PA update: Docs may request decision letter

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Thursday, August 17, 2017

WASHINGTON – The prescribing physician/practitioner may contact the DME MAC to request a copy of the prior authorization decision letter, CMS has announced. The request for the letter may be included with the documentation sent to the provider as part of the prior authorization request, or may be made separately. The DME MAC will not automatically send the letter. AAHomecare, which has expressed concern with the lack of physician involvement in the correspondence of the PA decision, applauded the change. “Unlike the PMD demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision,” the association stated. “AAHomecare thanks CMS for the opportunity to provide feedback and for implementing a crucial modification to the program.” In July, providers in all states began submitting prior authorization requests for two complex rehab codes, K0856 and K0861.