CMS schedules call for PA process

Friday, March 10, 2017

WASHINGTON – After two cancellations, CMS has scheduled a Special Open Door Forum to discuss the prior authorization process for two complex rehab codes.

The agency’s Center for Program Integrity will host the first in a series of Special Open Door Forums on March 16 to invite suppliers, physicians and other Medicare practitioners or interested parties to discuss the implementation of the prior authorization process for K0856 and K0861. CMS began accepting prior authorization requests for these two codes on March 6 for dates of delivery on March 20.

CMS cancelled a previous Special Open Door Forum on this topic scheduled for January. It then removed the topic from the agenda of a general Open Door Forum in February.

During the forum, CMS says it will outline the process for submitting a prior authorization request to the designated Medicare Administrative Contractor, the timeframes for the MAC to render their prior authorization decisions, and the process for subsequent claims submissions.

To participate in the forum, scheduled from 2 p.m. to 3:30 p.m. EST, dial 800-837-1935 and use the ID 85144406.