Rule Mandating Prior Authorization for DME Issued by CMS


CMS has issued a final rule to establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) that are often subject to unnecessary use.

The process requires identical information necessary for Medicare payment, but earlier in the process and with new clinical documentation requirements.

The process assures all coverage, coding, and clinical documentation are met before the item is provided to the beneficiary and before the claim is submitted for payment. CMS said this will help ensure beneficiaries are not responsible to pay for items not eligible for Medicare payment.

( 1/14/2016)