The Centers for Medicare & Medicaid Services today issued its final rule on prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies.
The rule moves necessary documentation earlier in the approval process, requiring all relevant coverage, coding, and clinical documentation to be completed before certain goods are provided to a beneficiary and before the claim is submitted for payment, according to a CMS statement published Dec. 30 in the Federal Register.
Prior authorization is an effective way to reduce or prevent questionable billing practices and improper payments for durable medical equipment, prosthetics, orthotics, and supplies, according to the statement.
The rule includes review and approval timeframes and a provision for expedited claims in which delayed approval could adversely impact a beneficiary’s health.
Some of the items subject to “frequent unnecessary utilization” include certain powered air mattresses, continuous airway pressure devices, power wheelchairs, oxygen concentrators, and prosthetic limbs (especially for lower extremities).
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