I don't have the current CMS reference but currently CMS is not requiring a therapist evaluation. They are requiring that a patient be seen for a face-to-face evaluation with their physician within 60 days of the wheelchair prescription. Many physicians are able to identify and document the mobility limitation of their patient but are not able to sufficiently document the patient’s functional ability to perform MRADLs within their home. Whereas a therapist is more able to thoroughly address the patient’s mobility limitations and identify which piece of Mobility Assistive Equipment will meet the patient’s needs. Keeping in mind that the least costly alternatives must be tried or at least considered and ruled out if a PMD is going to be considered for payment. Medicare has made it clear that for these situations the ordering physician may refer the patient to the PT/OT to perform a wheelchair assessment. However, the therapist performing this wheelchair assessment cannot have a financial relationship with the supplier of the equipment. This physician ordered wheelchair assessment is reimbursable through Medicare Part B. The physician may then sign the therapist's evaluation to show their agreement with the findings.
So at this point, the therapist is not technically required to do the evaluation, but is often called upon to do the evaluation that the physician then signs off on. The word is that the future of Medicare will be a therapist evaluation as a requirement for a power wheelchair. Even more interesting is that the current plan is that the therapist will have to be an ATP (Assistive Technology Practitioner through RESNA) by 2008 (I think April). Does that make sense? Mary Alice On Feb 5, 2007, at 6:32 PM, Ron Carson wrote: > I am no longer 100% up to date on Medicare regs, but I'm pretty > certain that a therapist eval is NOT required. I believe it is true > that there must not be any monetary exchange between the therapist and > the DME. Will someone cite a CMS reference concerning the therapist > requirement for an eval? > > Thanks, > > Ron > > ----- Original Message ----- > From: Chris Smith <[EMAIL PROTECTED]> > Sent: Monday, February 05, 2007 > To: [email protected] <[email protected]> > Subj: [OTlist] ethical wheelchair question > > CS> Absolutely not! The DME's have to have a therapist do the > CS> eval and write the med necessity letter. If you don't cooperate > CS> they won't be able to make their sale. If you are in a snf you > CS> need to explain to the administrator why is this unethical and the > CS> snf needs to protect their residents against these scum bag > CS> vendors by not allowing them into the facility. However if the pts > CS> are in independent living or their own homes then you can't do as > CS> much to prevent this. This is why medicare now requires a > CS> therapist not employed by the vendor to do the eval. I would talk > CS> to the reputable vendors about the problem they want it stopped, > CS> too. Often they will work to educate health care managers. Good > CS> luck. Chris > > CS> _______________________________________________ > CS> Join Excite! - http://www.excite.com > CS> The most personalized portal on the Web! > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > ********************************************************************** > **************** > Enroll in Boston University's post-professional Master of Science > for OTs Online. Gain the skills and credentials to propel your career. > www.otdegree.com/otn > ********************************************************************** > **************** -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected] ************************************************************************************** Enroll in Boston University's post-professional Master of Science for OTs Online. Gain the skills and credentials to propel your career. www.otdegree.com/otn **************************************************************************************
