What’s behind PMD demo denials?

Tuesday, November 5, 2013

INDIANAPOLIS – Prior authorization requests submitted as part of the PMD demo are being denied because of conflicting information in face-to-face examinations and other medical records, and insufficient face-to-face examination information, National Government Services announced in a recent bulletin. The list of reasons covers denials as of Oct. 24. NGS says face-to-face exams often do not specify: how a PMD will sufficiently improve the beneficiary’s daily life; the patient’s mobility limitations, the beneficiary’s ability to get into and out of a PMD; the beneficiary’s mental or physical ability to operate the device; or the beneficiary’s ability to stay stable while using the device. Other face-to-face exams neglect to include the beneficiary’s weight, NGS says.