As the doctor mentions this falls under the DME (durable medical equipment) provisions, which also just happens to be the big area where a lot of fraud has taken place. A specific visit is needed for this purpose, face to face.
He also addresses the work the staff needs to do and he speaks of paper forms that need to be filled out in addition to the exam notes, and there’s follow up, additional phone calls and questions. I have written about some of this before as relates to fraud, the crooks know how to bill better as they do not see patients and thus they are experts at getting all the required information together.
Hopefully some of this will change with CMS in time with making the process easier for the patients who need them and again keep fraud out of the picture too. One thing that is for sure is that there will be more needing mobility as our population and self included become part of the growing group of the aging due to the baby boom in the US. BD
WASHINGTON, July 16 /PRNewswire-USNewswire/ -- For years, homecare equipment providers have cited the many ramifications of the Medicare program's inefficient guidelines for documenting the medical necessity of power wheelchairs for beneficiaries. It is the root cause of claim denials that are frequently reversed, the target of excessive audits and it restricts access to power wheelchairs for patients. But rarely, until now, have physicians offered their perspective.
It is enlightening to hear physicians share their experiences with the documentation process for power mobility. Jerald Winakur, M.D., F.A.C.P., C.M.D., is Clinical Professor of Medicine and an associate faculty member at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio.
This is how Dr. Winakur describes the documentation process required by the federal agency that operates Medicare, the Centers for Medicare and Medicaid Services (CMS). This was published in the American Association for Homecare bulletin, "Mobility Matters:"
Take what should be a simple task: obtaining a power wheelchair for my patients when they need one to stay in their home. I cannot just order this device as I would a cane or a wheelchair or a walker, that is, by writing my request on a prescription pad and having it easily filled by a Durable Medical Equipment provider with minimal input and paperwork from me or my office.
No. My patient must come in for a CMS-mandated face-to-face 'Power Mobility Evaluation' examination. The equipment provider – prior to this special mandated exam – is in constant contact with my office gathering its own information from my patient's demographic and medical record. I am mandated to see the patient face-to-face even if he/she had just been in last week – at the time I suggested he might benefit from a power wheelchair.
I could have been – should have been – seeing another patient for a real illness. I can just picture my colleagues across the country in this same situation. How many of them would take a look at the requirements, glance at the thick stack of paper, burn with rage, and toss the forms into the trash, saying to office staff: 'Just tell Mr. So-and-So that I don't have the time for this. If he wants one of these things he's just going to have to pay for it out of his own pocket!
Here is my epiphany: CMS wants me to react in this way. They want me and my colleagues across America to get angry and refuse to fill out the paperwork. They have promised our elderly and disabled countrymen the benefit of power mobility, and industry has responded to the need.
Meanwhile, CMS looks down the road and sees a tsunami of old folks rising up out of the demographic ocean. We can't possibly pay for all these scooters and power wheelchairs, they whisper to each other in closed-door meetings. Let's just make it ridiculously hard for a doctor to get one of these things for his patient. Let's swamp 'em with paperwork! They hate paperwork!
I have now performed two or three 'Power Mobility Evaluations.' They take me most of an hour to see my patient, examine him or her, complete the redundant paperwork. I am also required to write a chart note in the patient's medical record re-hashing the same information I have put on a form, rather than just putting the form in the patient record. Then there is all the work my staff has to do behind the scenes – several communications with the provider by phone. I could have seen two ill patients – ones that really needed my ministrations – in this same time frame.
By its actions, Medicare stifles innovation, discourages physician participation in the program, and – most egregiously – restricts the autonomy of elderly and disabled citizens, the very ones it is the mission of CMS to help. And, paradoxically, CMS ends up spending more money, not less, in the long run. This is shameful behavior that deserves the transparent light of day shone brightly upon it.