Ramp Coalition: Lack of Input Results in Flawed Regulations and Confusion for Beneficiaries

• Jul 01, 2006

RAMP, an organization representing suppliers and manufacturers of power wheelchairs and scooters, said that CMS did a good job reaching out to the industry when drafting the National Coverage Determination (NCD) over a year ago, but since then the regulations related to the new coverage policy, as well as other new rules and regulations are being finalized without serious consideration of recommendations from suppliers, manufacturers and physicians.

"We felt that there was a healthy working relationship during the NCD process," said Mal Mixon, Chairman and CEO of Invacare Corp. "But since then, it has been back to business as usual. Regulations are being drawn up in a vacuum without being shaped by the practical, real-life experiences that the stakeholders can provide. The result is that the regulations are often ambiguous and confusing, and make it more difficult for qualified Medicare beneficiaries to receive mobility equipment.'"

Calling the experience "very frustrating," Dan Meuser, president of Pride Mobility, said that many of the problems could be resolved if CMS "would just have an open ear" before they finalize regulations. "It's unfortunate because we all have the same goal: the stakeholders, and CMS want a policy and process that allows qualified beneficiaries to obtain mobility equipment," Meuser said. "But by not considering industry recommendations, it is likely to produce the exact opposite result. We will have confusing regulations and delays in equipment deliveries."

The latest example is the new documentation requirements for power mobility devices released by CMS Program Safeguard Contractors (PSCs).

Already, the industry is making changes as quickly as possible to comply with these new requirements, but the changes will take time to implement. Yet, the publication leaves unclear the effective date of these documentation requirements, and it is unclear whether the PSCs are allowing any time for suppliers and physicians to modify processes or to prepare and initiate the physician education that CMS has asked suppliers to provide.

RAMP recommends a 90-day period to implement the changes. urrently, suppliers and physicians have no way to know if their documentation is sufficient. They have been attempting to comply with the provisions of the Interim Final Rule and the Final Rule, but there are now new changes that leave key questions unanswered. Suppliers are attempting to obtain information from the physicians, but have no consistent vehicle to reasonably do this.

After reviewing the new PSC requirements, RAMP believes the following issues must be quickly addressed:

• The guidance indicates that "Physicians shall document the evaluation in a detailed narrative note in their charts in the format they use for other entries." This should only be needed to confirm that the major reason for the face-to-face examination was a mobility evaluation. The entire report of the examination should not be required to be transcribed directly into the chart records. Physician notes in patient records are usually not very detailed. The six questions and sixteen bullet points of information asked for in this document are not typically found in the patient chart notes. While we agree that questionnaires and forms do not replace the comprehensive medical record, they can effectively be used to provide valid additional and explanatory supporting details. We ask CMS to acknowledge the validity and acceptability of this supporting documentation as long as it is placed in the patients chart as part of their medical record.
• The guidance implies that for certain diagnosis codes (COPD, Heart Failure, and Arthritis), the face-to-face examination will be discounted and a different documentation standard will apply. It is unclear what this statement means: "the major emphasis will be on symptoms and history of the progression of their condition rather than on the physical examination."
• Beneficiaries with this diagnosis comprise a large percentage of those needing power mobility equipment. Yet, this conflicts directly with the Rules stating: "In most cases, the information collected at the face-to-face examination will be sufficient." These conflicting statements need to be clarified. Is CMS setting up a two-tiered system whereby patients with COPD, heart failure and arthritis have a more difficult time qualifying for mobility equipment?
• As product manufacturer/model changes are made at the time of delivery, will suppliers be able to amend the Detailed Product Description (DPD) at the time of delivery or must a supplier postpone delivery until they can get a physician to resign a DPD with a new manufacture/model listed?
• The guidance indicates that additional documents will be obtained from the physician. Will CMS obtain these documents or will suppliers be expected to collect this information? If CMS collection attempts are unsuccessful, then will claims be denied because CMS cannot obtain these documents from physicians?
• Patients who qualify for a power wheelchair may use that device outside the home, but Medicare coverage is determined solely by the patient's mobility needs within the home.

  Therefore, the examination must clearly distinguish the patient's abilities and needs within the home from any additional needs for outside the home. If the documentation states that the equipment will be used outside of the home as well as in the home will that disqualify the patient?

CMS is seeking comments on the pricing information it has gathered for use in establishing the Medicare fee schedule amounts for power wheelchairs. Submit comments to [email protected] by Aug. 25. To view the CMS' sources, visit www.cms.hhs.gov/DMEPOSFeeSched/dowloads/pwc_pricing.zip.

This article originally appeared in the July 2006 issue of HME Business.