Hi List-members,
I was reviewing past discussion in the List serve archive about ADMC. I
understand that ADMC was utilized for Powered Mobility Devices. Prosthetics
and some Orthotic services should also qualify although currently, approval
still wouldn’t assure payment. I would think that if the Advance
Determination indicated that the services should be covered, any payment
denials would only be for non-clinical reasons. This would save the time and
expense of a redundant payment review of the patient’s physical
circumstances within say, 4 months of ADMC approval.
I’m wondering if any of you have submitted a request for an Advance
Determination for Medicare Coverage. What is the latest in efforts to
correct the current system? How have you adjusted to the threat of denials
or “claw backs”? I’ll post your responses.
Sincerely,
Randy McFarland, CPO
Sunny Hills Prosthetic Services, Inc.
Fullerton, CA
