PMD data not clear-cut, stakeholders say

Friday, October 25, 2013

WASHINGTON – Spending on power mobility devices in seven states has dropped nearly 50%, from $20 million in September 2012 to $11 million in June 2013, according to a recent CMS update on the PMD demo.

But the demo, which kicked off in September 2012, is only one factor causing spending to nosedive, industry stakeholders say.

“There have been quite a few changes in this space, including Round 2 of competitive bidding and the largest provider of this equipment (The Scooter Store) going out of business,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “There are other forces in play.”

Previously, CMS had reported that spending on power mobility devices in those states fell from about $15 million in January 2012 to $7 million in December 2012.

The most recent update also states 51% of prior authorizations submitted through the demo did not meet Medicare’s requirements. Again, that figure’s misleading, industry stakeholders say.

“Fifty one percent seems like an odd number,” said Peter Rankin, government affairs manager at AAHomecare. “It wouldn’t surprise me if that was the error rate for the initial prior authorizations. That’s how they generate other error rates—they don’t take into account overturned denials.”

Stakeholders say more specific data is needed to get a true picture of the demo’s progress.

“I’d like for the prior authorization denials to be broken down,” said Don Clayback, executive director of NCART. “How many were denied because the beneficiary doesn’t need power mobility; how many because the physician documentation isn’t there; and how many were for technical reasons, like a signature or date in the wrong spot?”

Also included in the update: As of August 2013, providers have submitted prior authorization requests for more than 27,500 Medicare beneficiaries. More than 1,650 of those were submitted electronically.

Previously, CMS had reported that, as of March 2013, providers had submitted requests for 12,000 Medicare beneficiaries. About 700 of those were submitted electronically.