The Durable Medical Equipment Medicare Administrative Contractors (MACs) published the exemption process for prior authorization of certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items per the Centers for Medicare & Medicaid Services. DMEPOS suppliers will be offered exemption from prior authorization under some conditions.
To earn exemption, the DME MACs will review the approval ratings of suppliers’ prior authorization claims. If the approval rate is 90 percent or higher, the supplier will have an option each year to be exempt from submitting prior authorizations for that year.
To determine supplier eligibility for continued exemption, the DME MACs will conduct an annual post-payment medical review sample to ensure compliance. From this claim sample, suppliers must again meet a claim approval rate of 90 percent or greater to continue their exemption. Suppliers who do not meet the 90 percent compliance rate threshold must continue submitting prior authorization requests as a condition of payment.
The DME MAC will notify suppliers at least 60 days before an exemption starts or is withdrawn before the effective date.
