Power mobility device provision: understanding Medicare guidelines and advocating for clients.
The Centers for Medicare and Medicaid (CMS) issued a new national coverage determination (NCD) for mobility assistive equipment (MAE) including wheelchairs in May 2005. CMS then issued a Final Rule in April 2006 that outlined significant changes required for documentation for prescribing MAE. Other insurance providers have since adopted and sometimes modified the NCD criteria and have begun to apply these criteria according to their own interpretations because some of the criteria are vague. In this report, we introduce a case example to show the components of the CMS NCD criteria, what was intended but poorly described in the language, how insurance providers may misinterpret or alter the criteria, and how clinicians can act as advocates.
Dicianno
Brad E
BE
Department of Physical Medicine and Rehabilitation Institute for Rehabilitation and Research and Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. diciannob@herlpitt.org
Tovey
Elyn
E
D014487:Centers for Medicare and Medicaid Services, U.S.; D002547:Cerebral Palsy / Q000150:complications / Q000534:rehabilitation; D003254:Consumer Advocacy; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000592:standards*; D008297:Male; D006278:Medicare / Q000592:standards*; D009983:Orthopedic Equipment; D011782:Quadriplegia / Q000150:complications / Q000534:rehabilitation; D014481:United States; D014910:Wheelchairs