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New regulations for power chairs.
Dana (C-4-5, 31 years post, 51, KC) |
--- Begin Message -------- Original Message ----- From: "Bob Kafka" <[EMAIL PROTECTED]> To: "Thomas, Stephanie" <[EMAIL PROTECTED]> Sent: Thursday, August 25, 2005 11:39 AM Subject: CMS Issues Updated Regulations for Power Wheelchair & POV Claims> > CMS ISSUES UPDATED REGULATIONS FOR POWER > > > WHEELCHAIR AND POWER OPERATED VEHICLE CLAIMS > > > > > > > > > CERTIFICATE OF MEDICAL NECESSITY NO LONGER > > > REQUIRED > > > > > > > > > The Centers for Medicare & Medicaid Services (CMS) > > > today took another step to streamline and ensure > > > appropriate access for people with Medicare to power > > > operated vehicles b?" commonly called b?oscootersb?? > > > b?' and power wheelchairs. In an interim final rule > > > with opportunity to comment that went on display > > > today at the Federal Register, CMS clarified the > > > requirements for prescribing, supplying, and > > > receiving payment for these vehicles. The interim > > > final rule builds on current clinical standards of > > > care. > > > > > > b?oThis interim final rule is a critical step in > > > ensuring that people with Medicare have access to > > > appropriate technology to assist them with > > > mobility,b?? said CMS Administrator Mark B. > > > McClellan, M.D., Ph.D. b?oAlong with Medicareb?Ts > > > decision earlier this year to replace the old b?~bed > > > or chair confinedb?T standard with new functional > > > criteria for eligibility, this interim final rule is > > > part of a comprehensive strategy to help Medicare > > > beneficiaries get the mobility assistance equipment > > > they need while avoiding unnecessary administrative > > > burdens and inappropriate Medicare spending. An > > > appropriate professional evaluation and its > > > documentation in the patientb?Ts record are the key > > > to the effective use of mobility devices and the > > > quality and continuity of care for our > > > beneficiaries.b?? > > > > > > CMS is eliminating the requirement that a > > > Certificate of Medical Necessity (CMN) signed by the > > > prescribing physician or other treating practitioner > > > accompany claims for power wheelchairs and scooters. > > > In place of the CMN, the interim final rule > > > describes the clinical documentation from a > > > patientb?Ts medical record that must be submitted > > > along with a written prescription to the supplier > > > before the supplier delivers a power wheelchair or > > > scooter to the beneficiary. > > > > > > b?oDocumentation in the medical record of the > > > beneficiaryb?Ts need for assistance with mobility in > > > the home, as well as the type of technology needed, > > > not only is the best evidence of medical necessity > > > b?" it also helps to promote continuity of care for > > > our beneficiaries,b?? said CMS Acting Chief Medical > > > Officer, Barry Straube, M.D. b?oAnd we are > > > recognizing this in our payments to providers.b?? > > > > > > Medicare already pays under the Physician Fee > > > Schedule for the office visit required to evaluate > > > the beneficiary. Because of the changes in the > > > documentation suppliers will need before delivering > > > a power wheelchair or scooter, CMS is authorizing an > > > additional payment to physicians and treating > > > practitioners for preparing and providing the > > > required documentation to the equipment supplier. > > > To receive this payment, the physician or treating > > > practitioner will include a special billing code on > > > the claim for the office visit. > > > > > > CMS is today notifying physicians and other > > > treating professionals, as well as PMD suppliers, of > > > this interim final rule through its Medicare > > > listserves. In addition, between the issuance of > > > this interim final rule and its effective date in 60 > > > days, CMS will target educational efforts to > > > physicians and other practitioners who prescribe > > > power wheelchairs and power scooters as well as to > > > suppliers of PMD, to help them understand the new > > > criteria and new documentation requirements. CMS > > > will also provide billing instructions for suppliers > > > before the implementation date. > > > > > > To help suppliers evaluate and document the > > > patientb?Ts need for a particular type of > > > technology, the contractors who process durable > > > medical equipment claims will issue specific > > > guidance about what information from the > > > beneficiary's medical record is needed to > > > demonstrate the medical necessity of the equipment. > > > This guidance will underscore that an appropriate > > > coverage determination for these products will take > > > into account the patientb?Ts medical history, > > > elements of a physical assessment such as strength > > > and range of motion, a functional needs assessment > > > as documented in the medical record, as well as the > > > availability of other types of devices. > > > > > > In early September, CMS will hold a special Open > > > Door Forum to address power wheelchair and power > > > scooter issues. Open Door Forums offer physicians, > > > suppliers and other stakeholders the opportunity to > > > participate in person or by conference call in a > > > discussion with senior staff about Medicare > > > policies. > > > > > > The interim final rule issued today is the latest > > > action CMS is taking to implement a Power Wheelchair > > > Initiative first announced in April 2004. That > > > multi-pronged initiative is focused on improving > > > coverage, payment policies, and quality of suppliers > > > of power wheelchairs and power scooters. In > > > addition to developing new, functional criteria for > > > coverage, CMS is adopting new billing codes for > > > power wheelchairs and power scooters that will allow > > > Medicare to differentiate among types of equipment > > > with different features and pay more accurately > > > depending on the characteristics of the particular > > > chair. > > > > > > The interim final rule also implements provisions > > > in the Medicare Modernization Act of 2003 (MMA) > > > affecting power wheelchairs and power scooters, > > > including a provision requiring a physician or > > > treating practitioner (who can be a physician > > > assistant, nurse practitioner, or clinical nurse > > > specialist) to conduct a face-to-face examination of > > > the beneficiary before prescribing a power > > > wheelchair or power scooter. > > > > > > The interim final rule also eliminates a > > > restriction that allows only a specialist in > > > physical medicine, orthopedic surgery, neurology or > > > rheumatology to prescribe a power scooter. This > > > restriction, which no longer reflects current > > > standards of care, has created barriers to > > > appropriate prescribing of equipment to meet a > > > patientb?Ts needs. The new rule allows both > > > physicians and treating practitioners to prescribe a > > > power wheelchair or power scooter. Finally, the > > > interim final rule requires a supplier, before > > > billing Medicare, to obtain a written prescription, > > > signed and dated by the physician or treating > > > practitioner who performed the face-to-face > > > examination, within 30 days of the examination. > > > > > > The actions CMS is taking today underscore the > > > principle that the beneficiaryb?Ts physician or > > > treating practitioner is in the best position to > > > evaluate and document the beneficiaryb?Ts clinical > > > condition and medical needs. Good medical practice > > > requires that this evaluation be adequately > > > documented. Thus, to minimize the documentation > > > requirements for providers while assuring that > > > documentation is adequate, physicians and treating > > > practitioners will now submit copies of relevant > > > existing documentation from the beneficiaryb?Ts > > > medical record, rather than having to transcribe > > > medical record information onto a separate form such > > > as a CMN. > > > > > > The interim final rule will be published in the > > > August 26 Federal Register, and will become > > > effective for services on or after October 25. > > > Comments will be accepted until November 25, and a > > > final rule will be published at a later date. > > > > > > Note: The Interim Final Rule and a Fact Sheet > > > will be posted on the CMS Website at: > > > > > > www.cms.hhs.gov/coverage/wheelchairs.asp > > > <http://www.cms.hhs.gov/coverage/wheelchairs.asp> > > > > > > > > > > > > This press release is available online at: > > > > > http://www.cms.hhs.gov/media/press/release.asp?Counter=1540 > > > > > > > > > > > > > > > > > > > > > > > > > > > > ____________________________________________________ > > Start your day with Yahoo! - make it your home page > > http://www.yahoo.com/r/hs NATIONAL ADAPT MAILING LIST - Adapt MiCASA List http://www.adapt.org
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