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Regulatory updates: Low volume appeals, prior auths

Regulatory updates: Low volume appeals, prior auths

CMS will be accepting expressions of interest for low volume appeals from April 12-June 8, 2018, for all NPIs. An EOI must be submitted for each NPI. The appeals are only offered to appellants that have less than 500 appeals sitting at OMHA and/or the Medicare Appeals Council as of Nov. 3, 2017, and each appeal must have a total billed amount of $9,000 or less. More information can be found here…CMS has removed the following items from the prior authorization Master List: hospital bed semi-electric (E0260); CPAP (E0601); oxygen concentrator (E1390); and wheelchair (K0004). CMS is required to adjust the payment threshold for inflation annually. The payment threshold is $1,018 or greater, or an average monthly rental of $102 or greater. The four items did not meet the payment threshold.

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