PMD demo: Approval rate improves

Tuesday, October 16, 2012

GWCC – A month and a half into the PMD demo, things are looking up, says Seth Johnson, vice president of government affairs for Pride Mobility Products.

"We've been tracking the demo quite closely," said Johnson during his Tuesday session, "Complex Rehab and Mobility Industry: Legislative & Regulatory Update." "It sounds like things are moving in the right direction."

Johnson has collected data on the seven-state demo ever since providers started submitting prior authorization requests for power mobility on Sept. 1.

Of the 115 prior authorizations he's tracked, nearly 60% have been successful.

The reason for many of the early denials: The seven-element order was dated before Sept. 1, Johnson says, excluding them from the demo. Other denials haven't been for valid reasons, he says. For example, reviewers have missed date stamps and have looked for items the LCD doesn't require, like an ICD-9 code in the physician's records.

The good news, Johnson says, is that reviewers have been open to dialogue with providers, and many issues have been resolved through phone conversations.

"It appears as though reviewers are doing what they need to do to get this process right," he said.

So far, 11 of the 12 providers that have resubmitted claims after having prior authorizations denied have passed the second time around, Johnson says.

Another positive note: Providers have been able to use templates without trouble, Johnson says.

"They've been extremely helpful," he said. "I'm very pleased with the direction Medicare is continuing to move in with the prior authorization process."

Providers going through the prior authorization process can share their outcomes with Johnson at