On May 19, 2015, HR 2437 was introduced by Tennessee Representative Marsha Blackburn. This legislative piece seeks to require CMS to create and implement a prior authorization program (similar to that of the Power Mobility Device Demo) for high cost DMEPOS items, such as Oxygen which is specifically mentioned in the language of the bill. The bill also has a provision to exempt claims that are approved for prior authorization from both pre-pay and post-pay audit.
Prior authorization has been an increasingly popular Medicare initiative for DMEPOS in the last few years. First with the live expansion of the PMD Prior Authorization demo into 12 new states and...
Prior authorization has been an increasingly popular Medicare initiative for DMEPOS in the last few years. First with the live expansion of the PMD Prior Authorization demo into 12 new states and...
then with the introduction of a proposed rule to institute prior authorization for DMEPOS in general. With HR 2437 we see a scaled down version of the proposal for DME prior authorization, which broadly discusses high cost DME, but specifically addresses Oxygen.
The bill requires the HHS Secretary to expedite emergency review of prior authorization requests to ensure same day delivery expectations can be met by suppliers for items such as Oxygen.
The regulation requires that stakeholder input be included in the development process and that priority be assigned to items that are subject to a high number of contractor audits (specifying Oxygen as a priority).
Overall the tone of the bill is positive and seeks to reduce the audit burden for suppliers providing high cost DME items through a prior authorization process. To see the full text of the bill use this link: http://thomas.loc.gov/cgi-bin/query/z?c114:H.R.2437:.
The bill requires the HHS Secretary to expedite emergency review of prior authorization requests to ensure same day delivery expectations can be met by suppliers for items such as Oxygen.
The regulation requires that stakeholder input be included in the development process and that priority be assigned to items that are subject to a high number of contractor audits (specifying Oxygen as a priority).
Overall the tone of the bill is positive and seeks to reduce the audit burden for suppliers providing high cost DME items through a prior authorization process. To see the full text of the bill use this link: http://thomas.loc.gov/cgi-bin/query/z?c114:H.R.2437:.
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