Demo needs tweaks

Friday, May 24, 2013

The PMD demo could work in other states, say stakeholders—if a few key changes are made. 

“As a provider from Pennsylvania, I would welcome it in my state,” said John Letizia, owner of Laurel Medical Supplies in Ebensburg, Pa., and outgoing chair of the Complex Rehab Mobility Council. “But there are still some issues to work out.”

Among them, he said: Doctors need better documentation and communication tools.

Those are the industry’s main complaints since CMS began requiring prior authorizations (PAs) for power mobility devices in seven states Sept. 1, 2012. 

Stakeholders want a tool like the private sector uses for prior auhtorization systems—a document that outlines what Medicare requires to prove medical necessity. Using it would also ensure consistency among reviewers, stakeholders say.

“We need a standardized documentation collection tool in order for reviewers to have the information they need to make a coverage decision,” said Seth Johnson, vice president of government affairs for Pride Mobility.

Peter Rankin, manager of government affairs for AAHomecare, would also like to see more use of the Electronic Submission of Medical Documentation (esMD) tool, which allows users to submit information back and forth electronically. Providers can submit requests through esMD, but CMS doesn’t send back responses through the system.

“The MACs are sending faxes or letters back,” said Rankin. “I’d like to see two-way electronic communication.”