Providers debate prior auth proposal

Friday, June 13, 2014

YARMOUTH, Maine – A majority of HME providers welcome the idea of prior authorizations for certain DME, but they say Medicare’s proposed timeline for returning decisions is unreasonable.

Sixty-nine percent of the 160 respondents to a recent HME Newspoll think CMS’s proposal to implement a prior authorization process for certain DME is a good idea. Eighty-four percent say they already go through a similar process with other payers, anyway.

“It would save so much time and money because it should reduce the amount of audits,” said Stan Grilliot of Hutchinson, Kansas-based Health-E-Quip.

But as always, the devil is in the details. In a proposed rule published in the May 28 Federal Register, CMS says it will make a “reasonable effort” to issue decisions on prior authorizations within 10 days.

Sixty percent of poll respondents say that’s not fast enough.

“This is yet another example of the disconnect between CMS and the real world,” said one respondent. “Medicare beneficiaries who meet the coverage criteria need the equipment now, not 10-plus days from now.”

Other providers think adding a prior authorization process is overkill.

“Current mandates, such as the face-to-face and detailed written order requirements, provide the oversight that focuses on working together to provide appropriate health care,” said Cindy Marvin of Canton, Ohio-based Aultman Home Medical Supply. “This would add an additional layer of unnecessary work on an industry already struggling with providing services to a challenging population.”

But if prior authorizations provide some protection from audits, the extra steps would be worth it, say many providers.

“I’d rather have my documents reviewed before I release the product to the patient any time,” said Lori Sears of Active Home Medical Supply in Lapeer, Mich. “I simply can’t afford to lose an audit so I support any plan that reduces that risk.”