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Tag: Prior authorization


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Össur positions system as tool for new requirement 

June 21, 2022HME News Staff

FOOTHILL RANCH, Calif. - Össur’s Empower Practice and Workflow Management system now seamlessly complies with new prior-authorization requirements announced by CMS for some commonly prescribed knee and spinal orthoses. “Although CMS has previously enacted prior authorization requirements, the new standards can create authorization challenges for patients with urgent medical needs and the clinicians who care for them,” said Mark Tymchenko, Össur’s vice president,...

knee orthoses, Ossur, Prior authorization, spinal orthoses


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AHA supports scrutiny of Medicare Advantage 

May 31, 2022HME News Staff

WASHINGTON – The American Hospital Association has urged the U.S. Department of Justice to establish a task force to conduct False Claims Act investigations into commercial health insurance companies that are found to routinely deny patients access to services and deny payments to health care providers.  The AHA’s letter follows a recent report from the Office of Inspector General that found Medicare Advantage organizations are violating their obligation to cover the...

American Hospital Association, Medicare Advantage, Prior authorization


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Are health insurers willing to reform PA process? AMA has its doubts

May 25, 2022HME News Staff

CHICAGO – The health insurance industry has made little progress in reforming prior authorization processes, according to the results of a new survey of physicians from the American Medical Association.  In January 2018, the AMA and other national organizations signed a consensus statement outlining a shared commitment to five key reforms to the prior authorization process that promote safe, timely and affordable access to evidence-based care for patients, enhance efficiency and reduce...

American Medical Association, health insurers, Prior authorization


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CMS addresses urgent need for orthotics 

April 18, 2022HME News Staff

WASHINGTON – CMS has published a FAQ for situations when patients need orthotic braces earlier than the two-day expedited timeframe. The agency says providers need to bill claims for L0648, L0650, L1832, L1833 and L1851 in these situations with the ST modifier and they will not undergo prior authorization. In a competitive bidding area, they need to bill these claims with the modifiers KV, J5 or J4, along with the ST modifier. Starting April 13, L0648, L0650, L1832, L1833 and L1851 were...

Orthotic braces, Prior authorization


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Certain L codes up for prior authorization

February 11, 2020HME News Staff

ATLANTA - CMS plans to update the Federal Register today to add certain L codes to the prior authorization list for DMEPOS, according to the van Halem Group.CMS will add the following codes to the list of items that require prior authorization as a condition of payment:L5856 - (Addition to lower extremity prosthesis, endoskeletal knee-shin system, microprocessor control feature, swing and stance phase, includes electronic sensor(s), any type)L5857  - (Addition to lower extremity prosthesis,...

L codes, Orthotics, Prior authorization, Prosthetics


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Prior auths for support surfaces to go nationwide

September 24, 2019HME News Staff

WASHINGTON - A prior authorization requirement for Group 2 pressure reducing support surfaces will expand to all states and territories effective Oct. 1. Prior auths for dates of delivery on or after July 22 were already in effect in California, Indiana, New Jersey, and North Carolina for E0193, E0277, E0371, E0372 and E0373. CMS announced the addition of the codes to the national prior authorization program in April, along with seven additional codes for complex rehab power mobility devices. During...

Prior authorization, support surfaces


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CMS bulks up PA program

April 19, 2019HME News Staff

WASHINGTON - CMS has added seven codes for complex rehab power mobility devices and five codes for support surfaces to the national prior authorization program, AAHomecare reports.The agency will roll the PMD codes into the program within 90 days, or July 21 by the association's estimates.The support surface codes will added in two phases, within 90 days in California, Indiana, New Jersey and North Carolina, and within 180 days, or Oct. 19, 2019, by AAHomcare's estimates, in all states.The codes...

Home oxygen therapy, Master list, Power mobility devices, Prior authorization, support surfaces


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CMS issues guidance on national PA program

August 9, 2018HME News Staff

WASHINGTON - CMS has published guidance for power mobility device providers on the transition to the national prior authorization program. “Inclusion of Power Mobility Device Codes in the Prior Authorization Program for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items” lists all the HCPCS codes that will be included in the program starting Sept. 1, according to a bulletin from AAHomecare. For states not currently in the demonstration, the MACs will start accepting...

PMD demo, Power mobility, Prior authorization


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Mobility

CMS expands prior authorization program

June 4, 2018HME News Staff

WASHINGTON - CMS will roll the standard power mobility device codes that are currently part of a PMD Prior Authorization Demonstration in 19 states into the National Prior Authorization Program on Sept. 1, the agency announced late on Friday.The PMD PA Demo was due to expire Aug. 31. Industry stakeholders have been lobbying CMS to expand the prior authorization requirement for PMDs to all states and to also apply it to complex rehab wheelchairs.Currently, there are only two codes in the National...

National program, PMD demo, Prior authorization


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GAO: Extend prior auth program

May 23, 2018HME News Staff

WASHINGTON - CMS should continue with its prior authorization programs and expand prior authorizations to include power wheelchair accessories, according to a new report from the Government Accountability Office.The prior authorization demonstration project launched in seven states in 2012 and was expanded to an additional 12 states in 2014. Originally set to expire Aug. 31, 2015, the deadline was pushed to Aug. 31, 2018 and CMS has not announced plans to extend the deadline again.The GAO estimates...

PMD demonstration, Prior authorization


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