CMS puts demo details on paper

Friday, May 4, 2012

WASHINGTON – CMS last week released a draft version of an operational guide for the seven-state power mobility device (PMD) demonstration project.

Providers called in to an Open Door Forum May 3 to hear CMS review the draft, which details how the demo’s prior authorization process will work.

"You hear us answer lots of your questions on these phone calls and on the website in the FAQs, but we really want to have a one-stop-shop to lay out all of the details," said Melanie Combs-Dyer, deputy director of the Provider Compliance Group at CMS. "It's a bit of a skeleton but, nonetheless, we wanted to put it out early and get your input. We recognize that a lot is still missing."

The 16-page document details, among other things, what codes are included in the demo, how prior authorization requests should be submitted, and what to do when a request is affirmed or denied.

CMS has held three open door forums so far dedicated to the demo. Still, providers continue to voice confusion and concerns. 

Among the questions asked during last week’s forum: What’s the point of the demo if it doesn’t prevent audits? CMS officials reiterated that it would lessen the likelihood of a pre-pay review from the DME MAC, unless the contractor reviews information outside of the prior authorization request, like a home assessment.

Another caller asked whether the added step of submitting prior authorization requests would mean providers have more time to deliver equipment to patients. CMS officials stated all current timeframes remain the same. 

One concern that keeps coming up: Possible confusion resulting from base units being included in the demo, but not accessories. CMS officials stated they would take this under advisement.

The next Open Door Forum on the demo is 3-4:30 p.m. EST May 31.

The operational guide is available at