CMS revamps PMD demo, sets start date

Thursday, February 2, 2012

WASHINGTON - CMS will drop the prepayment review phase from its planned power mobility device demonstration, it announced today.

CMS also said that PMD providers will be allowed to submit prior authorization requests on behalf of physicians.The demo, announced in November, was originally slated to start Jan. 1. It will now start on or after June 1 in seven states--California, Texas, Florida, Michigan, Illinois, North Carolina and New York. The demo was delayed in late December after industry stakeholders, consumers and physicians raised concerns with the demonstration. 

Among those concerns: that the demonstration could create cash flow issues for providers, and access problems for beneficiaries.

Other changes in the demo: there will be a 60-day public comment period on reducing paperwork burdens; and the demo will start at the approximately the same time in all seven states. 

CMS said it will hold Open Door Forums prior to the implementation of the demo.

CMS today also announced that the Recovery Audit Prepay Review demonstration, which was also delayed from its Jan. 1 start date, will begin on or after June 1. 

The 11-state demo calls for RACs to review claims before they're paid to ensure providers have complied with Medicare payment rules. Claims included in that demo will include those that historically result in high rates of improper payments.

The Feb. 3 announcement is available here.





This is excellent news! Of course the devil is in the details and we need to see if CMS will provide a reasonable standard to the prior authorization process. But assuming the PA process is reasonable then this will be a win for our industry because it will take much of the uncertainty out of the process.

Also the 11 state RAC prepayment demo is for hospitals and not home medical equipment. This is a point of clarification that the article above did not provide.