CMS issues final rule on prior authorization process for durable medical equipment
The new rule makes DMEPOS subject to the same authorization policies as other Medicare-covered services and will stop Medicare beneficiaries from being stuck with costs for items not covered by Medicare.
The rule is necessary, CMS officials said, because these items are often prescribed unnecessarily. Reports outlining the officials' concerns have been published by the Department of Health and Human Services’ Office of the Inspector General and the U.S. Government Accountability Office.
CMS has attempted to quell the problems with DMEPOS items by establishing the DMEPOS Competitive Bidding Program, more stringent screening of DMEPOS providers and the expansion of a three-year prior authorization demonstration program for power mobility devices (PMDs).
Another component of the final rule is a master list of DMEPOS items CMS officials have determined to be frequently utilized in an unnecessary way. The list will be updated each year, and items will stay on the list for 10 years unless the purchase amount for the item decreases to lower than the payment threshold.
Prior authorization will be mandated for all DMEPOS items on the Required Prior Authorization List. All pertinent documents must be submitted before a beneficiary receives the item. Every effort will be made to complete authorization determinations within 10 business days, CMS officials said.
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