PMD demo: Spending plummets across the country

Tuesday, October 22, 2013

WASHINGTON – CMS has cut spending for power mobility devices by more than half since the PMD demo began, according to a Sept. 28 update

According to the update, spending in the seven demo states dropped from $11 million in September 2012 to $5 million in June 2013. 

In non-demo states, spending also declined, from about $20 million in September 2012 to about $11 million in June 2013.

“We believe many national suppliers have adjusted their billing practices nationwide and are now complying with CMS policies based on their experiences with prior authorization in the demonstration states,” CMS states in the update.

CMS began requiring providers in California, Illinois, Michigan, New York, North Carolina, Florida and Texas to submit prior authorization requests for power mobility devices in September 2012. 

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 requests were submitted electronically.

About 51% of the prior authorization requests did not qualify for the benefit—a statistic that CMS says illustrates the need for the demo.