Tag: Prior authorizations

WASHINGTON – The Better Medicare Alliance, a research and advocacy organization, believes a CMS proposed rule on prior authorizations for Medicare Advantage plans will help to coordinate safe, effective care and streamline the process. “While we continue to review the proposed rule in closer detail, we believe it complements our goals of protecting prior authorization’s essential function in coordinating safe, effective, high-value care, while also building on the Medicare Advantage...

WASHINGTON - CMS will turn around requests for prior authorizations for support surfaces in five business days, the agency announced during a Special Open Door Forum on Tuesday.CMS will turn around expedited requests in two days, it says.Starting July 22, providers in four states—California, Indiana, New Jersey and North Carolina—will have to submit prior authorization requests for five codes for support surfaces. Starting Oct. 21, providers in all states will have to submit prior authorization...

WASHINGTON - CMS says a demonstration project requiring prior authorization requests for power mobility devices in 19 states will become permanent and will expand to all states.CMS announced June 1 that it will transition nearly all of the codes included in the demo project, which was set to expire on Aug. 31, to its national prior authorization program on Sept. 1. Currently, the agency has two codes in the national program: K0856 and K0861, two complex rehab codes.“This is something the industry...

WASHINGTON - CGS and Noridian on March 6 began accepting prior authorization requests for K0856 and K0861 for providers in Illinois, West Virginia, Missouri and New York. They are accepting requests for dates of delivery on or after March 20. The two contractors have launched web pages on their websites with information on the process. For CGS's, go here; for Noridian's, go here. The contractors have also indicated that they plan to schedule new education on the process. Stakeholders are concerned...

YARMOUTH, Maine - 2016 was the year that HME providers fought back.The most read story on www.hmenews.com in 2016 was “In wake of cuts, HME providers let chips fall.” When CMS implemented the Round 2 re-compete and the first phase of its nationwide rollout of competitive bidding on July 1, providers directed angry referral sources right to lawmakers. Other providers washed their hands of bid products and services—products and services that they had provided for years.In the No....

BALTIMORE - CMS is moving forward with its plans to implement a prior authorization process for certain DME and stakeholders say it should make life easier for providers.“The fact of the matter is, the items that are going to be subject to prior auths are already under prepay review in one form or another,” said Andrea Stark, a reimbursement consultant with MiraVista. “Anything that mitigates supplier risk and financial liability is, in my book, a positive thing.”The rule...

BALTIMORE - CMS today issued a final rule that would establish a prior authorization process for certain durable medical equipment.The agency, which issued a proposed rule in May 2014, had originally said a final rule would not be forthcoming until 2017.CMS says prior authorizations will reduce overutilization of certain high cost DME without impeding beneficiary access. The agency has a “master list” of 135 codes that meet that criteria and will be potentially subject to prior authorizations.Specifically,...

YARMOUTH, Maine - The increasing number of states turning to managed care to run their Medicaid programs is creating a logistical nightmare for providers.Many of the respondents to a recent HME Newspoll report that working with managed care companies can mean a cumbersome prior authorization process, slow payments, irregular policies and inconsistent reimbursement rates.“They're very slow to pay, if at all,” wrote in Steve Williams of Motion Mobility in Canton, Ohio. “Prior authorizations...

YARMOUTH, Maine - CMS recently extended a demo requiring prior authorizations for certain power mobility devices, and providers say it may be time to consider other product categories, too.“I think prior auths could work for a lot of DME,” said Eric Hagan, director of business development for Green Bay, Wis.-based HME Home Medical.CMS issued a proposed rule in May 2014 seeking comments on prior authorizations for other DME.The agency has since indicated, however, that a final rule is...

WASHINGTON - Rep. Marsha Blackburn, R-Tenn., introduced a bill last week that would require prior authorizations for high-dollar DME.The bill, H.R. 2437, would also exempt DME that has gone through this prior authorization process from pre- and post-payment audits, according to The VGM Group.“These pre-approved items could then only be subject to audits for fraud and abuse purposes,” the group stated in a bulletin to members. “The intention of this is to reduce the number of intrusive...