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What Healthcare Providers Should Know About Competitive Bid for PMD

A Window has Opened

Medicare’s competitive bidding program has been delayed until 2021, with the possibility of the open window extending even longer than the next two years.

All Round Two Recompete CBID contracts expired December 31, 2018.  There is currently a two-year opportunity window for physicians to use their preferred  DME providers that may have previously been shut out of the Power Mobility market due to the CBID.

What are the Challenges entering the PMD market?

Ask any physician who treats a patient with a medical need of a power mobility device (PMD) what their biggest obstacle is, and their answer is something like, “No matter how much I document, I always miss something they wanted me to address.”

Ask any DME Supplier who services PMD patients what their biggest obstacle is and the answer is usually the same: getting fairly reimbursed in a timely manner for the services and products they provide. It relies on their ability to collect complete, substantial clinical documentation demonstrating medical necessity of the product for the patient.

Historically, physicians have been challenged in their responsibility to adequately address the patient needs for power mobility devices. This is not because of inadequate skill sets, but because it is an onerous burden to sift through the Medicare guidelines that intricately detail the multitude of patient issues that must be addressed to evidence medical need.

Even Einstein would have been challenged to remember the enormous volume of details that Medicare NCD and LCD guidelines incorporate for power mobility.

Physicians know the answers, They just don’t know what questions are being asked!

According to quarterly Medicare Power Mobility Audits, as much as 80% of all submitted PMD documentation failed to adequately substantiate medical necessity for the patient, resulting in claim denials.

This high failure rate was NOT because the patient didn’t have medical need or that the physician erred in judgment. It was entirely because of inadequate documentation during the face-to-face patient exam and the corresponding assessment record.

These guidelines and documentation challenges have been solved.

Continue reading about the easy solution for physicians to electronically provide suppliers complete and comprehensive documentation quickly, and how utilizing this new technology allows for suppliers to now offer additional equipment services to patients needing PMD’s.

The Power Mobility Market

Providers  have previously avoided servicing power mobility patients due to the previously mentioned challenges, but today’s technology allows for physicians to more adequately work in conjunction with the DME Supplier.

There are 10,000 baby boomers reaching retirement age every single day in America, and many of them have multiple challenges related to their mobility and daily activities. These hardships can be solved with a variety of power and manual assistive mobility devices.

There are numerous configurations of mobility equipment uniquely designed for a wide variety of patient needs, and these patients could really benefit from more Providers  servicing their mobility needs.

There are also patients out there with specific mobility challenges, such as complex conditions like Musculoskeletal Deformities, Degenerative Muscle Diseases, Paraplegia, and Quadriplegia.

These patients have unique needs and often require Specialty Power Mobility chairs.  Specialty or ‘Rehab’ level power chairs usually involve unique seating systems, drive mechanisms and other high-end features that allow these types of patients to have adequate mobilization.

With Medicare’s competitive bid program delayed until 2021, Physicians may currently send these orders to their locally trusted DME supplier and have a special opportunity to treat the needs of a select patient base.  

There are now technology solutions available to make servicing these patients easier.  

It’s all about the Documentation

Again, the key to success in both servicing the patient well and maintaining good business sense relies on validating medical necessity via a face-to-face patient encounter that addresses the elements of assessment required by Medicare and other payers.

Given the challenges physicians have previously had with providing that documentation, what is the solution that now exists to simplify the entire process?

HealthSplash, a clinical assessment software solution, completely solves this challenge. Physicians, suppliers, and physical therapists (PT) can utilize HealthSplash’s patient assessment and documentation technology.

This revolutionary technology was created in 2010 (then called PMDRX) and has assisted physicians with thousands of PMD assessments to successfully provide patients with the equipment they need in a timely manner. The assessment tool also allows the supplier to confidently bill insurance for these devices and be reimbursed in a timely manner.

For Rehab Level Power Chairs, a physical therapist must perform a Functional Mobility and Seating Assessment.  The PT can utilize the HealthSplash Functional Assessment tool to guide them step-by-step through the Mobility and Seating Assessment process.  The result is a comprehensive record of the PT’s assessment for the supplier.

Revolutionary and Extraordinary

Technology has revolutionized everything we do in our everyday life.  Why not take advantage of a technology that can revolutionize your medical documentation collection process?

HealthSplash, Inc. has pioneered unique tools that are simplifying and streamlining the task of clinical assessment for physicians and suppliers and the corresponding exchange of that information via electronic access of the completed documentation in real-time.  A supplier can access the completed documents the very instant the prescriber signs it.

Find more helpful whitepapers on compliance and documentation practices on our blog homepage.

By |2019-06-12T16:28:36+00:00April 10th, 2019|All, Blog, Documentation, For Doctors, For Suppliers, Technology, Uncategorized|0 Comments

About the Author:

Gary brings more than 45 years of healthcare experience to the table. He spent the majority of his career as a respiratory therapist, and later in his career started two businesses revolving around DME. Gary was the founder of PMDRX, which later converted to DMERX, and is today the basis for the SplashRx portion of the HealthSplash brand. His knowledge and expertise in the healthcare industry allows him to discover new trends and identify where there are the biggest needs for technology innovation.

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