Full steam ahead for PMD demo

Friday, August 31, 2012

WASHINGTON – Despite protest from HME stakeholders, CMS officials stated during an Open Door Forum Aug. 29 that a new power mobility demonstration project would kick off as scheduled Sept. 1.

AAHomecare on Aug. 27 called for CMS to start the demo 30 days after it released a final version of instructions. CMS released those instructions during the forum.

“We’re very excited (to get) started,” said Melanie Combs-Dyer, deputy director of the Provider Compliance Group at CMS.

The three-year demo, which requires providers to go through a prior authorization process for all PMD claims, kicked off Sept. 1 in seven states.

CMS may have kept to its schedule, but it made several other changes to the demo that took into consideration industry feedback. One of the biggies: CMS will not prohibit the use of templates to facilitate record keeping. Officials had hinted at this during previous forums, but the language is now officially included in the instructions as part of Appendix G.

Other changes:

• Accessories: Providers should send in documentation for accessories with their prior authorization requests for bases to help establish medical necessity. (Accessories will not be approved or denied during the process, however.)

• Upgrades: Providers should submit a prior authorization request for the equipment the beneficiary qualifies for, not the upgraded equipment. 

• Change in providers: Prior authorization decisions will follow a beneficiary if he or she changes providers.

Additionally, CMS added a new section, Appendix F, which outlines the rules about amendments and corrections to progress notes, orders and other documentation.

As for a electronic clinical template to help physicians document a patient’s medical need: While stakeholders would have preferred to have the template available in time for the demo, they’re pleased that CMS plans to have it up and running some time in the fall.

The next demo Open Door Forum for the demo is scheduled for Sept. 26 at 2 p.m. 

FMI: go.cms.gov/pademo.