The Region C DME Medicare Administrative Contractor (Palmetto GBA) has released the much-anticipated documentation guidance for power mobility devices. Seth Johnson, chair of AAHomecare’s Rehab and Assistive Technology Council, noted that the document includes some new requirements, which will go into effect in August. The other DME MACs are expected to publish the same guidance shortly.
While the document is primarily a compilation of previously released documentation information included in the current local coverage determination and other DMERC publications from last year on the interim final rule, there are some new requirements. Key points the new guidance makes include:
- Reiterates the 45-day timeframe for providers to receive the documentation upon completion of the physician face-to-face exam.
- Providers must date-stamp all documentation upon receipt from physician.
- Providers are required to prepare a written document that lists the specific base (HCPCS code and manufacturer name/model) and all options and accessories that will be separately billed.
- For claims with dates of service on or after Aug. 24, 2006, providers must list their charge and the Medicare fee schedule allowance for each separately billed item. The physician must sign and date this detailed product description and the provider must receive it before delivery of power mobility device.
- For claims with a date of service on or after Aug. 24, 2006, the PMD delivery must occur within 120 days of the face-to-face examination.
- Physicians must document the evaluation in a detailed narrative note in their charts in the format used for other entries. It states that even if the physician completes a provider-generated form and puts it in his/her chart, this is not a substitute for the comprehensive medical record.
- Physicians may refer the patient to a licensed/certified medical professional (LCMP) who has experience and training in mobility evaluations to perform part of the face-to-face examination. This individual may not be an employee of the HME provider or have any financial relationship with the provider. (Exception: If the provider is owned by a hospital, an LCMP working in the in-patient or out-patient hospital setting may perform part of the face-to-face examination.)
- If the report of an LCMP evaluation is to be considered as part of the face-to-face examination, there must be a signed and dated attestation by the provider that the LCMP has no financial relationship with the provider. This requirement will be enforced on claims that are received by the DME contractor on or after Aug. 10, 2006. (Note: Evaluations performed by an LCMP who has a financial relationship with the provider may be submitted to provide additional clinical information, but will not be considered as part of the face-to-face examination by the physician.)
- NOTE: Even if an LCMP performs a major part of the mobility evaluation, there still must be a face-to-face examination by the physician.
- In the event the DME Program Safeguard Contractor (PSC) asks for documentation on individual claims, additional documents (e.g., notes from prior visits, test reports, etc.) shall also be obtained from the treating physician to provide a historical perspective that reflects the patient’s condition, corroborating the information in the face-to-face examination, and painting a picture of the patient?s condition and progression of disease over time.
Source: American Association of Homecare
