Fighting on the Hill for a bridge
Mobility stakeholders have spent a lot of time on the Hill lately.
First of all, they (plus consumers participating in the Roll on Capitol Hill starting today!) are fighting for H.R. 4378, the bill that would create a separate benefit for complex rehab. As of last Friday, there were 16 members of Congress signed on, half of whom are on key committees like Energy and Commerce, Ways and Means and the Disability Caucus.
Secondly, they're fighting to convince lawmakers to intercede with CMS on two major issues: the seven-state power mobility device demo, and the creation of a clinical template for the face-to-face exam.
See, stakeholders who see power mobility's CERT error rates from 70% to 90% are worried there will be access issues during the demo.
Right now, when denials happen, the beneficiary already has his or her chair and it's up to the provider to duke out the payment issues through appeals. Moving that whole process to the front end during the demo will create delays and access to care issues, stakeholders say.
The underlying cause of all those denials, says Seth Johnson, vice president of government affairs for Pride Mobility, is the physician's documentation.
He says a template needs to be linked to the demo prior to the start of the project later this summer.
But Seth, I said, the electronic clinical template won't be ready for months. Do you want them to delay the demo until it's ready?
Nope, they're not looking for a delay until the electronic clinical template is ready. Instead, Seth Johnson wants a bridge.
"We need some interim tool to bridge the gap," he told me. "We need some type of tool to assist physicians, to walk them through the evaluation process step by step—to walk them through the complex nature of Medicare's coverage criteria."
Stakeholders have been getting the word out about the complications of starting the demo without a template in place, and Congressman Ed Towns and Senator Marco Rubio have added their voices to the cause, both writing letters to CMS Administrator Tavenner within the past few weeks.
Most prior authorization processes, through private insurance or different state Medicaid programs, have a template. Doctors are used to using them. And if CMS wants doctors to hit all the notes it requires during the face-to-face exam, doctors need one for Medicare too—so patients can get what they need when they need it.
"We support the demo," said Seth. "All we ask is for them to do it right."
Read more about the industry's feelings on this in AAHomecare's bulletin.