Providers will face new rules in March that change the way they’re reimbursed for certain types of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS).
There are frequent issues with “unnecessary utilization” of DMEPOS, the Centers for Medicare & Medicaid Services asserted in a Federal Register on December 29.
The rule would establish a prior authorization process to “ensure beneficiaries receive medically necessary care while minimizing the risk of improper payments.”
Providers have generally favored the change because it will ostensibly clear up ongoing bottlenecks caused by audits and claim denials.
Once implemented, the new rule would require claims for DMEPOS items to have an affirmed prior authorization decision as a condition of payment. It also would make review contractors’ decisions on prior authorization of coverage non-appealable.
A list of affected DMEPOS will appear on the annual fee schedule. Items on the list will remain for 10 years unless the purchase amount drops below the payment threshold (currently an average purchase fee of $1,000 or greater or an average monthly rental fee schedule of $100 or greater).
In 2014, CMS said new DMEPOS reimbursement rules would cut more than $4.4 billion over four years.