recently hospitalized beneficiary, within 45 days after the date of discharge from the hospital.
Supporting Documentation: CMS eliminated the Certificate of Medical Necessity stating that the CMN "does not serve to help physicians better document their patients' critical needs for a PMD, it did not serve to ensure that beneficiaries always received appropriate equipment, and it did not serve as an effective deterrent to fraud and abuse."
The physician or treating practitioner who performs the face-to-face examination must submit to the DME supplier the written prescription accompanied by supporting documentation of the beneficiary?s need for the PMD in the home. This supporting documentation will include pertinent parts of the medical record that clearly support the medical necessity for the PMD in the beneficiary?s home, which may include the history, physical examination, diagnostic tests, summary of findings, diagnoses, and treatment plans. It may also include information from other examinations, as well as relevant reports from other consultants and practitioners. This supporting documentation must be received by the supplier within 45 days after the face-to-face examination, or in the case of a recently hospitalized beneficiary, within 45 days after the date of discharge from the hospital.
Mike Pfister, president of the SCOOTER Store responded to the final rule by stating, "Power mobility devices serve as a health care solution for thousands of people across the United States trying to conduct their activities of daily living. Without clear and consistent documentation guidelines, people who have a true medical need will experience a substantial delay as suppliers work with physicians, struggling to determine if enough medical information has been provided to successfully fill a prescription."
Between now and June 5, 2006, providers should continue to follow the requirements outlined in the interim final rule.
Read the entirety of the final rule by visiting the front page of AAHomecare's Web site at www.aahomecare.org.
This article originally appeared in the April 2006 issue of HME Business.