The Centers for Medicare & Medicaid Services (CMS) recently published a checklist for physicians and treating practitioners to follow in order to help them comply with documentation requirements for the face-to-face examination that must occur prior to the physician ordering a Power Mobility Device (PMD) for a Medicare beneficiary. The checklist contains the information that is essential for Medicare in determining whether payment should be made for a PMD. However, it is vital to note that the checklist is merely a guide and does not replace the underlying medical records. The following is the checklist offered by CMS:
- Signs/Symptoms that limit ambulation;
- Diagnoses that are responsible for these signs/symptoms;
- Medications or other treatment for these signs/symptoms;
- Progression of ambulation difficulty over time;
- Other diagnoses that may relate to ambulatory problems;
- How far the patient can ambulate without stopping and with what assistive device (such as a cane or walker);
- Pace of ambulation;
- History of falls, including frequency, circumstances leading to falls, what ambulatory assistance (cane, walker, wheelchair) is currently used and why it is not sufficient;
- What has changed in the patient’s condition that now requires the use of a power mobility device;
- Reason for inability to use manual wheelchair (such as assessment of upper body strength);
- Why does the patient need a power wheelchair rather than each level of mobility assistive equipment (a cane, walker, optimally configured wheelchair, scooter)? What are the reasons that the patient should not or could not use a cane, walker, optimally configured wheelchair or scooter in the home to satisfy their needs?; and
- Description of the home, including the ability to perform activities of daily living in the home, as well as the ability to utilize the PMD in the home.
The medical records should include sufficient information to support PMD coverage. These records are often discovered during the audit process to lack the necessary information for payment. If you have any questions regarding compliance with PMD criteria, or other DME compliance issues, please contact a Wachler & Associates attorney at 248-544-0888 or www.Wachler.com.