CMS dishes on new prior auth proposal

Friday, June 20, 2014

WASHINGTON – CMS officials last week acknowledged that some providers feel “angst” about prior authorizations (PAs), but they say, given a chance, the process will prove beneficial.

“We know there is some level of angst out there about this new process,” said Connie Leonard, acting deputy director of the Provider Compliance Group, during a Special Open Door Forum June 17. “That’s understandable.”

CMS scheduled the call to provide information “on all of the prior authorization initiatives.” In the May 28 Federal Register, the agency outlined its plans to implement a PA process for certain DME.

During the call, however, officials didn’t provide any specific information on DME. They did, however, try to address some common questions, including whether there would be a form (no) and whether claims with a PA attached would be subject to audits (unlikely).

“It goes for most, if not all of the PA affirmations, that a claim that has the PA decision isn’t typically reviewed again,” said Leonard. “That’s some peace of mind for the supplier that, three years later, Medicare is not going to come looking for the claim.”

CMS officials also discussed the PMD demo project, which it will expand to an additional 12 states. They said the agency remains committed to its continued success.

“We do have frequent meetings with the MACs to be sure things are running smoothly,” said one official. “We do spot checks to make sure everything is appropriate.”

It’s the success of that project that’s pushing CMS to implement PAs for other equipment, Leonard said.

“Some of you may remember that you did not want this and thought it was the worst thing that ever happened to Medicare,” she said. “Today, CMS believes that, for the most part, most suppliers actually like the demonstration or would like to be part of it.”

CMS is accepting comments on the proposed rule until July 28.