CMS offers cover sheet, flowcharts for demo

Friday, March 23, 2012

WASHINGTON - The educational materials that CMS released last week shed some light on the logistics of the seven-state PMD demonstration project, but they could be more detailed, industry sources say.

During an Open Door Forum last week, CMS released draft versions of a cover sheet that providers will use as part of the prior authorization process, and several flowcharts describing the process.

Instead of a cover sheet that asks for provider, physician and beneficiary information and briefly outlines the required documentation, Don Clayback, executive director of NCART, would like to see a more detailed request form, much like the prior authorization forms used by Medicaid programs.

"We're not looking to add paperwork unnecessarily, but if that kind of form would expedite the processing, I think that's something CMS would be willing to look at," said Clayback, a member of the AAHomecare/NCART workgroup that provides feedback to CMS about the demo.

CMS officials are accepting feedback on the cover sheet and flowcharts at

Like Clayback, Peggy Walker, a billing and reimbursement adviser for U.S. Rehab, wants as much clarity as possible. For example, "other relevant medical documentation," one of the items listed as required documentation on the cover sheet, is too vague, she said.

"You're not supposed to assume anything, so I'd like to see the 'other relevant medical documentation' better defined," Walker said.

The flowcharts follow a claim through the prior authorization process, depict the DME MAC's decision-making processes, and illustrate the PT/OT's involvement in the service delivery process. These, too, need more detail, industry sources say.

"I think CMS is looking at the flowchart and saying, 'This captures the overview, and then people can refer to the LCD for more detail,'" said Clayback. "We think having more detail on the flowchart itself might help with the education process."

The key, industry sources say, will be to find a balance between not enough and too much detail, since the latter would create more confusion.

The next demo Open Door Forum is scheduled for April 26.

To view the cover sheet, go here.

To view the flowcharts, go here.