CMS answers questions about PMD demo

Friday, August 15, 2014

WASHINGTON – CMS officials assured providers during a Special Open Door Forum last week that there won’t be any surprises when the PMD demo rolls into 12 new states Oct. 1.

Coverage and documentation requirements will be the same as in the seven original states, they said.

“The question is, ‘What’s new in this expansion?’ and the answer is, ‘Just the additional states,’” said Dr. Dan Schwartz, chief medical officer of the Survey and Certification Group at CMS. 

The expansion will require prior authorization requests for PMDs in Arizona, Maryland, Georgia, Indiana, New Jersey, Kentucky, Louisiana, Missouri, Ohio, Pennsylvania, Tennessee and Washington. The original states are not affected by the expansion.

Providers also wanted to know more about the timing of the demo’s start.

“We can’t submit the paperwork until Oct. 1 and can’t deliver until after Oct. 1,” said Stacy Lewis of CG Medical Family Health. “Do we make the beneficiaries wait, or submit prior to that and deliver later?”

A CMS official’s response: The demo applies to all seven-element orders signed by doctors on or after Oct. 1.

CMS officials also reviewed the logistics of the demo. The DME MACs have 10 business days to postmark their written decisions to prior authorization requests, and 20 days to consider and make determinations on resubmissions of denied requests.

A provider asked if the demo would provide protection from post-payment audits. Generally, the prior authorization process would exclude a provider from post-payment audits, Schwartz said.