January 26, 2010
Medical Review Power Mobility FAQs
- Q1. Are there any resources available to help us educate physicians concerning the information that should be included in a face-to-face evaluation for power mobility?
- A. The four DME MAC Medical Directors have written a letter to physicians, Power
Wheelchairs and Power Operated Vehicles — Documentation Requirements,
which explains the physician's documentation responsibilities in regards
to a beneficiary's need for power mobility. Suppliers are encouraged
to use this letter in their physician education efforts. When questioned,
remind physicians that the information regarding the beneficiary's
mobility limitations should be objective or measurable. Subjective
statements are open to individual interpretation and do not offer a
clear picture of the beneficiary's mobility status. Objective information,
on the other hand, provides a common quantifiable reference. Examples
are listed below:
Subjective Information Objective Information The patient has difficulty walking and can only walk short distances. The patient becomes short of breath after walking 15-20 feet and must stop and rest. The patient needs power mobility in order to complete MRADLs. He is too unstable to use a cane or walker and does not have the endurance to propel a manual wheelchair. The patient does not have the stability to walk from the bedroom to other rooms in the house with either a cane or walker. He has experienced two falls in the past month in his home despite use of a wheeled walker. A trial with a lightweight manual wheelchair failed. Severe osteoarthritis in shoulders and wrists has resulted in limited range of motion and propelling the wheelchair more than 15 feet results in pain rated at 7/10. The patient has weakness in the upper extremities. Strength in right upper extremity is 3/5 and 2/5 on the left. Patient cannot lift more than 5 pounds. - Q2. What measurements should be included in a home assessment for a beneficiary receiving a power mobility device?
- A. The power mobility LCD requires that the supplier or practitioner
perform an onsite evaluation of the patient's home prior to or at the
time of delivery. There is no requirement that specific measurements
be taken. However, the assessment must verify and record that the patient
can adequately maneuver the device that is provided considering the home's:
- Physical layout,
- Doorway widths,
- Doorway thresholds, and
- Floor surfaces.
If the report notes that the patient cannot access certain rooms with the wheelchair, there must be an explanation of how that will be mitigated. Failure to provide this explanation will result in claim denial. When completed, the report should be signed or initialed and dated by the person who performed the assessment and available to either the DME MAC or other Medicare contractors upon request.
- Q3. I know that suppliers are not allowed to complete any part of a 7-element order for a power mobility device. But, can a physician's employee write or type the other elements of the order as long as the physician signs and dates the order?
- A. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) is the basis for many of the current documentation rules concerning power mobility. The MMA requires that the physician or treating practitioner ordering the device create the written prescription. Therefore all elements of the order should be entered by the physician. This order can either be handwritten or electronic.
- Q4. Even though CMNs are no longer required for manual or power wheelchairs, can suppliers continue to use them in lieu of a detailed written order and to gather medical information?
- A. Suppliers shall not use any retired CMS documents including the manual and power wheelchair CMNs. It is a misrepresentation of Medicare policy, if the CMN has been retired, to request the ordering physician to complete section B and sign and date section D. In the event of a prepayment or post payment claim review, a retired CMN will not be accepted as a substitute for a detailed written order.
- Q5. Medical Review denied one of my claims because the reviewer could not read the physician's written order. Many physicians are now using prescription pads with anti-tampering watermarks that obscure information when the order is coped or faxed. How can I make sure my claims do not get denied because of illegible faxed documents?
- A. It is the supplier's responsibility to assure that all Medicare documentation requirements are met and legible copies can be made available upon request. If in doubt as to whether a document will be legible if faxed, we suggest that the supplier fax a test copy to themselves. In situations where the faxed document is too dark to read, photocopying may provide a more readable document. Suppliers have the option of sending the records via mail or delivery service. Refer to the development letter for the address and mailing instructions.
- Q6. In response to a development letter requesting additional documentation, I faxed a copy of my records to CIGNA. It has been several weeks since I sent the information and a payment decision has not shown up on a remittance notice. Should I resend the information or rebill the claim?
- A. According to CMS guidelines, Medical Review has up to 60 days from the date of receipt to review additional documentation and make a claim determination. Once a supplier has responded to an additional documentation request, they should take no further action unless they receive notice of a claim denial. In that situation, if the supplier disagrees with the decision, they should follow the appeal process.
