Demo set to arrive in 12 new states

Friday, September 12, 2014

YARMOUTH, Maine – CMS’s PMD demo is set to arrive in 12 new states in just a few weeks and, for the most part, providers are welcoming it with open arms.

“One of our primary vendors is doing some education on it,” said James Rogers, CEO of Phoenix Rehab and Mobility in Hixson, Tenn., one of the states being added to the demo. “The feedback we’ve received from them is this has been a positive development in the industry and should help out as far as the audits.”

The demo, which requires providers to submit prior authorizations for PMDs, started in seven states in 2012 and is expanding to Pennsylvania, Ohio, Louisiana, Missouri, Washington, New Jersey, Maryland, Indiana, Kentucky, Georgia, Tennessee and Arizona.

Two big reasons for the comfort level of providers in these new states: First, they’re used to submitting prior authorizations for other payers; second, they figure CMS has gotten any bugs with the demo worked out by now.

“We’re not the guinea pigs, so we should be able to flow right into that,” said Bob Miller, president and CEO of Hackettstown, N.J.-based Bach’s Home Health Care.

There are some providers, however, that have heard mixed reviews of the demo, depending on the region. They’re taking a wait-and-see approach before rendering a verdict.

“I think that as long as the process can happen quicker than advanced determination of Medicare coverage, I’m all for it,” said Peter Norman, owner of Bellevue, Wash.-based Bellevue Healthcare. “I’m cautiously optimistic about it, with cautious probably the right emphasis.”