Monday, December 4, 2023
OANDP-L
  • Login
No Result
View All Result
The O&P EDGE
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
    • EDGE Flipbooks
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
    • EA Homepage
    • EA Data
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
  • PECOS
  • Magazine
    • Subscription
    • Current Issue
    • Issue Archive
    • News Archive
    • Product & Service Directory
    • Advertising Information
    • EDGE Flipbooks
  • O&P Jobs
    • Find a Job
    • Post a Job
  • EDGE Advantage
    • EA Homepage
    • EA Data
  • O&P Facilities
  • Resources
    • Product & Service Directory
    • Calendar
    • Contact
    • About Us
    • O&P Library
    • The Guide
    • Custom Publications
    • Advertising Information
    • EDGE Direct
    • Amplitude Media Group
No Result
View All Result
The O&P EDGE Magazine
No Result
View All Result
Home News

CMS Proposes Prior Authorization for DMEPOS Subject to “Unnecessary Utilization”

by The O&P EDGE
May 23, 2014
in News
0
SHARES
10
VIEWS
Share on FacebookShare on Twitter

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that are frequently subject to “unnecessary utilization.” About 90 L-Codes that pertain to lower-limb prostheses and components may be affected.

Section 1834(a)(15) of the Social Security Act authorizes the secretary of the U.S. Department of Health and Human Services (HHS) to develop and periodically update a list of DMEPOS that the secretary determines, on the basis of prior payment experience, are frequently subject to unnecessary utilization and to develop a prior authorization process for these items. The proposed rule will implement the authority. As part of the rule, CMS has created a proposed initial Master List. The two criteria for inclusion on the list, either of which must be met, are as follows:

  • The item has been identified in a U.S. Government Accountability Office or HHS Office of Inspector General report that is national in scope and published in 2007 or later as having a high rate of fraud or unnecessary utilization.
  • The item is listed in the 2011 or later Comprehensive Error Rate Testing program’s Annual Medicare Fee for Service Improper Payment Rate Report Durable Medical Equipment Service Specific Overpayment Rate Appendix.

CMS also proposes to include an item on the initial Master List if the item appears on the DMEPOS Fee Schedule list and has an average purchase fee of $1,000 or greater, or an average rental fee schedule of $100 or greater. The Master List will be self-updating annually, and items will typically remain on the Master List for ten years. However, presence on the list would not automatically require prior authorization, as a subset of items, called the Required Prior Authorization List, will be initially implemented.

The proposed prior authorization process would not create new clinical documentation requirements. Instead, it would require the same information necessary to support Medicare payment, just earlier in the process. CMS or its contractors would make “reasonable efforts” to communicate the decision within ten days of receipt of all applicable information, or within two business days if a delay would “seriously jeopardize the life or health of the beneficiary.”

If this proposed rule is finalized, prior authorization would become a condition of payment for the items on the Required Prior Authorization List. However, the rule will allow unlimited resubmissions. The proposed rule would also add a contractor’s decision regarding prior authorization of coverage of DMEPOS items to the list of actions that are not initial determinations and therefore not appealable.

CMS is accepting comments on the proposed rule for 60 days after the date of publication in the Federal Register. The rule is scheduled to be published in the Federal Register on May 28. Comments can be submitted electronically at www.regulations.gov

Related posts:

  1. New Medicare Rules Take Effect for O&P Care
  2. Final Rule Establishes Prior Authorization for Orthotics and Prosthetics
  3. DMEPOS Proposed Rule Expands O&P Prior Authorization, Underscores Need for Legislation to Separate O&P From DME
  4. Prior Authorization for Medicare O&P Services
Previous Post

OHI Acquires PedAlign

Next Post

East Coast O&P Orthotist Honored By SUNY Downstate

Next Post

East Coast O&P Orthotist Honored By SUNY Downstate

  • VIEW CURRENT ISSUE
  • SUBSCRIBE FOR FREE

RECENT NEWS

News

Factors Identified to Maximize Telehealth Walking Self-management Intervention

by The O&P EDGE
November 21, 2023

Researchers conducted a study in an effort to understand therapist-identified factors influencing clinical adoption of a telehealth walking self-management intervention...

Read more

Wearable Hand Orthosis Aids Child in Daily Life

Minimal Exercise Can Benefit Lower-limb Amputees

Prosthetist Named Chief Clinical Officer

Get unlimited access!

Join EDGE ADVANTAGE and unlock The O&P EDGE's vast library of archived content.
SUBSCRIBE TODAY

O&P JOBS

Eastern

Certified Pedorthist

Central

Clinical Manager

Central

Certified Prosthetist/Orthotist (CP/CPO)

 

© 2023 The O&P EDGE

  • About
  • Advertise
  • Contact
  • EDGE Advantage
  • OANDP-L
  • Subscribe

CONTACT US

866-613-0257

[email protected]

201 E. 4th St
Loveland, CO 80537

The most important industry news and events delivered directly to your inbox every week.

  • About
  • Advertise
  • Contact
  • EDGE Advantage
  • OANDP-L
  • Subscribe

© 2023 The O&P EDGE

No Result
View All Result
  • PECOS
  • MAGAZINE
    • SUBSCRIBE
    • CURRENT ISSUE
    • ISSUE ARCHIVE
    • NEWS ARCHIVE
    • PRODUCTS & SERVICES DIRECTORY
    • ADVERTISING INFORMATION
  • O&P JOBS
    • FIND A JOB
    • POST A JOB
  • EDGE ADVANTAGE
    • EA Homepage
    • EA Data
  • FACILITIES
  • RESOURCES
    • PRODUCTS & SERVICES DIRECTORY
    • CALENDAR
    • CONTACT
    • ABOUT US
    • O&P LIBRARY
    • THE GUIDE
    • CUSTOM PUBLICATIONS
    • ADVERTISING
    • EDGE DIRECT
    • AMPLITUDE
  • OANDP-L
  • LOGIN

© 2023 The O&P EDGE

Welcome Back!

Login to your account below

Forgotten Password?

Retrieve your password

Please enter your username or email address to reset your password.

Log In
The O&P EDGE Magazine
 
Required 'Candidate' login to applying this job. Click here to logout And try again
 

Login to your account

  • Forgot Password? | Sign Up

Reset Password

  • Already have an account? Login

Enter the username or e-mail you used in your profile. A password reset link will be sent to you by email.

Signup to your Account

  • By clicking checkbox, you agree to our Terms and Conditions and Privacy Policy

    Already have an account? Login

Close
Are you sure want to unlock this post?
Unlock left : 0
Are you sure want to cancel subscription?
 

Account Activation

Before you can login, you must activate your account with the code sent to your email address. If you did not receive this email, please check your junk/spam folder. Click here to resend the activation email. If you entered an incorrect email address, you will need to re-register with the correct email address.