Why have PMD referrals from physicians declined?

Date Published: April 30 2015

Many physicians – as many as 60 percent nationwide - have stopped referring PMD because of limited understanding about PMD documentation, lack of time and low reimbursement.

A routine physical exam does not cover all the criteria CMS is requiring to be documented for a PMD referral. For example, a routine physical exam may not address the patient’s ability to maintain postural stability, which is necessary to address when prescribing a scooter. Many non-affirm decisions are a result of a physician not properly documenting a data point that CMS is looking to have addressed during the patient encounter.

According to a 2013 survey by the American Academy of Family Physicians, doctors spend 34.1 hours in direct patient care each week, about 22 minutes per encounter, with an average of 2,367 people under each physician's care; 19 patients per day. Physicians don’t have time to complete PMD paperwork once, let alone twice.

Physicians must balance patient care with being profitable. Completing paperwork doesn’t make money, but does take time. CMS has attempted to reduce this burden by encouraging electronic templates to gather the necessary documentation. In addition CMS provides reimbursement to the physicians for completing the extra paperwork for prescribing PMD. They may bill the G0372 for providing the initial documentation and if the physician is located in a PA Demo state and they submit the PA request they can bill G9156. The real question is “how can I get physicians to start referring PMD again?” 

From our expertise with face-to-face documentation we have found that DME suppliers and referral sources are fast to adapt when specific objective criteria and standards are implemented and adhered to consistently. Empowering physicians to effectively do their part from a documentation standpoint requires readily available information during the patient encounter illustrating what CMS is looking to have substantiated for the PMD. A standardized online documentation tool, with Medicare coverage criteria built into the program that is quick and easy to use during an exam, fills the DME documentational void.

- Jamie Loper, ATP, Chief Compliance Officer,, can be reached at or 800-986-9368.

Back to news

What people are saying

" is the perfect solution to time management and accurate documentation," James Smith, M.D.