PMD demo: Ask and you shall receive

Friday, October 26, 2012

WASHINGTON – CMS officials have extended an olive branch to power wheelchair providers who complain that they deny too many claims due to simple clerical errors.

During an Oct. 24 Open Door Forum for the PMD demo, CMS officials said providers may not have to resubmit prior authorization requests that have been denied due to clinical errors like a missing date or signature.

"The supplier may contact the DME MAC and inform them that there was a clerical error," said Doris Jackson, a health insurance specialist at CMS. "It is the DME MAC's sole discretion to determine if they will accept that information after reviewing the claim again and to determine if they're going to change that decision."

CMS officials updated the operational guide for the PMD demo to reflect this change and others. The demo kicked off in seven states in September.

During the forum, CMS officials also addressed a concern providers voiced during the first two months of the demo: inconsistency.

"Our goal is to be as consistent as possible," said Melanie Combs-Dyer, deputy director of CMS's Provider Compliance Group, in response to a caller's question. "We require that our contractors participate in an error reviewer reliability study every month." 

As part of that study, reviewers from all contractors score the same claims and share their outcomes to try to increase consistency, Combs-Dyer said. 

This was the final demo open door forum.

View the latest operational guide at