Despite challenges, ‘so far, so good’ for lookup service, CMS says

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Friday, January 17, 2020

WASHINGTON – Getting providers to participate in a pilot Documentation Requirement Lookup Service has been a challenge, CMS officials said during a Special Open Door Forum on Jan. 16.

The service, which was launched in 2018 and is still being tested, pulls together existing requirements currently scattered among various manuals, National Coverage Determinations and Local Coverage Determinations, and presents them in a machine-readable format within the electronic health record, according to the agency.

“It has been a bit of a challenge finding participation on the provider side—it’s been much easier on the payer side,” said one official during the call, in response to a question from a caller.

A big part of the problem with getting more provider participation: limited use of EHRs and the use of different EHRs, said CMS officials. They can’t integrate with the EHR standards being used in the pilot program.

Despite the challenges, overall, early feedback on the service has been good, said CMS officials.

“So far, so good,” one official said.

Other updates from the forum:

A survey of EHR vendors, payers and clinicians/providers found that payers typically don’t make documentation and prior auth requirements publically available; providers must go to multiple sources for requirements; and that communication between payers and providers most often takes place via phone, fax or mail, rather than EHRs.

Clinicians/providers also favor physician alerts that better address DME eligibility for patients.