At Ethos Therapy Solutions, we aim to make it easy for patients and caregivers to fully understand what they need to be eligible for our support surfaces. The following checklist walks you through the requirements for a Group 3 pressure-reducing support surface.
Detailed Written Order
Although the Center of Medicare & Medicaid Services (CMS) outlines acceptable requirements for a Dispensing Order, Ethos policy requires all necessary criteria to be captured in the form of a Detailed Written Order.
- The date of the order
- The treating physician/practitioner’s name
- The treating physician/practitioner’s signature
- Handwritten or electronic AND
- In accordance with CMS Signature Requirements
-Legible full signature OR
-Illegible signature over a typed/printed name OR
-Other acceptable signatures at http://www.cgsmedicare.com/jc/pubs/news/2010/0410cope12069.html
- The date the treating physician signed the order (personally entered by physician).
- A clear, detailed description of the type of support surface the physician is ordering.
- Any changes or corrections have been initialed/signed and dated by the ordering physician.
Medical Records
- The medical record includes a face-to-face examination by the treating physician that meets the following requirements:
- The examination happened within 6 months prior to the date of the written order that was obtained prior to delivery
- The examination documents that the beneficiary was evaluated and/or treated for a health condition that supports the need for an air fluidized bed
- The medical record documents a discussion between the physician and the patient/caregiver about the surface options where the patient/caregiver agreed to use of the therapy surface
- The medical record supports that the beneficiary meets all the following criteria:
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- The beneficiary has a stage III (full-thickness skin loss) or stage IV (deep tissue damage) pressure ulcer
- The beneficiary is bedridden or chair-bound as a result of severely limited mobility
- Without an air-fluidized bed, the beneficiary would require institutionalization
- The air-fluidized bed is ordered in writing by the beneficiary’s attending physician based upon a comprehensive assessment and evaluation of the beneficiary after completion of a course of conservative treatment
- The evaluation generally must be performed within one month prior to initiation of therapy with the air-fluidized bed
- The course of conservative treatment was at least one month in duration without progression towards wound healing
- This month of prerequisite conservative treatment may include some period in an institution if there is documentation available)
A physician directs the home treatment regimen and reevaluates and recertifies the need for the air-fluidized bed on a monthly basis. All other alternative equipment has been considered and ruled out.
Treatment Requirements
Conservative treatment should include all of the following six elements:
- Frequent repositioning of the beneficiary with particular attention to relief of pressure over bony prominences (usually every 2 hours)
- Use of a Group 2 support surface to reduce pressure and shear forces on healing ulcers and to prevent new ulcer formation
- Necessary treatment to resolve any bacterial infection or other complication
- Optimization of nutrition status to promote wound infection
- Debridement by any means, including wet-to-dry gauze dressings, to remove devitalized tissue from the wound bed
- Maintenance of a clean, moist bed on granulation tissue with appropriate moist dressings protected by an occlusive covering, while the wound heals
Occlusive Barrier
An occlusive barrier is required, when necessary, to maintain a moist wound-healing environment that may otherwise be compromised by the drying action of airflow generated by air-fluidized therapy.
If moist dressings are NOT required because of the wound characteristics (e.g. heavily exudative wound), the occlusive barrier is not required as a condition for reimbursement.
Wet-to-Dry Dressings
Use of wet-to-dry dressings for wound debridement, begun during the period of conservative treatment and which continue beyond 30 days, will not preclude coverage of an air-fluidized bed. When used for debridement, wet-to-dry dressings do not require an occlusive dressing.
Should additional debridement again become necessary while a beneficiary is using an air-fluidized bed (after the first 30-day course of conservative treatment) that will not cause the air-fluidized bed to be denied.
Additional Treatment Recommendations
Conservative treatment should generally include:
- Education of the beneficiary, caregiver, and family members on preventive measures and management of pressure sores
- Assessment by a physician, nurse, wound care specialist, or other licensed healthcare professional at least weekly
- Appropriate management of moisture/incontinence
- A trained adult caregiver available to assist the beneficiary with activities of daily living, including:
- Fluid Balance
- Dry Skin Care
- Repositioning
- Recognition & Management of Altered Mental Status
- Dietary Needs
- Prescribed Treatments
- Management & Support of the Air-Fluidized Bed System and its Problems
Documentation Requirements for Continued Coverage Beyond the First Month
- The size of the ulcer
- If the ulcer is not healing, what other aspects of the care plan are being modified to promote healing
- Continued use of the bed is reasonable and necessary for wound management
This monthly physician statement must be kept on file by the supplier and be available for inspection upon request. Continued use is covered until the ulcer is healed.
Discover Pressure Injury Support Solutions with Ethos
Our mission is to help at-risk patients find the support surface that’s the right fit for their treatment plan. With air fluidized beds, immersion beds, and mattress replacements & overlays available, we are proud to support patients across the United States. Contact our team or give us a call to begin your Ethos journey today.