How's the demo going?


I've been asking providers for three weeks now how the PMD demo is going. Also on the to-be-bothered list are the usual suspects in mobility – Simon Margolis of NRRTS, Don Clayback at NCART, Seth Johnson at Pride… I've even asked Walt Gorski at AAHomecare.

And, until this week, the story from providers and industry leaders was always the same: "It's too soon to tell."

One exception: Last week, we heard The Scooter Store testify at a congressional hearing that all of its prior authorization requests had been "non-affirmed." (How's that for some new industry jargon?)

This week, during the PMD demo Open Door Forum, I hoped CMS would give us some insight into how the demo's going. Not so much. I did hear from Monroe Wheelchair that they'd received some responses, and they were affirmative. 

This week's AAHomecare update says the agency has tracked prior authorization decisions and they're seeing a troubling trend: demanding something that's not outlined in the LCD, "requiring the date of the seven-element order and a detailed product description to be two days apart."

AAHomecare also says that the 10-day timeline providers were promised for a decision turnaround hasn't always held up. 

I also got an email this morning from a provider who says every request he's sent in has been denied based either on a minute technicality or subjective interpretation of ambiguous doctor’s requirements—not for, you know, fraud. So he's frustrated, especially with a claim denied for lack of a HCPCS code that, um, has a HCPCS code on it. 

"This is pure insanity," he told me. He requested his name be left out of anything I write. 

So how's the demo going so far? Well, even with these reports, the answer may still be, "too soon to tell."

Providers will have to get used to a new system and the newly-hired Medicare contractors will have to brush up on what the LCD specifies. 

Here's hoping that the CMS's goal of a prior authorization system that actually makes providing PMDs easier for good providers and harder for people trying to commit fraud happens—and soon. That's something both CMS and the industry want.