Why Is It So Hard To Get A Power Wheelchair or Scooter? T.V. Makes It Look Easy!
Many years ago Medicare realized that many Medicare patients and many Medicare suppliers were ripping off the Medicare program. To off set this Medicare increased the complexity of the documentation required from the physician to receive all mobility products. Have you ever noticed that adds on TV leave out this information? In order for Medicare to pay for such products legally all of the following issues must be addressed by the physician in a face to face visit in the physician progress notes:
Please note, there are NO generic forms to be completed; NO fill-in-the-blanks. Medicare expects Power Mobility Device evaluations to be documented in your own record-keeping format. Not only do they find forms to be insufficient in painting a clear picture of your patient’s mobility deficits, but they can also be construed as a form of “coaching,” which is against the rules. CMS states that instead of completed forms, “What is required is a thorough narrative description of your patient’s current condition, past history, and pertinent physical examination that clearly describes their mobility needs in the home and why a cane, walker, or optimally configured manual wheelchair is not sufficient to meet those needs.”
Reason for Visit
Face-to-face Power Mobility Evaluation
Evidence of physical evaluation
Upper Extremity Strength (__/5)
Lower Extremity Strength (__/5)
Gait— Unsteady? Fall&Fx risk?
O2 Sat—(% w/exertion)
Pain Ratings—shoulders, hands/wrists, hips, back, knees, ankles, etc. (__/10)
Restricted ROM anywhere?
Quantity of falls—in the past month or two? Consequences?
Rule out cane or walker
Include 2-3 reasons why a cane/walker is insufficient
Include quantifiable justification
Example: Patient cannot use a cane or walker because of lower extremity weakness of 3/5, history of falls with a walker (2 in the last month), and bilateral knee pain of 6/10.
Rule out manual wheelchair
Include 2-3 reasons why patient cannot self-propel
Include quantifiable justification
Example: Patient cannot self-propel in a manual wheelchair because of upper extremity weakness of 3/5, decreased grip strength of 3/5, and declining endurance. Patient cannot self-propel more than 5 ft.
Rule out electric scooter/POVIf the patient is not appropriate for a scooter it must be ruled out
Example: Not enough operating room in the home, Pt. is unsafe in transfers to/from scooter, Scooter may exacerbate patient’s back/ shoulder pain, Scooter doesn’t offer enough postural support, Patient has strength in the upper extremities of less than 3/5
Indicate that patient is capable and motivated to use power wheelchairInclude your assessment of the patient’s capabilities and motivation to use the power wheelchair in the home
Example: Patient is physically and mentally capable of using a power wheelchair, and motivated to do so.
How will the patient use the power wheelchair in their homeInclude the MRADL’s the patient will perform in the power wheelchair
Example: Toileting, grooming, eating, meal preparation, transferring room-to-room, housekeeping
Rule of thumb…
if you can walk into a provider’s office with a prescription from your doctor stating you need a PMD, you won’t qualify for one. It’s that strict. In 2013 California was one of the states that Medicare began auditing all prescriptions and physician progress notes up front before the Power Mobility Device is dispensed. Hang in there everyone! Click Here For More Information