Best Practices For Building an Effective Prior Authorization Program for DME
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Recorded On: 03/08/2016
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Prior Authorization is coming in 2016 for up to 135 select DME items based on a CMS decision. We welcome the news and believe the new prior authorization program is going to lighten the load for DME suppliers.
This ruling will add some complexities to your current routines and there will be some new friction points in your deliveries. But let’s be honest, in all the rush to get everything out the door as quickly as possible, don’t you wish there was just a little more time to make a clear and concise decision before letting your inventory go? This is precisely what the prior authorization program offers. This friction point ultimately protects your revenue and allows you to deliver in confidence. It also offers a Medicare affirmation, or "blessing" of sorts, on the initial documentation. A study conducted by the CERT contractor in 2014, revealed that 92% of improper payments made for DMEPOS claims were due to insufficient documentation. This finding was determined after delivery and after suppliers assumed the financial risk. But prior authorization shifts the burden to Medicare before delivery. This process is just what we need.
But prior authorization will not be a magic wand. There are complexities and best practices to consider to fully mitigate your risk and increase the likelihood of affirmed decisions. That is why reimbursement guru Andrea Stark has put together this timely training. She will talk you through which products are affected, how this will be rolled out and how to increase your likelihood of success under this new protocol. You don’t have to take on this new process alone, download this playback today!
Listeners will be able to:
If you have trouble processing your payment via PayPal, we are happy to take your registration and payment over the phone. Please call 803-462-9959 for assistance.
Prior Authorization is coming in 2016 for up to 135 select DME items based on a CMS decision. We welcome the news and believe the new prior authorization program is going to lighten the load for DME suppliers.
This ruling will add some complexities to your current routines and there will be some new friction points in your deliveries. But let’s be honest, in all the rush to get everything out the door as quickly as possible, don’t you wish there was just a little more time to make a clear and concise decision before letting your inventory go? This is precisely what the prior authorization program offers. This friction point ultimately protects your revenue and allows you to deliver in confidence. It also offers a Medicare affirmation, or "blessing" of sorts, on the initial documentation. A study conducted by the CERT contractor in 2014, revealed that 92% of improper payments made for DMEPOS claims were due to insufficient documentation. This finding was determined after delivery and after suppliers assumed the financial risk. But prior authorization shifts the burden to Medicare before delivery. This process is just what we need.
But prior authorization will not be a magic wand. There are complexities and best practices to consider to fully mitigate your risk and increase the likelihood of affirmed decisions. That is why reimbursement guru Andrea Stark has put together this timely training. She will talk you through which products are affected, how this will be rolled out and how to increase your likelihood of success under this new protocol. You don’t have to take on this new process alone, download this playback today!
Listeners will be able to:
- Itemize the protocols and processes outlined in this rule.
- Identify the products affected by the rule
- Decipher the relevance of items on the Master List vs. Required List.