Service Assists Prior Auth Compliance for Braces

Össur’s Empower solution helps clinicians ensure they comply with new requirements for knee and spinal brace claims.

Össur’s Empower practice and workflow management system now complies with CMS’s new prior-authorization requirements for commonly prescribed knee and spinal orthoses, which the agency has been rolling out this year.

“Although CMS has previously enacted prior authorization requirements, the new standards can create authorization challenges for patients with urgent medical needs and the clinicians who care for them,” said Mark Tymchenko, Össur’s vice president, Americas Bracing & Supports. “It is important that clinicians comply with the new regulations to avoid payment delays or clawbacks for claims already paid.

CMS’s new prior authorization requirements also currently require a face-to-face (F2F) patient encounter and written order, and directly apply to five of the most frequently prescribed knee and spinal cord orthoses (L-1832, L-1833, L-1851, L-0648 and L-0650, respectively), as well as a prefabricated upper orthosis frequently prescribed for a patient’s shoulder, elbow, wrist and hand (L-3960). They were introduced in select U.S. geographies in April and will be implemented across the country in a phased schedule throughout 2022.

The first medical practices required to comply with the new requirements were based in New York, Florida, Illinois and California. The second phase of the regulations, which take effect on July 12, involves medical practices from Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona and Washington state. All remaining states and U.S. territories must comply by the start of the third and final phase of the regulations beginning on October 10.

“The good news is that Empower has addressed these prior authorization requirements so that clinicians can provide care without delays when clinically required while also remaining compliant with Medicare standards,” Tymchenko added. “This new functionality builds on last year’s updates that ensure customer compliance with CMS’ Competitive Bidding practice requirements mandated for off-the-shelf spine and knee bracing.”

Empower by Össur is an automated, customizable web-based solution that helps physician practices, HME providers, and prosthetic and orthotic suppliers with day-to-day practice management solutions by combining reimbursement, real-time inventory management and consulting services within a single paperless platform. Össur is a global innovator in prosthetic and non-invasive orthopedic technologies.

In addition to complying with new regulatory requirements, Empower by Össur companies that are enrolled in Empower by Össur can receive hands-on benchmarking of their practices with the help of dedicated Business Solutions Managers, as well as consulting, auditing and compliance reviews for all aspects of DMEPOS business practices and procedures.

Additional details regarding Empower by Össur and CMS’s new prior authorization requirements are available on Össur’s website at www.ossur.com/en-us/professionals/orthotic-and-prosthetic-services/empower.

CMS’s Prior Authorization guidelines are also available via CMS directly at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/DMEPOS/Prior-Authorization-Process-for-Certain-Durable-Medical-Equipment-Prosthetic-Orthotics-Supplies-Items - :~:text=CMS announced in the Federal,, beg.

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