Power+Mobility+Device

Here are some hints to help navigate the strict Medicare/Medi-Cal/CCHP guidelines for power wheelchairs or scooters. toc Update 9/20/2013

General Information:
Medicare has tightened up further on their strict guidelines for qualifying a patient for a power mobility device (power wheelchair or scooter) and also severely limited the vendors that can be used. Please read the attachments included in this email. Please read the general info sheet from if you think a patient needs a power chair - please read - very important
 * If the patient cannot get the device into/out of their home and use it IN the home then they **will not qualify**.
 * If they can functionally ambulate with/without a device to perform their daily ADL's then they **will likely not qualify**
 * Please make sure the patient knows they can't pick which device they want. That will be based on mobility need and in home use.

There are important guidelines on the face to face visit documentation requirements. Your visit notes are crucial in reflecting the patient's functional limitations.

**Face-to-face visit documentation**
This is the most important part. Do it first, before any referrals to vendors, or physical therapy.
 * New Medicare/insurance guidelines dictate that a Face-to-Face Evaluation with an MD must be completed **prior** to making a referral to therapy. This will help determine if a PT evaluation is even necessary (either they obviously qualify or they obviously do not). With this process, only the questionable cases that need a bit more input are forwarded on to Rehab.
 * Your Face to Face Visit documentation **must** include:
 * **__Visit Purpose:__ Mobility Evaluation**
 * H & P, current condition, PMH including physical exam – systems assessment
 * IN HOME mobility concerns: falls, pace of ambulation, assist needed for ambulation, assist for transfers, unable to get to bathroom in timely manner.
 * Why can’t a cane or walker suffice? Specific need for wheelchair use IN HOME
 * Why can’t a manual wheelchair suffice? Specific reasons why pt can’t push manual chair
 * Quantitative strength/ROM/Pain/Endurance/Respiratory –oxygen saturation
 * Be general about type of device – don’t specifically say ‘scooter’ – will leave that up to therapy/vendor to assess. ‘Power mobility device’ will suffice.
 * Does pt have physical & mental ability to operate Power Device safely IN HOME?
 * Be general about type of device – use the term “Power Mobility Device”. **DO NOT specifically say ‘scooter’** – will leave that up to therapy/vendor to assess.
 * Pain: intensity and locations
 * Endurance limitations – Respiratory or Cardiovascular limitations–oxygen saturation

Example
**THIS IS AN EXAMPLE OF WHAT YOU NEED TO WRITE IN YOUR NOTE for Face to Face visit. DO NOT USE THIS AS A TEMPLATE FOR YOUR NOTE OR MEDICARE WILL DENY. USE AS GUIDE ONLY*** your note needs to look just like other notes you have in the patient chart)

Mobility Examination Reason for Exam: Mobility Examination needed due to………………… Subjective/Chief Complaint: Objective:
 * Pain – locations and intensities - how it limits patient
 * Height/Weight:
 * Musculoskeletal Exam: (include functional limitations)
 * Right/Left Upper and Lower Extremities
 * Range of Motion
 * Strength Testing


 * Other Systems Exam as needed:
 * Gait/Balance: (comments re: fall risk, use of device, endurance, gait pattern, time to complete)
 * O2 Saturation or Respiratory impairments w/Exertion:

Assessment: Include answers on the following topics: If not, describe why If not, describe why
 * Medical Condition(s) which limit participation in MRADL’s (Mobility Related Activities of Daily Living)in home:
 * MRADL’s which are impaired due to mobility limitation in the home: (i.e. moving from room to room, dressing, grooming, toileting, feeding, bathing)
 * Does a cane or walker meet the patient’s mobility needs in the home?
 * Does a manual wheelchair meet the patient’s mobility needs in the home?
 * Does the patient have the physical and mental abilities to operate a power mobility device safely in the home?
 * Is the patient willing and motivated to use a power mobility device?

Summary/Plan: (may include power device or manual device) (may include assessment by therapist and vendor if appropriate – or can refer to therapy if patient needs therapy for improving mobility and is not ready for a device yet)

Physical Therapy Referrals
FIRST COMPLETE A FACE TO FACE ENCOUNTER - If it is unclear from the face-to-face whether a device is indicated, or if there may be custom components that need to be determined, then write a PT/OT INT REF for a **Mobility Evaluation.**

Physical therapy screens the referrals for mobility assessments to see if they are appropriate. Many are not. Please read the guidelines. Please help explain these guidelines to the patients and we will also. We will let you know if the patient is not appropriate and why. Please call or email if you have any questions - thank you for your attention to these details.

Follow-Up Process
After physical therapy does a mobility assessment and recommends a device, they are asking the care coordinators to be the primary liason between the vendor and the Medical Provider in order to get all of the necessary documents signed in a timely manner. There is a strict 45 day timeline between the final face to face MD visit and the submission of the package by the vendor to Medicare. Within this timeframe the vendor performs the home visit and sends paperwork to you for signature. All must be signed/dated appropriately. We will assist in connecting you with the vendor, but we in rehab will not manage all of the signature paperwork. That is to be done between the vendor and the Medical Provider/Care Coordinator since it usually needs to occur with the visit.


 * Therapist will complete the assessment and contact vendor. Vendor will contact patient for an in home assessment. Vendor will communicate with your care coordinator for necessary paperwork.
 * **Please educate patient not to initiate this process with a vendor.** They will need to work with a contracted County vendor (even if Medicare is the primary insurance). Patient needs to know that they need to meet certain mobility restrictions for approval, and that insurance bases approval for the device on if the patient will use it __IN THE HOME__.
 * The Rehab department and/or vendor will send you any other documentation needing signatures, including the final prescription.
 * The vendor will send you any other documentation needing physical signatures, including:
 * PT/OT Mobility Evaluation
 * 7 Element Written order which details ICD 9 coding and diagnoses
 * Vendor Detailed Product Description
 * May need second Face to Face visit required to complete your MD visit note if first note is incomplete.