News Briefs

Fixed performance areas for random JCAHO surveys

The fixed performance areas for random, unannounced surveys of home care organizations by the Joint Commission on Accreditation of Healthcare Organizations in 2005 are: assessment and care/service, patient safety, information management, and the 2005 National Patient Safety Goals that are applicable to home care. The Joint Commission has conducted one-day surveys at a randomly selected 5% of accredited organizations since 1993. The Joint Commission also posted a clarification to the national patient safety goal related to infusion pumps. It is acceptable to have "pre-assembled" free-flow protective mechanisms, rather than "intrinsic" free-flow protection, on intravenous administration sets used with infusion pumps.

CMS codes, coverage for wheelchairs and scooters

In its continuing effort to improve Medicare coverage and payment for power wheelchairs and scooters while protecting the Medicare program and taxpayers from abuse, the Centers for Medicare & Medicaid Services (CMS) recently released draft coverage criteria, the National Coverage Decision (NCD) for these devices, as well as new codes to ensure proper payment.

Medicare’s proposed coverage criteria would rely on clinical guidance for evaluating whether a beneficiary needs a device to assist with mobility, and if so, what type of device is needed. This new approach would replace an older, more rigid standard that relied on whether a patient was "nonambulatory" or "bed- or chair-confined." The analysis begins with whether the beneficiary has a mobility limitation that prevents him or her from performing one or more mobility-related activities of daily living in the home.

The evaluation includes the consideration of whether an assistive device — a simple cane, a sophisticated power wheelchair, or anything in between — would improve the beneficiary’s ability to function within the home. The criteria also take into account any conditions, such as visual or mental impairment, that would affect the beneficiary’s ability to use the mobility equipment effectively.

CMS plans to publish the final NCD in March and to provide guidance on how to use and document the new criteria. It also is establishing new billing codes for power wheelchairs and scooters to assure that Medicare pays appropriately for these devices. To better reflect the range of power mobility products now available on the market, Medicare will expand the number of codes used for billing from five to 49. The more detailed coding will help get the right products to patients and improve Medicare’s ability to pay suppliers appropriately. The codes go into effect Jan. 1, 2006.

The proposed NCD will be posted at www.cms.hhs.gov/coverage. A description of the new billing codes for wheelchairs will be posted at www.cms.hhs.gov/suppliers/dmepos.