Tag: Prior auths

MINNEAPOLIS – United Healthcare will extend the temporary suspension of certain prior authorization requirements for in-network hospitals and skilled nursing facilities through Jan. 31, AAHomecare reports. They were originally set to expire Jan. 8. The suspensions include COVID-19 oxygen-related requests. In those cases, oxygen can be delivered without a prior auth and does not need to meet current clinical criteria. UCH also noted that it may perform retrospective reviews for services...

WASHINGTON - Starting Aug. 3, auditors will restart their audit functions, according to a recently published FAQ from CMS.If selected for review, HME providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness, states the guidance.CMS says all reviews will be conducted in accordance with statutory and regulatory provisions, as well as related billing and coding requirements. Waivers and flexibilities in place at the...

WASHINGTON - CMS has issued guidance for its new prior auth program for lower limb prostheses and sought to reassure providers that it would closely monitor implementation.CMS officials during a Special Open Door Forum March 11 also sought to reassure participants that, for the most part, it will be business as usual.“The policy hasn't changed and the way the DME MACs will review these claims will be exactly the way we've done so over the last few years,” said one official.Among the new...

WASHINGTON - CMS has implemented a shorter, five-day turnaround time for prior authorizations for support surfaces, but there are no changes to the coverage criteria, CMS officials said during a Special Open Door Forum on June 4.The agency will turn around expedited PA requests for support surfaces in two days, it says.“We realize that the support surfaces process is a lot different than with power mobility,” a CMS official said during the call. CMS announced in April that it planned...

WASHINGTON - Industry stakeholders expect it to be mostly business as usual on Sept. 1, when CMS is set to expand a demonstration project requiring prior authorizations for standard power mobility devices nationwide.Prior authorizations for these devices were previously required in 19 states.“We remain optimistic because the demonstration has been mostly successful so far,” said consultant Sylvia Toscano, owner of Professional Medical Administrators.Already part of the National PA Program:...

WATERLOO, Iowa - The VGM Group has released the results of a “Delivery Cost Survey” that puts into perspective how costly it is for HME providers to provide patients with the necessary equipment.In New England, for example, providers report that it costs them $22.43 in vehicle costs per delivery and $18 in labor costs per hour, according to the survey. When you take into account the 23.33 miles from business to home and the 31.67 minutes it takes for in-home set up, that's an average...

WASHINGTON - Round 2 of Medicare's competitive bidding program does not appear to have impacted access to oxygen or enteral supplies for most beneficiaries, according to two new reports from the Office of Inspector General.The OIG analyzed claims data from three months before and six months after the July 1, 2013, kick-off of the program in both CBAs and non-CBAs.For oxygen, the OIG found that Medicare payments continued for 86% of beneficiaries in CBAs and 89% of beneficiaries in non-CBAs. Those...

WASHINGTON - CMS has scheduled a call to solicit stakeholder input on its methodology for using information from the competitive bidding program for adjusting Medicare fee schedule amounts in non-bid areas.The 21st Century Cures Act mandated that the agency solicit and take into account stakeholder input on future pricing in non-bid areas.The act also mandated that CMS take into account the highest amount bid by a winning supplier in a bid area, as well as make comparisons in bid and non-bid areas...

WASHINGTON - CMS has published an FAQ for the prior authorization process for DME. A number of the questions address the agency's “master list” of 135 products for which a prior authorization could be required. Those products include CPAP devices, semi-electric hospital beds, manual wheelchairs and oxygen concentrators. Stakeholders are still waiting for sub-regulatory guidance on when prior authorizations will be required and for what products. CMS published its final rule for the prior...