Making Your Referral Sources Work for You

• By Paul Komishock
• Feb 01, 2009

How to help referral partners document PMD need.

One of the most common issues that providers of power mobility equipment encounter is a referral source’s lack of understanding about the rules and requirements governing the provision of a power mobility device (PMD) through the Medicare program.

These issues can be avoided by taking a simplified look at the basic formula the current policy uses to determine coverage. First a mobility deficit must be identified, and then it must be determined what the best solution for the beneficiary is to fix that deficit. Through all the changes in coding and terminology and regulations, those two actions — identify the need and determine the solution — continue to be the basic overall objectives.

Guidelines for Helping Referral Sources

There are a few important guidelines a provider should keep in mind to help their referral sources through the process and aid them in better documenting the need for a PMD. Here are some things to remember.

A little education can go a long way. Providers have become one of the most significant sources of information for their referral sources on Medicare policy. This creates both an opportunity and a challenge for providers. At first you might need to spend a good amount of time and effort with a referral source to explain policy and the requirements that go along with it. This initial effort will be rewarded later, as it is generally less time consuming to provide informed referral sources with periodic updates.

Once the referral source is properly trained and educated, dealing with them will become much easier. Not only will you and your referral sources be speaking the same language, they will likely come to actually depend on you to keep them up to date on the latest regulatory updates.

Develop relationships with your referral sources. Open up lines of communication with clinicians. Medicare in no way wants to prohibit discussions between a DME provider and their referral sources. Quite the opposite, since healthy relationships will help achieve positive patient outcomes. What Medicare doesn’t want is for the DME provider to actually do the work that a clinician should be doing, such as attempting to make medical diagnoses. To illustrate, you can tell a physician that policy requires that a patient must be determined unable to use a manual wheelchair to qualify for a power chair. You can’t tell a physician that a client is unable to self propel due to a torn rotator cuff. That’s a clinical determination the referral source should make.

Some physicians by their own admission are not PMD experts. Certain types of physicians might be more adept at the process of documenting the need for a PMD than others. A basic requirement for any PMD is that the ordering physician must see the patient face-to-face. A portion of that face-to-face may also be performed by another clinician, such as a PT or OT. Let physicians know that they can refer their patients out to another clinician to perform part of that face-to-face. Often, therapists who have experience in dealing with patients who require PMDs are familiar with the process, including the regulations and paperwork, and physicians are pleased to utilize this expertise. Keep in mind that the prescription for the PMD shouldn’t be written until the face-to-face is complete.

Figure out how to get what you need. Almost every provider at one time or another has run into a referral source that continually drags their feet in providing needed information. While it’s always a good idea to develop relationships with your referral sources, it’s also a good idea to cultivate relationships with office managers. These are the people who keep the paperwork flow running smoothly and they may be the ones that will be able to provide you with the documentation you need from the physician. Remind the office that they can bill Medicare for the paperwork costs in addition to the office visit using code G0372. The patient’s best interests should be the goal of all involved. If a referral source is not providing you with needed information, get the patient or the patient’s family involved in the process. Sometimes a call to the physician from the patient, spouse, or child can go a lot further than a call from a provider.

Make sure your client has realistic expectations. If you have a particular client who you know will not qualify based on policy, make sure that’s understood up front. A client should never be surprised at the end of the process to discover that they are not receiving the equipment they expected. Such a situation is not conducive to the overall well being of the client or your business. Make sure that you give them options, such as offering to provide a product, but request the patient sign an Advanced Beneficiary Notice.

Stay On Top of Regulatory Changes

Of course, all of this assumes that you, as a provider, are constantly working to stay educated and well informed on the latest regulatory news and information. You must have a handle on the process yourself in order to educate referral sources effectively. Once that is accomplished, many providers have found that having a process in place, developed through partnerships with their referral sources, tends to ensure a smooth flow from start to finish. Remember the ultimate goal for everyone involved is the best solution for the patient. The more willing a referral source is to view you as a partner the easier it will be to meet that goal.

This article originally appeared in the February 2009 issue of HME Business.