CMS Solidifies Dates for Expanded Prior Authorization

Prior authorization for most new codes added to the program goes into effect on July 21, with PA for the remainder to going into effect on Oct. 21.

The implementation dates for the new HME categories being added to CMS’s national Prior Authorization program will go into effect on July 21, except for support surfaces, which will be rolled out in two phases.

In a Dec. 30, 2015 final rule, CMS added seven power mobility device codes and five therapeutic support surface codes. Where the support surfaces are concerned, one phase that covers California, Indiana, New Jersey, and North Carolina, will implement those codes July 21. CMS will implement prior authorization for those codes nationally on Oct. 21.

A statement from the American Association for Homecare said the organization was supportive of prior authorization for certain DME, and that prior authorization offered benefits for providers, such as guaranteed payment for items that met prior authorization and audit protection for certain claims.

That said, the organization argued that not all items were suited to prior authorization.

“CMS has a 10-business day timeline to make an initial PA decision, and two business days for the expedited review process for certain situations,” a statement from the organization read. “AAHomecare is concerned about the potential impact on timely access to care for beneficiaries in need of support surfaces.”

More information can be found at the CMS prior authorization website

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.


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