According to the update on Feb 7th, 2020, the CMS has already selected six additional items of the DMEPOS category to be subject to prior authorization. L5856, L5857, L5858, L5973, L5980, and L5987 will be implemented in two phases.
The States which will be seeing the first phase implementation will be Texas, Michigan, California, and Pennsylvania. The remaining states and authorities will be seeing the latest phase implementation.
CMS has also organized a special open door forum on the March 20th of 2020, to discuss the addition of the six lower limb prosthetic HCPCS codes to the list of Prior Authorization! As a DME supplier, you must be aware that a major chunk of improper payments happen due to insufficient documentation and errors with benefits checks.
Hence, it is critical for you to address your DME prior authorization process, streamline it so that you can accelerate your reimbursements by making your practice management efforts a lot more transparent.
On 2018, The CMS issued a brief on access challenges to DME for the dually eligible beneficiaries. It outlined, the facilitation access to Medicaid Durable Medical Equipment for Dually Eligible Beneficiaries in the fee for service system: The Three State approaches.
It cites the logistical challenges created by the mismatch of the processing rules of the Medicare and Medicaid, creating hindrance in access to care. By the beginning of September 1, 2018, there were nearly thirty-one additional power mobility device codes which got subjected to prior authorization. Finding a definitive team in DME prior authorization that stays ahead with the adjudication requirements and changing regulations will be a great advantage for any supplier.
In today’s times, finding a complete team offering full-service approach will be an excellent advantage. You need someone to help you get your authorization approved on time, getting the eligibilities worked upon, order entry confirmations, scheduling the delivery on time.
All this heavy lifting work has to performed by a quality team that has the unique ability to transform your practice management standards, offer a plan that drives your reimbursements on time in the longer run. Getting your DME prior authorization done on time is almost half the work done! A specialized resource working on a dedicated basis can eliminate process challenges with the right specialization.
In the end, all you need is a steady flow of cash to grow and expand, getting paid for your services on-time and also reduce your operational expenses! It can double up your chances of making more with a synchronized approach in your daily process of managing DME prior authorization.