Dicianno Brad E, Tovey Elyn
Department of Physical Medicine and Rehabilitation Institute for Rehabilitation and Research and Center for Assistive Technology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Arch Phys Med Rehabil. 2007 Jun;88(6):807-16. doi: 10.1016/j.apmr.2007.03.024.
The Centers for Medicare and Medicaid (CMS) issued a new national coverage determination (NCD) for mobility assistive equipment (MAE) including wheelchairs in May 2005. CMS then issued a Final Rule in April 2006 that outlined significant changes required for documentation for prescribing MAE. Other insurance providers have since adopted and sometimes modified the NCD criteria and have begun to apply these criteria according to their own interpretations because some of the criteria are vague. In this report, we introduce a case example to show the components of the CMS NCD criteria, what was intended but poorly described in the language, how insurance providers may misinterpret or alter the criteria, and how clinicians can act as advocates.
医疗保险和医疗补助服务中心（CMS）于2005年5月发布了一项针对包括轮椅在内的移动辅助设备（MAE）的新的全国覆盖范围判定（NCD）。CMS随后于2006年4月发布了一项最终规则，概述了开具MAE所需文件的重大变化。此后，其他保险提供商采用了NCD标准，有时还对其进行了修改，并开始根据自己的解释应用这些标准，因为其中一些标准不够明确。在本报告中，我们介绍一个案例，以展示CMS NCD标准的组成部分、其意图但在措辞中描述不佳的内容、保险提供商可能如何误解或改变这些标准，以及临床医生如何充当倡导者。
