A critical part of the documentation needed to get a wheelchair is the Medicare Face to Face Requirement. This is often the base document that Medicare uses to determine your need for a power mobility device or manual wheelchair. There are no real shortcuts or ways to sidestep this requirement either. It has to be done and it has to be done right.
Scheduling the Medicare Face to Face
Once you determine you may be eligible for a mobility device, call your doctor and schedule an in-person appointment. This is usually scheduled with your primary care doctor because most specialists will not do these evaluations. It could also be scheduled with the Physician’s Assistant (PA) or Nurse Practitioner (NP) IF they have a PECOS certification to prescribe to Medicare patients.
When you schedule the appointment, make sure that the receptionist knows that appointment is for a mobility or wheelchair evaluation. This appointment should not be for a checkup or your regularly scheduled visit. It must be a separate visit and the main reason has to be the mobility evaluation. Most doctors require extra time to for these evaluations because they take longer than a follow-up visit.
Arriving at the Face to Face Appointment
As always, be a little early. When you sign in at the front desk, confirm with the receptionist that you are there for a face to face mobility exam. It is a good idea to bring someone with you as well because you may be asked to walk for the physician to demonstrate that you need the equipment.
When the nurse comes to get you, make sure (again!) that she knows you are there for your face to face. I realize you may be getting tired of hearing that but you would not believe how many times I get copies of progress notes sent to me that do not state the visit was for the face to face. If they don’t indicate that, you may have to go back again.
The nurse will then usually weigh you. This is an important part of the visit because Medicare requires your weight be documented to make sure you do not exceed the weight limits of the equipment. This is critical if your equipment is in the heavy-duty category. The nurse will also take your blood pressure, oxygen levels, and ask you about any changes in medications, etc.
Sometime during this appointment, you may be asked about bringing “forms.” Just so you know, Medicare does not allow physicians to complete forms for the Face to Face. The documentation must be included in the narrative section of the progress notes.
What to Expect During the Mobility Exam
This doctor visit will probably be more intense than you are used to having. The doctor must properly document your inability to walk, the strength of your muscles, and how far you can bend all your joints. You will need to answer a lot of questions. Some of them may be personal and delicate in nature.
Be sure to describe to your physician the layout of your home. Explain why you are unable to get to your bathroom or kitchen and how the power chair will make it possible. You and the doctor will also need to discuss why you cannot use a cane or walker in the home. If you cannot propel a manual chair, this will need to be documented as well. Medicare will only pay for the lowest tech option that will work for you. For example, if you can safely use a walker, that is what Medicare is going to pay for.
When the physician is measuring your muscle strength and your joint movement, the measurements must be recorded in objective terms. This basically means numbers. Strength measurements are usually written in terms of a score with 5 being the highest: 5/5 is the best strength. I typically see numbers like 3-/5 or 4+/5 on progress notes that I receive in my ATP practice. Joint movement is referred to range of motion (ROM) and is measured in degrees of movement.
A neurological and orthopedic exam will be part of the face to face as well. The physician should note any orthopedic (bone and joint) issues like contractures, deformities, and spinal problems and curvatures. Neurological issues should be noted like numbness, tingling, or paralysis.
Referring the Mobility Exam to a Physical or Occupational Therapist
The reality of healthcare today is that many doctors do not have the time to perform a full and complete mobility exam. Reimbursements are decreasing for their practices too and they need to see a certain number of patients every hour to keep their practice running. To help make sure you get the correct documentation, Medicare allows your physician to refer the mobility exam portion to a physical or occupational therapist.
It is important to understand though that referring the exam is not a substitution for a face to face. You still must see the doctor in person for a visit to get a mobility device. Referring to the PT/OT will reduce the amount of documentation that the doctor must include though. Actually, I recommend you always have a therapy mobility evaluation to get the proper documentation. Should your physician choose to refer the mobility exam to another medical professional, he/she will need to sign the mobility exam and state that they concur with the findings of the therapist. Medicare calls this a “statement of concurrence” and it is very important.
Once your physician has received the report, signed it, and stated concurrence with the report, Medicare considers your Face to Face exam complete. They even call this the Face to Face Completion Date. This is a very important date for paperwork that comes later in the process.
Medicare Face to Face Summary
The face to face appointment is just one step in the process. It is also one of the most critical. It must be done correctly. There are no shortcuts! It is very important for determining which level of mobility product you qualify for.
Have questions? Drop them in the comments below or contact me for a private response.