When physicians are ordering power mobility for their patients, there is one form that is often the catalyst for many bumps in the road - the 7 element order. This 7 element order serves as the prescription for the power mobility device, and unless executed properly, a denial for an invalid order will inevitably result.
What are these standards?
In addition to National and Local Coverage Determinations, Policy Articles and an assortment of other resources available from CMS, here is a quick reference explaining each of the elements of the 7 element order, as well as answers to some of our most frequently asked questions surrounding the 7 element order.
1. Beneficiary or Patient Name
The prescribing physician must complete the 7 element order in its entirety. No exceptions.
Make sure that the patient name you list matches the rest of your medical record as well as the beneficiary name that Medicare has on file.
2. Face to Face Completion Date
The in-person visit (with the physician) and the mobility evaluation (with the therapist) are often referred to as the complete face-to-face examination.
The results of both components are combined to address Medicare’s power mobility algorithm in its entirety.
Either the date of the physician’s visit, or the date of the physician’s signature and concurrence with the therapist’s evaluation - whichever date is the latest in sequence - is considered to be the completion of the face-to-face, or F2F completion date.
3. Equipment Recommended
Remember this is a prescription, or order, for a power mobility device or power wheelchair. Either of those terms, or their abbreviations (PMD or PWC), is perfectly acceptable for Medicare.
4. Diagnosis or conditions related to the need for the power mobility device
The mobility-related diagnosis and any other conditions that directly impact mobility are sufficient. The physician does not need to list
ICD-10 codes, but they can if they wish. For example, narrative descriptions such as ALS or MS are fine.
5. Length of need
Medicare will not purchase a power mobility device for a short-term condition that is expected to resolve. Terms such as “lifetime” or “99 months” support lifetime mobility needs and communicate these needs to Medicare on your prescription.
6. Physician’s signature
The physician who performed the face-to-face mobility examination (ordering physician) must complete and sign with a valid signature. Ink or valid electronic signatures only – no stamps.
7. Date the physician signed the 7 element order
The date the physician completed and signed the 7 element order. This date can be the same as, or later than, the face-to-face completion date.
Frequently Asked Questions
1. Can the supplier, a nurse, or a medical assistant in my office complete the 7 element order for me?
The supplier may provide a template listing the 7 required elements, but is prohibited from completing any part of the 7 element order.
The ordering physician must personally complete the 7 element order; no one else in their office can complete. Reference the CMS Program Integrity Manual or Local Coverage Determination (LCD): Power Mobility Devices (L33789) for more details. https://www.cms.gov/medicare-coverage-database/details/lcd-details
2. I sent in the 7 element order, but now there’s another piece of paperwork that was sent to my office. Why wasn’t this “Detailed Product Description” included in the initial request?
Due to Medicare guidelines, the supplier must receive your 7 element order, mark it received with a date stamp within 45 days of the face-to-face completion date, and then generate and send the Detailed Product Description to the physician for signature and date. Medicare routinely checks that these dates all in alignment in their review and auditing processes.
3. Is a typed 7 element order acceptable? (Ex: a PDF that my medical assistant could complete and I’d sign.)
In a word – no. Medicare will accept true electronic 7 element orders - those that are integrated into electronic medical record systems as electronic prescriptions that show an audit trail - the physician completed it and electronically signed and dated. A PDF copy would not contain those elements and would not illustrate to Medicare that the physician completed the form on his/her own. This would result in a denial.
4. The physician that performed the patient’s face-to-face examination left our practice. Can the new doctor who is taking over the caseload write the 7 element order?
Not without seeing the patient for a face-to-face examination themselves. Medicare is very specific in their interpretation of this guideline. They must examine the patient for their power mobility needs.
Understanding Medicare’s guidelines for the 7 element order is the key to less frustration with the technical paperwork components required in Medicare’s power mobility process.
Like any other prescription, a 7 element order must be correct in order for the item to be authorized, dispensed and, ultimately, funded by Medicare. One element at a time, cleaner, faster orders can be achieved!
- CMS: Program Integrity Manual: 5.9.2 - Evidence of Medical Necessity: Wheelchair and Power Operated Vehicle (POV) Claims (Rev. 242: Issued: 02-22-08; Effective/Implementation Dates: 03-01-08) https://www.cms.gov/RegulationsandGuidance/Guidance/Manuals/downloads/pim83c05.pdf
- CMS: Local Coverage Determination (LCD): Power Mobility Devices (L33789) https://www.cms.gov/medicare-coveragedatabase/details/lcd-details.