By Kim Turner, RN
In 2018, Medicare paid approximately $46.7 million for PMD repairs, including replacement parts. DME suppliers must maintain documentation from the physician or treating practitioner indicating that the power mobility device (PMD) being repaired continued to be medically necessary (continued medical need) and that the repairs were reasonable and necessary.
Repair means to fix or mend. During a repair, parts or components of a base item may be replaced. The replacement of parts or components that make up a base item is considered a repair. When the base item is completely replaced with a new base item then that is considered a "replacement". The default 5-year reasonable useful lifetime applies to replacement of the base item, not to parts and accessories. DME suppliers must also maintain detailed records describing the need for and nature of all repairs, which includes a justification for the replaced parts and the labor time. A new CMN and/or treating physician/practitioner’s order is not needed for repairs.
DME suppliers are reminded that continued medical need and continued use are two separate requirements.
CONTINUED MEDICAL NEED
Documentation to support continued medical need must be timely and may be fulfilled by one of the following:
- A recent order by the treating physician for refills.
- A recent change in prescription.
- A properly signed CMN or DIF with an appropriate length of need specified.
- Timely documentation in the beneficiary’s medical record showing usage of the item.
CONTINUED USE
With respect to continued use, suppliers are responsible for monitoring the utilization of supplies or rented items by the beneficiary. Therefore, the presence of an order from the ordering practitioner is not sufficient to meet the requirements for continued use. Any of the documents listed below may serve as documentation that an item submitted for reimbursement continues to be used by the beneficiary:
- Timely documentation in the beneficiary’s medical record showing usage of the item, related option/accessories and supplies.
- Supplier records documenting the request for refill/replacement of supplies in compliance with REFILL DOCUMENTATION/REQUIREMENTS section. This is deemed sufficient to document continued use for the base item as well.
- Supplier records documenting beneficiary confirmation of continued use of a rental item.
For both continued medical need and continued use, timely documentation is defined as a record in the preceding 12 months unless otherwise specified.
If a supplier suspects the repair to the beneficiary owned PMD is needed due to beneficiary abuse/misuse of the equipment, the supplier may render the service and request that the beneficiary sign an Advance Beneficiary Notice of Noncoverage (ABN). The supplier may then submit the claim to the Medicare and append the GA modifier on each affected claim line.
Unsure if your PMD documentation will comply with Medicare requirements? Contact vHG today for assistance.