Power Mobility Funded by Medicare
To be eligible for an electric mobility device with Medicare funding, physicians, nurse practitioners, medical assistants, or clinical nurse specialists who treat a patient for their mobility needs, must assess a patient for their electric mobility needs. and document the review in their regular file. keep the format to meet Medicare guidelines for electric mobility. […]

To be eligible for an electric mobility device with Medicare funding, physicians, nurse practitioners, medical assistants, or clinical nurse specialists who treat a patient for their mobility needs, must assess a patient for their electric mobility needs. and document the review in their regular file. keep the format to meet Medicare guidelines for electric mobility.


These guidelines can present a daunting task, but working in tandem with a licensed healthcare professional, such as a physiotherapist or occupational therapist who is knowledgeable in mobility assessments, can make this process much easier.

Working with a PT or occupational therapist to complete this exam, often called a full face-to-face for power mobility, can also present opportunities for duplication of effort. When the results of the exam are reproduced by both the physician and the therapist, such as strength measurements, range of motion measurements, and other objective tests, the results can often be different. For example, a patient might have an upper extremity strength of 4 +/- 5 on a morning exam with their doctor, and then, perhaps days or even weeks later, experience an upper extremity strength of 3. / 5 during a test by his physiotherapist or occupational therapist during an afternoon. or evaluation in the evening. This can introduce conflicting information into the full face-to-face meeting and hence the desirability of rejection from CMS and other payers who follow CMS guidelines.

How best to avoid these denials?


1. Doctors: Don't be afraid to be subjective - at least with some parts of your exam documentation.

When you refer a therapist to complete part of the mobility assessment process, there will be a comprehensive report containing detailed strength measurements, range of motion measurements and other objective findings to support the subjective statements you make. For example, something like “the patient has marked weakness in his bilateral upper limbs”. As long as the therapist's objective conclusions, you state your agreement, and you sign / go to the full face-to-face record, correlate with the subjective statements you provide, no denial of conflicting information should result. result.

2. Check the "normal" statements.

Most DME and EHR systems default to "normal" statements and should be replaced to indicate abnormal results. Statements such as “patient is outpatient and entered clinic today” or “outpatient: normal” may be considered conflicting information when viewed against the rest of the medical literature.

3. It is important to note that Medicare expects the physician, nurse practitioner, physician assistant or clinical nurse specialist who performs the face-to-face examination for electric mobility to perform the tasks. following:

  • This visit should document the decision to prescribe an electric mobility device.
  • There should be a history and physical examination by the physician focusing on an assessment of their patient's mobility limitation and needs during a typical day.
  • The physician should document the examination in a detailed narrative note in his table in the format he uses for other entries.
  • It should contain as much objective data as possible; however, the duplication of effort between the therapist's assessment and the physician's examination (i.e. strength, amplitude, etc.) is
  • not required and when present, may conflict with the therapist's assessment of mobility and introduce opportunities for denial.
  • The note should clearly indicate that one of the main reasons for the visit was a mobility examination and provide the diagnosis (s) related to the patient's mobility.
  • The exam is personalized, as is the patient's complex rehabilitation equipment, to the individual's conditions. The physical examination focuses on the bodily system (s) responsible for limiting mobility.

Remember, first of all, that the exam results presented by the doctor and the mobility assessment documented by the therapist should work together, like a full face-to-face e-mobility record, to paint a picture functional capabilities and limitations of the client during a typical day. . The better these two reports work together to support Medicare qualification guidelines, the less denials the customer will experience and ultimately the faster the customer will receive their complex new electric mobility equipment.

References
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/dwnlds/SE1112.pdf

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33789&ver=31&SearchType=Advanced&CoverageSelection=Both&NCSelection=NCA%257CCAL%257CNCD%257CMED%7FA257CNCD%257CMEDC% 257CNCD%257CMEDCACT7CType7CT% 25CT7CT PolicyType = Final & s = 5% 257C6% 257C66% 257C67% 257C9% 257C38% 257C63% 257C41% 257C64% 257C65% 257C44 & KeyWord = wheelchairs & KeyWordLookUp = Doc & KeyWordqSearch = TrueAA & kAAAB & AAA = true

Head of Corporate Compliance - West Division;  Executive Director of Training and Compliance Education

Author

Head of Corporate Compliance - West Division; Executive Director of Training and Compliance Education

Andria Pritchett has worked for Numotion since 2010. Prior to starting her career in complex rehabilitation technology, she was a practice administrator for a large multi-specialty therapy clinic. Focusing on complex rehab technology in 2010, Andria has used her vast managerial, clinical and Medicare knowledge to develop and manage the traditional Medicare part of many aspects of Numotion's business. She has managed Medicare billing and Medicare audits, ALJ hearings, funding and order fulfillment, and has been very active in the Medicare training program within Numotion. As a current member of the Medicare Jurisdiction D DME MAC Advisory Committee - Rehab A Team, this vital role allows her to stay on top of the reimbursement environment and educate both internally and externally to the top. level. Andria is currently developing a wide range of programs and educating Numotion executives, PTAs and external clinicians nationwide on a variety of topics.


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