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Disability Advocates Tell Medicare: Use a Clinical Template to Accurately Document Medical Need for Wheelchairs
Date:7/27/2012

irtually all Medicare beneficiaries with prescriptions for power mobility devices."

Kelly Buckland, executive director of NCIL, wrote that, as a power wheelchair user, he understands the "value of independence and mobility" afforded by the Medicare benefit.

"However, we are very concerned that Medicare beneficiaries will be denied their mobility independence if CMS designs and develops a prior authorization process that does not follow similar, time tested processes and procedures or incorporate a clinical medical necessity template prior to the implementation of the Prior Authorization Demonstration project later this summer," he wrote. "NCIL is asking CMS to work with power wheelchair users and stakeholders to develop a well-defined program that maintain(s) access to these much needed devices while preventing fraud and abuse… Failure to do so poses too great a risk to the health, safety and independence of people with disabilities."

Buckland said that Medicare beneficiaries are essentially caught in the middle, having "no choice but to rely on their physicians and/or treating practitioners to document medical necessity and verify the plan of care executed by the prescription of a power mobility device in order to meet Medicare's coverage criteria and payment requirements. In our experience most beneficiaries provided a PMD have a genuine medical need for the device."

Meanwhile, Altom of APRIL, wrote, "We remain concerned that the program CMS has designed… has the potential to eliminate the Medicare benefit for power mobility devices for individuals who reside in one of the seven States where the program will be implemented. This could be rectified very easily if CMS designed, developed and implemented a prior authorization process that includes the utilization of a clinical medical necessity template to provide necessary clarity and guidance to physicians, treating practitioners, suppliers, and beneficiaries attempting to me
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SOURCE American Association for Homecare
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