Dr Medicare Guide

Medicare has changed the rules for “Certification of Medical Necessity” as of 5/5/2005.

A face-to-face mobility examination with the referring physician is required prior to any mobility device being prescribed.

Medicare will only pay for equipment necessary for mobility inside the home.

Medicare looks for the following information from the physician: Copies of your actual progress/charts notes from the mobility evaluation.

NOTE: ANY FORM CREATED BY ANYONE WILL NOT BE ACCEPTED BY MEDICARE

THIS RULING INCLUDES STATEMENTS WRITTEN ON PHYSICIAN’S LETTERHEAD

1. It must be stated in your progress/chart notes one of the reasons for the office visit was the face-to-face evaluation for a power mobility device.

2. Describe the patients mobility limitation and how does it interfere with the performance of the activities of daily living.

3. Explain why a cane, crutch or walker can not meet the patient’s mobility needs in the home (skip this step if a cane, crutch or walker is being prescribed & write prescription for a cane, crutch or walker).

4. Explain why a manual wheelchair not meet the patient’s mobility needs in the home (skip this step if a manual wheelchair is being prescribed & writes prescription for a wheelchair) For high-end super light weight wheelchairs (K0004/K0005) we need specific reasons that a standard or light weight wheelchair (K0001-K0003) is inappropriate.

5. Does the patient have the physical and mental abilities to operate a power mobility device in the home?

6. Explain why a mobility scooter can not meet the patient’s mobility needs in the home (skip this step if scooters is being prescribed & write a prescription for a mobility scooter).

Please understand these questions can not be answered on this paper. The information must come from the patient’s comprehensive medical record (progress/chart notes) and is required to satisfy the Medicare documentation requirements. Florida Mobility Products must receive the prescription and copies of the chart notes within 45 days of the face-to-face evaluation or the evaluation will need to be redone.

Medicare has also changed the prescription requirements for dates of service after 8/15/2006. A specialized Rx is required for all Commodes, Walkers, Wheelchairs, Mobility Scooters and Power Wheelchairs. Upon receipt of the standard Rx we will prepare the Medicare Rx and fax it to the physician for signature and any other information required.