REF EDU/0107-37, Rev. B (1HR) PMD Documentation Requirements Made EASY for Clinicians Clinical Development & Technical Education www.prideprovider.com www.quantumclinician.com 800-800-8586 REF EDU/0107-37, Rev. B (1HR) Learning Objectives The participants will review Medicare’s PMD policy and coverage criteria to ensure they have and understand the most current accurate information. The participants will identify how to obtain and verify that all documentation requirements have been met. The participants will learn the most critical information for PMD funding and how to ensure it is clearly written in the wheelchair evaluation. REF EDU/0107-37, Rev. B (1HR) Satisfactory Completion Requirements As a learner…. 1) 2) 3) 4) Sign-in. 100% Attendance requirement Sign out Sign-out Required to complete an evaluation form on the day of the event. Failure to abide by any of these will result in no credit. A learner must sign-in, sign-out, and complete an evaluation form to get a Certification of Completion. If one item is missing, it will be treated as if the learner was never in attendance. No partial credit will be awarded. REF EDU/0107-37, Rev. B (1HR) Balance Was the Detailed Product Description signed? Were all least costly alternatives ruled out? I know the patient qualifies! The patient needs it! Is the 7 Element Order valid? Did we do a home assessment? Did we get the attestation with LCMP? Chart note? Why can’t we use a form? We will lose the sale! It is obvious! Is the Face to Face Exam a chart note? Did physician cosign LCMP evaluation? Did I date stamp everything? REF EDU/0107-37, Rev. B (1HR) PMD Coverage Criteria REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Effective Date – 5/5/2005 • Implementation Date – 7/5/2005 • “Mobility assistive equipment” (MAE) includes, but is not limited to, canes, crutches, walkers, manual wheelchairs, power wheelchairs, and scooters • Determination of a mobility deficit will be made by an algorithmic process REF EDU/0107-37, Rev. B (1HR) MAE Coverage Criteria (Algorithm) REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • MAE is reasonable and necessary for beneficiaries who have a personal mobility deficit sufficient to impair their participation in mobility-related activities of daily living (MRADLs) such as – toileting, – feeding, – dressing, – grooming, and – bathing • in the customary locations within the home REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Does the beneficiary have a mobility limitation that significantly impairs his/her ability to participate in one or more MRADLs in the home? • A mobility limitation is one that: – Prevents the beneficiary from accomplishing the MRADLs entirely = (Independently) – Places the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to participate in MRADLs = (Safely) – Prevents the beneficiary from completing the MRADLs within a reasonable time frame = (Timely) REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Can the functional mobility deficit be sufficiently resolved by the prescription of a cane or walker? – The cane or walker should be appropriately fitted to the beneficiary for this evaluation – Assess the beneficiary’s ability to safely use a cane or walker Tried and failed ……..(safety or reasonable time frame) Considered and ruled out ……(safety or reasonable time frame) REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Does the beneficiary have sufficient upper extremity function to propel a manual wheelchair in the home to participate in MRADLs during a typical day? • The manual wheelchair should be optimally configured (seating options, wheelbase, device weight, and other appropriate accessories) for this determination. – Limitations of strength, endurance, range of motion, coordination and absence or deformity in one or both coordination, upper extremities are relevant. REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment – A beneficiary with sufficient upper extremity function may qualify for a manual wheelchair wheelchair. The appropriate type of manual wheelchair, i.e. light weight, etc., should be determined based on the beneficiary’s physical characteristics and anticipated intensity of use. – The beneficiary's home should provide adequate access, maneuvering space and surfaces for the operation of a manual wheelchair wheelchair. – Assess the beneficiary’s ability to safely use a manual wheelchair. REF EDU/0107-37, Rev. B (1HR) PMD Documentation Requirements Quantitative Measurements (must be provided when applicable) Muscle Strength Grading 5/5 - Full range of motion, full resistance 4/5 - Full range of motion, some resistance 3/5 - Full range of motion with gravity 2/5 - Full range of motion without gravity 1/5 - Slight contraction, no movement 0/5 - No contraction Range of Motion Oxygen Saturation Pt. On 4 liters with a SAT of X% with minimal exertion drops to X% REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A standard manual wheelchair (K0001) is covered if: The patient has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. AND The patient’s mobility limitation cannot be sufficiently resolved by the use of an appropriately fitted cane or walker. Covered for an individual who is unable to ambulate safely, timely or independently. Typically for short-term use. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A standard hemi-wheelchair (K0002) is covered when the patient meets the coverage criteria for a standard manual wheelchair and requires a lower seat height (17” to 18”) because of short stature or to enable the patient to place hi /h feet his/her f t on the th ground d ffor propulsion. l i A lightweight wheelchair (K0003) is covered when a patient meets the coverage criteria for a standard manual wheelchair and: cannot self propel in a standard wheelchair in the home; and the patient can and does self-propel in a lightweight wheelchair. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A high strength, lightweight wheelchair (K0004) is covered for a patient who meets the coverage criteria for a: Standard manual wheelchair (K0001) and: (rule out cane and walker) Self propels the wheelchair while engaging in frequent activities in the home that cannot be performed in a standard or lightweight wheelchair, and/or (rule out K0001 and K0003) Requires a seat width, depth, or height that cannot be accommodated in a standard, lightweight, or hemi-wheelchair, and Spends at least two hours per day in the wheelchair Note: A high strength lightweight wheelchair is rarely reasonable and necessary if the expected duration of need is less than three months (e.g., post-operative recovery). Many K0004 W/Cs can be customized to meet the client’s condition (long term use) REF EDU/0107-37, Rev. B (1HR) Coverage Criteria Ultra lightweight wheelchairs (K0005) are eligible for Advance Determination of Medicare Coverage (ADMC aka “Prior Authorization”) Patient’s diagnosis duration of condition and expected prognosis Patient s diagnosis, prognosis, Patient’s abilities and limitations as they relate to the equipment, A description of the patient’s routine activities, the types of activities the patient frequently encounters A description of the features of the K0005 base which are needed compared to the K0004 base Size and proper position of propulsion wheels (need for an adjustable rear axle) REF EDU/0107-37, Rev. B (1HR) K0005 Update Effective March 1, 2013 For MEDICARE - An ultra lightweight manual wheelchair (K0005) is covered for a beneficiary if criteria (1) or (2) is met and (3) & (4) are met: 1. The beneficiary must be a full-time manual wheelchair user. 2. The beneficiary must require individualized fitting and adjustments for one or more features such as, but not limited to, axle configuration, wheel camber, or seat and back angles, and which cannot be accommodated by a K0001 through K0004 manual wheelchair. 3. The beneficiary must have a specialty evaluation that was performed by a licensed/certified medical professional (LCMP), such as a PT or OT, or physician p y who has specific p training g and experience p in rehabilitation wheelchair evaluations and that documents the medical necessity for the wheelchair and its special features (see Documentation Requirements section). The LCMP may have no financial relationship with the supplier. 4. The wheelchair is provided by a Rehabilitative Technology Supplier (RTS) that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the patient. REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Does the beneficiary or caregiver demonstrate the p y and the willingness g to consistently y operate p capability the MAE safely? • Safety considerations include personal risk to the beneficiary as well as risk to others. The determination of safety may need to occur several times during the process as the consideration focuses on a specific device. • A history of unsafe behavior in other venues may be considered. • NOTE: If the beneficiary is unable to self-propel a manual wheelchair, and if there is a caregiver who is available available, willing willing, and able to provide assistance, a manual wheelchair may be appropriate. REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Does the beneficiary have sufficient strength and postural t l stability t bilit tto operate t a POV/ POV/scooter? t ? – A POV is a 3- or 4-wheeled device with tiller steering and limited seat modification capabilities. The beneficiary must be able to maintain stability and position for adequate operation. – The beneficiary's home should provide adequate access, maneuvering space and surfaces for the operation of a POV. – Assess the beneficiary’s ability to safely use a POV/scooter. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria • A POV is covered if the patient is able to: • Safely transfer to and from a POV, and • Operate the tiller steering system system, and • Maintain postural stability and position while operating the POV in the home. • The patient's home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided. • Use of a POV will significantly improve the patient's ability to participate in MRADLs and the patient will use it in the home home. REF EDU/0107-37, Rev. B (1HR) Clinical Considerations Scooters are good for people who… • Have head/trunk control and can use their arms/hands to steer/control the throttle • Can get in and out of the seat safely • Travel longer distances • Can walk short distances REF EDU/0107-37, Rev. B (1HR) Clinical Considerations • Scooters are not good when … – Seating and/or positioning components are necessary or f there is a projected future need – Power seating functions are needed or may be required in the future – An alternative drive method is required or may be necessary in the future g radius limits mobility y – The turning or independence REF EDU/0107-37, Rev. B (1HR) National Coverage Determination for Mobility Assistive Equipment • Are the additional features provided by a power wheelchair needed to allow the beneficiary y to p participate p in one or more MRADLs? • The pertinent features of a power wheelchair compared to a POV are typically control by a joystick or alternative input device, lower seat height for slide transfers, and the ability to accommodate a variety of seating needs. • The type of wheelchair and options provided should be appropriate for the degree of the beneficiary’s functional impairments. • The beneficiary beneficiary'ss home should provide adequate access, access maneuvering space and surfaces for the operation of a power wheelchair. • Assess the beneficiary’s ability to safely use a power wheelchair. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Power Wheelchair (PWC) (K0813-K0891, K0898) is covered if: • All of the basic coverage criteria for a PMD (A-C) are met; and • The patient does not meet coverage criterion D, E or F for a POV; and • Either criterion J or K is met; and • Criteria L, M, N and O are met; and • Any coverage criteria pertaining to the specific wheelchair type are met. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Power Wheelchair (PWC) (K0813-K0891, K0898) is covered if: J. The patient has the mental and physical capabilities to safely operate the power wheelchair that is provided; or K If the patient is unable to safely operate the power wheelchair K. wheelchair, the patient has a caregiver who is unable to adequately propel an optimally configured manual wheelchair, but is available, willing and able to safely operate the power wheelchair that is provided; and L. The patient’s weight is less than or equal to the weight capacity of the power wheelchair that is provided and greater than or equal to 95% of the weight capacity of the next lower weight class. M. The p patient’s home p provides adequate q access between rooms,, maneuvering g space and surfaces for the operation of the power wheelchair that is provided. N. Use of a power wheelchair will significantly improve the patient’s ability to participate in MRADLs and the patient will use it in the home. For patients with severe cognitive and/or physical impairments, participation in MRADLs may require the assistance of a caregiver. O. The patient has not expressed an unwillingness to use a power wheelchair in the home. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Group 2 Single Power Option PWC (K0835 – K0840) is covered if all of the coverage g criteria for a PWC are met and if: The patient requires a drive control interface other than a hand or chin-operated standard proportional joystick (examples include but are not limited to head control, sip and puff, switch control); or The patient meets coverage criteria for a power tilt or a power recline seating system (see Wheelchair Options and Accessories policy for coverage criteria) and the system is being used on the wheelchair; and The patient has had a specialty evaluation that was performed by a licensed/certified medical professional. The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in person involvement in the wheelchair selection for the patient. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Group 2 Multiple Power Option PWC (K0841-K0843) is covered if all of the coverage g criteria for a PWC are met and if: The patient meets coverage criteria for a power tilt and recline seating system (see wheelchair Options and Accessories policy) and the system is being used on the wheelchair; or The patient uses a ventilator which is mounted on the wheelchair; and The patient has had a specialty evaluation that was performed by a li licensed/certified d/ ifi d medical di l professional. f i l The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in person involvement in the wheelchair selection for the patient. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Group 3 PWC with no power options (K0848-K0855) is covered if: The patient's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity; The patient has had a specialty evaluation that was performed by a licensed/certified medical professional. The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in person involvement in the wheelchair selection for the patient. patient REF EDU/0107-37, Rev. B (1HR) Coverage Criteria Group 3 – Examples of Neurological, Myopathy, Congenital Skeletal Deformity N l i l conditions diti th Neurological thatt iimprove – Cerebral Vascular Accident (Stroke) – Traumatic Brain Injury Static neurological conditions – Cerebral Palsy – Post Polio Syndrome – Spinal Cord Injury Progressive P i neurological l i l conditions diti – Alzheimer’s Disease – Amyotrophic Lateral Sclerosis – Multiple Sclerosis – Parkinson’s Disease – Spinal Muscular Atrophy Not all inclusive REF EDU/0107-37, Rev. B (1HR) Coverage Criteria Group 3 – Examples of Neurological, Myopathy, Congenital Skeletal Deformity Myopathies – Muscular M l D Dystrophies hi – Myositis Congenital Skeletal Deformities – Spina Bifida – Osteogenesis Imperfecta Not all inclusive REF EDU/0107-37, Rev. B (1HR) Coverage Criteria A Group p 3 PWC with Single g Power Option p (K0856-K0860) ( ) or with Multiple p Power Options (K0861-K0864) is covered The patient's mobility limitation is due to a neurological condition, myopathy, or congenital skeletal deformity; and The patient meets the coverage criteria for the single power option or multiple power options respectively (tilt and recline) The patient has had a specialty evaluation that was performed by a licensed/certified medical professional. The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in wheelchairs and who has direct, in person involvement in the wheelchair selection for the patient. REF EDU/0107-37, Rev. B (1HR) Options and Accessories REF EDU/0107-37, Rev. B (1HR) Headrest Attendant Control Adjustable Height Arms Power Recline Power Tilt Skin Protection Positioning Back & Positioning Expanded Cushion Controller Power ELRs/ Articulating Foot Platform Under Medicare, options and accessories for wheelchairs are covered if the patient has a wheelchair that meets Medicare coverage criteria and the option or accessory is medically necessary. REF EDU/0107-37, Rev. B (1HR) Coverage Criteria The medical necessity for all options and accessories must be documented in the p patient’s medical record and be available to Medicare upon request. An order for each item billed must be signed and dated by the treating physician kept on file by the supplier, and made available upon request. Accessories to a wheelchair base must be billed on the same claim as the wheelchair base. REF EDU/0107-37, Rev. B (1HR) PMD Documentation Requirements REF EDU/0107-37, Rev. B (1HR) Documentation Checklist 1. The seven element order signed and dated by the treating physician. 2. The written detailed product description (DPD) of the device base and separately billable options and accessories signed and dated by the treating physician. 3. Notes of physician visits prior to the face-to-face examinations which document the progression of the patient’s mobility impairment. 4. The written face-to-face examination by the treating physician. Portion of the face-to-face examination conducted by an independent physical therapist (PT) or occupational therapist (OT), if applicable, including an attestation that the PT/OT had no financial relationship with the supplier. 5. Any other medical records describing the justification for the power mobility device and separately billable options and accessories. These records could include physician’s office records laboratory or other test reports, records, reports hospital records, records nursing home records records, home health agency records, and records from other health care professionals. 6. The on-site home assessment record. 7. Proof of delivery of the items to the beneficiary. REF EDU/0107-37, Rev. B (1HR) (1) Seven Element Order Checklist Beneficiary name Date of the face to face examination (completion of the face to face exam) Description of the item ordered Pertinent diagnosis/condition Length of need Physician’s signature (with legible identifier) Date of physician’s signature Double CHECK Correct date of the face to face. Date stamp of when received by the supplier. Legible identifier (printed name, etc.). REF EDU/0107-37, Rev. B (1HR) (2) Detailed Product Description (DPD) Checklist MUST include a narrative description (manufacturer and make/model) of each item separately p y billable. Must include a start date (Date the physician signed the 7‐Element Written Order). Only separately billable items should be listed on the DPD. MUST be sent to the physician (after the supplier receives the order, face to face and if applicable LCMP evaluation). MUST be signed by ordering physician prior to deliver. The DPD must be signed, dated and received by the supplier (date stamped to prove it) prior to or on the date of delivery (PMD cannot be delivered without it). Physician signature indicates agreement. Double CHECK Signed by the ordering physician prior to delivery. Date stamped of when received by the supplier . Signed by the ordering physician after the 7 element order and the face to face examination received and date stamped by the supplier (actual stamp). REF EDU/0107-37, Rev. B (1HR) (3) Patient’s History/Progression Physician Chart Notes Checklist Notes of physician visits prior to the face-to-face examinations which document the progression of the patient’s mobility impairment. Double CHECK No contradictoryy information in the p previous chart notes. Attempted to obtain history, however, none available with relevant information. REF EDU/0107-37, Rev. B (1HR) (4) Face-to-Face Examination Checklist Physician’s face to face examination MUST be in the format of a detailed narrative chart note and MUST address (A) from PMD LCD Supplier/physician generated forms are NOT acceptable LMNs are NOT acceptable The physician MUST document the examination in a detailed narrative note in their charts in the format that they use for other entries The physician’s note MUST clearly indicate that a major reason for the visit was a mobility examination (content) The majority of the content MUST address the patient’s mobility limitation(s) REF EDU/0107-37, Rev. B (1HR) (4) Face-to-Face Examination Minimum required information from the ordering physician when there is a LCMP (PT/OT) evaluation Symptoms that limit ambulation Diagnoses that are responsible for these symptoms Medications or other treatment for these symptoms Progression of ambulation difficulty over time Other diagnoses that may relate to ambulatory problems History of falls, including frequency, circumstances leading to falls REF EDU/0107-37, Rev. B (1HR) (4) Face-to-Face Examination If there IS NOT an LCMP evaluation, the physician’s chart/progress notes must address the patient’s mobility limitations and why the patient cannot safely/reasonable timeframe use a least costly alternative to perform MRADLs in their home home. = Face to Face E Examination i ti REF EDU/0107-37, Rev. B (1HR) (4) Face-to-Face Examination If there IS an LCMP evaluation, the physician’s chart/progress notes at a minimum must address the patient’s mobility limitation (A – mobility deficit relative to MRADLs) per LCD p cannot The LCMP evaluation must address whyy the patient safely/reasonable timeframe use a least costly alternative to perform MRADLs in their home (B - cane/walker, C - manual wheelchair and if applicable D - scooter per LCD) The ordering physician must co-sign, date and state agreement or disagreement on the LCMP evaluation prior to delivery + = Face to Face Examination REF EDU/0107-37, Rev. B (1HR) (4) Face-to-Face Examination Double CHECK Documented in the chart note (NO forms, NO LMN) In a detailed narrative format similar to other entries MUST address the diagnosis/condition responsible for the mobility limitation (A) Least costly alternatives must be addressed by either the ordering physician OR the LCMP (PT/OT) Attestation of no financial relationship with LCMP REF EDU/0107-37, Rev. B (1HR) (4) Clinical Documentation Clinical documentation MUST rule out the least costly alternatives (A – C) per Power Mobility Device LCD - Safety and/or reasonable timeframe MUST be addressed REF EDU/0107-37, Rev. B (1HR) (5) Medical Records (Other Health Care Professionals) Checklist Any other medical records describing the justification for the power mobility device and separately billable options and accessories - Physician’s office records Laboratory or other test reports Hospital records, nursing home records, home health agency records Records from other health care professionals Double CHECK No contradictory information in the medical records Attempted to obtain history, however, none available with relevant information REF EDU/0107-37, Rev. B (1HR) Quantitative Measures Evaluation 1. Balance (Sitting / Standing)‐ 0, 1, 2, 3, 4, 5 Dependent, Poor, Fair, Good, Normal 2. Strength0/5, 1/5, 2/5, 3/5, 4/5, 5/5 No movement, Trace, Poor, Fair, Good, Normal Within Normal Limits (WNL) or Within Functional Limits (WFL) Grip strength measurement of _____ # 3. Range of motion (ROM)Goniometric Measurement (-40, 20 - 110) WNL (within normal limits) WFL (within functional limits) 4. Tone and ReflexesHypertonic, Spastic, Hypotonic, Flaccid, Fluctuating tone, Athetoid, Ataxic, Tremors ATNR, STNR, Extensor Thrust, Clonus 5. SensationIntact, Absent or Impairedlight touch, sharp/dull, deep pressure with a description of the dermatome or size and location Assessment 1. Unsteady, falls 2. Weakness, decreased or limited strength Weak grasp, poor grip 3. Decreased or limited range of motion, poor reach 4. Stiff, Limp, Uncoordinated, Shaky, Jerky 5. Numbness, tingling REF EDU/0107-37, Rev. B (1HR) Quantitative Measures Evaluation 6 Pain rates 0 – 10 on the pain scale 6. Assessment 6 Painful 6. Painful, has pain pain, experiences pain 7. _____ liters 02 / minute, 02 saturation levels, Pulse oximetry readings, Vital capacity, Respiration rate 7. Short of breath, gasping, wheezing 8. Blood pressure ___/___, heart rate, pulse 8. Chest pain, light headed 9. PosturePelvic tilt, obliquity, rotation Kyphosis Lordosis, Kyphosis, Lordosis Scoliosis Abduction, Adduction, Flexion, Extension 9. Leaning, Slouching REF EDU/0107-37, Rev. B (1HR) Quantitative Measures Evaluation 10. Ambulates _____ feet with ______ device Requires max. (75%), mod. (50%), min. (25%), stand by assistance, contact guard assistance or supervision to ambulate Assessment 10. Not an independent ambulator Not a functional ambulator Not a safe ambulator Timeliness? Efficiency? Settings of anticipated use? 11. Propels a manual w/c _____ feet with Both (B) upper extremities Both (B) lower extremities R / L upper and lower extremities Requires max. (75%), mod. (50%), min. (25%), stand by assistance, contact guard assistance or supervision to propel Timeliness? Efficiency? Settings of anticipated use? 11. Non-functional manual w/c propulsion REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation Subjective Information Objective Information The patient has difficulty walking and can only The patient becomes short of breath after walking walk short distances. 15-20 feet and must stop and rest. The patient needs power mobility in order to The patient does not have the stability to walk from complete MRADLs. He is too unstable to use a the bedroom to other rooms in the house with cane or walker and does not have the either a cane or walker. He has experienced two endurance to propel a manual wheelchair. falls in the past month in his home despite use of a wheeled walker. A trial with a lightweight manual wheelchair failed. Severe osteoarthritis in shoulders and wrists has resulted in limited range g of motion and propelling the wheelchair more than 15 feet results in pain rated at 7/10. The patient has weakness in the upper Strength in right upper extremity is 3/5 and 2/5 on extremities. the left. Patient cannot lift more than 5 pounds. DME MAC C, Medical Review Power Mobility FAQ, January 26, 2010 REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation If the patient is thought to require a PMD due to respiratory illness or injury: Does the patient use home oxygen? If yes, what is the frequency, duration, delivery system, and flow rate denoted? How far does the patient report that she/he can walk or self-propel a manual wheelchair before becoming short of breath (with best oxygenation provided)? Describe the ADLs that make him/her short of breath in the home (with best oxygenation provided) and the interventions that palliate them. How have these signs/symptoms changed over time? http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation If the patient is thought to require a PMD due to cardiovascular illness or injury: Specifically, describe any clinically significant increased heart rate, palpitations, or ischemic pain that occurs or worsens when the patient attempts or performs ADLs within the home (with best oxygenation provided)? What p palliates these signs/symptoms? g y p How far does the patient report that she/he can walk or self-propel a manual wheelchair before experiencing these signs/symptoms? How have these signs/symptoms changed over time? http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation If the patient is thought to require a PMD due to neuromusculoskeletal illness or injury or malformed body member: Describe the patient’s impairments. For example, does the patient exhibit joint/bone signs/symptoms, changes in strength, coordination or tone? How do these signs/symptoms relate to the patient’s functional state and the ability to perform ADLs in specific? How far does the patient report that she/he can walk or self-propel a manual wheelchair before these signs/symptoms interrupt that activity? How have these signs/symptoms changed over time? http://www.cms.gov/MLNProducts/downloads/MedQtrlyCompNL_Archive.pdf REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation • Records may be corrected if errors were made or additional information about the already‐completed examination is needed for clarification. – When changes to the record are made for such a correction or addition, a change to the F2F date is not necessary, since all information arises from the already‐completed F2F examination. • New information acquired outside of or in addition to the already‐completed F2F exam, however, changes the date used for the F2F exam to the date that the ordering physician incorporates the new information into the F2F. – If the date of the F2F changes, all requirements that are linked to the F2F are affected (F2F date on the 7EO, 45‐day document delivery requirement, 120‐day product delivery date, completion date of the DPD, etc.). As the F2F date changes, these other items may be impacted as well. DME MAC B, FAQ, January 24, 2013 REF EDU/0107-37, Rev. B (1HR) Evaluation and Documentation • From a document review perspective, the core issue is to identify when a change to the F2F represents a simple correction or addition to the already‐created examination vs. the addition off new information f aside from f the already‐created exam. • This assessment rests upon the quality of the information provided by the person making the correction or amendment in identifying clearly the nature and source of the added information. • CMS gives reviewers some latitude to make judgments but the instructions clearly tell us that inference is never a substitute for incomplete, unclear or confusing records. DME MAC B, FAQ, January 24, 2013 REF EDU/0107-37, Rev. B (1HR) Supplier ATP Appraisal Checklist The supplier must employ a RESNA-certified Assistive Technology Professional ((ATP)) who specializes p in wheelchairs and who has direct,, inperson involvement in the wheelchair selection for the patient. Required for any power wheelchair coded K0835 and above. Double CHECK Report should not included clinical viewpoint. Report should focus on product selection. Employment of RESNA certified ATP can be documented by providing a copy of the RESNA Certificate or a printout from the RESNA website showing credential is current. REF EDU/0107-37, Rev. B (1HR) (6) On-site Home Assessment Record Checklist Prior to or at the time of delivery of a POV or PWC. Perform an on-site evaluation of the patient’s home to verify that the patient can adequately maneuver the device that is provided. There must be a written report of this evaluation available on request. Home assessment must be signed and dated by the person performing the assessment prior to or on the day of delivery. Double CHECK Home assessment cannot be performed (dated) prior to the supplier receiving (verified with date stamp) the valid 7 element order DME MAC C, Medical Review Power Mobility FAQ, January 26, 2010 REF EDU/0107-37, Rev. B (1HR) (7) Proof of Delivery Checklist Delivery ticket with description of item(s) provided along with beneficiary signature and date received Double CHECK Date of delivery listed on delivery ticket must match the date of service on the claim (1st month if capped rental) REF EDU/0107-37, Rev. B (1HR) Thinking out loud • What are two things you learned and how can you relate it to your practice? • How does this course relate to your practice setting? p g • How will this course change your behavior in the future? REF EDU/0107-37, Rev. B (1HR) Thank you for your time. Thank you for your time. Any questions?