Physicians must obtain prior authorization for power mobility devices starting Sept. 1

posted 08.21.12

Beginning Sept. 1, 2012, Texas physicians must receive prior authorization for scooters and power wheelchairs for patients with fee-for-service Medicare. The three-year Power Mobility Devices demonstration rolls out seven states prone to fraud and errors, including Texas.

The demonstration is designed to help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines, and that the Medicare beneficiary receives quality products from accredited suppliers, according to the Centers for Medicare and Medicaid Services. 

Under the new prior authorization process, documentation to support a claim must be submitted before the power mobility device is delivered. Suppliers or physician offices will submit the prior authorization request. After receiving the relevant documentation, the durable medical equipment contractor will have 10 business days to conduct a review and communicate a decision on whether the device meets all Medicare coverage requirements. The DME contractor will send the decision letter to the physician or physician practice, the supplier, and the Medicare beneficiary.

Detractors have criticized the paperwork burden placed on physicians, saying that it is an attempt to minimize payment under complex medical necessity determinations, not target fraud. With potential submissions and resubmissions, the process could also result in unnecessary delays of care.

Without an official template for the required face-to-face examinations, TAFP developed a clinical guide and accompanying video for evaluating a patient for a power mobility device to help family physicians conform with Medicare’s extensive documentation requirements. Go to the prescribing practices page of the practice resources section of www.tafp.org to access these tools.

Find more information on CMS’ Prior Authorization of Power Mobility Devices Demonstration webpage.