PMD demo hits one-year mark

YARMOUTH, Maine - With a year now under their belts, providers say there is a mixture of pros and cons to the power mobility device (PMD) demonstration project. 

“It's been a learning process for everybody—CMS, suppliers and doctors,” said Patrick Maxey, operations manager and ATP at Orange Park, Fla.-based Medco Incorporated.

Providers in seven states—California, Texas, Illinois, Michigan, New York, North Carolina and Florida—began submitting prior authorization requests to CMS for all PMDs starting Sept. 1, 2012.

'It takes some of the pressure off'

Providers say one of the biggest benefits of the program has been smoother relationships with the physicians who document the need for PMDs.

“We don't have to fight with the doctors,” said Roger Lichty, owner of Rockford, Ill.-based Mobility Connection. “CMS sends everyone the same response, and when doctors get that from CMS, they believe it. It takes some pressure off us.”

Another bonus: Having some assurance before dispensing a wheelchair that Medicare will pay for it.

“I'd rather know upfront whether the wheelchair will be approved or denied,” said Carey Britton, owner of Pompano Beach, Fla.-based Active Mobility Center.

Not necessarily audit free

Despite these benefits, providers say having to submit prior authorization requests adds to the wait time for wheelchairs, increasing a patient's risk of injury. Additionally, they often have to deal with physicians frustrated with the number of denied requests.

“I now have three doctors that refuse to write PMD prescriptions because of the troubles in submitting face-to-face notes that pass muster,” said Craig Rae, owner of Salisbury, N.C.-based Penrod Medical Equipment.

Perhaps most troubling: Providers had hoped getting CMS's approval on the front end would mean fewer audits down the line, but that hasn't always been the case.

“The only downside is we've seen audits on two or three files that went through PMD authorization,” said Derek Miller, vice president of rehab for Indianapolis-based Home Health Depot. “It's a little disappointing, and I'm hopeful that those were just isolated incidents.”

The demo is slated to run through Sept. 1, 2015.