Early results mixed, but optimism reigns

Wednesday, October 24, 2012


HME News reached out to providers in September to find out how the PMD demo was going.

The verdict: “It’s too soon to tell.”

Providers in seven states began submitting prior authorization requests for power mobility devices Sept. 1. Medicare has 10 days to reply to those requests, so many providers still hadn’t heard back by press time. 

“I’m cautiously optimistic,” said Doug Westerdahl, CEO of Rochester, N.Y.-based Monroe Wheelchair. “I’m very hopeful it goes as smoothly as CMS said it would.”

Unfortunately, early results for other providers weren’t promising.

“The Medicare prior authorization program, to date, has denied virtually all the claims submitted by The Scooter Store,” Michael Clark, senior vice president and general counsel told senators during a Sept. 19 congressional hearing. 

Another provider echoed that sentiment. Every request he’s submitted so far has been denied based either on a technicality or subjective interpretation of “ambiguous requirements.” He even had a claim denied for lack of a HCPCS code even though the claim had a HCPCS code on it. 

“This is pure insanity,” he said. 

AAHomecare has been tracking the demo and already has spotted a troubling trend: Denials that weren’t based on the local coverage determination. CMS contractors were requiring the seven-element order and the detailed product prescription to be signed two days apart.

AAHomecare also stated that some providers aren’t getting decisions back from CMS within the promised 10-day timeframe.