CMS offers further analysis of PMD demo

Wednesday, January 8, 2014

BALTIMORE - CMS reported in December that its power mobility device (PMD) demonstration project brought down overall expenditures in seven states from $12 million in September 2012 to $4 million in September 2013. Expenditures in non-demo areas fell from $20 million to $9 million during the same timespan. In demo states, the agency estimates it saved $10.3 million through denials of claims without prior authorizations, $350,000 through non-affirmed requests, and $876,909 through claims whose denials were upheld under reconsideration. CMS says the agency's spending fell, in part, because providers have been better educated and have adjusted their billing practices. “While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” the agency stated. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.”