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Power wheelchair/DME coverage

This article was originally published in The Gray Sheet

Executive Summary

A physician's certificate of medical necessity (CMN) is sufficient to justify Medicare coverage of durable medical equipment (DME) such as power wheelchairs, and CMS cannot require DME suppliers to obtain medical records or other documentation to prove that such equipment is reasonable and necessary, according to a recent California federal court ruling in Maximum Comfort v. HHS Secretary Tommy Thompson. The power wheelchair provider had sued HHS after CMS balked on paying for power chairs it said did not qualify. However, CMS is considering changes to the CMN, according to Leslie Norwalk, CMS acting deputy administrator. Referring to the case at the July 7 Banc of America Securities Washington Health Care Conference, Norwalk noted that CMS has "a number of options. Even if we didn't appeal, as the judge points out, CMS is in fact responsible for the [CMN], and we can change it if we want." CMS also is developing guidance to clarify power wheelchair coverage criteria as part of a broader effort to combat fraud (1"The Gray Sheet" June 21, 2004, p. 29)...
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