A six-year-old Medicare demonstration program that focuses on pre-approvals for power wheelchairs and other mobility devices will get new life this fall.
Overall, 31 items were added to the program, according to a June 1 notice from the Centers for Medicare & Medicaid Services.
A Government Accountability Office report released in May, which urged continuation and/or expansion of pre-approvals, preceded the CMS announcement.
States that were in the initial phase of the program were involved because they historically had high rates of improper payments and fraud. They were: California, Florida, Illinois, Michigan, New York, North Carolina and Texas. A dozen more were added later.
The GAO estimates the program, which was set to expire Aug. 31, has saved the government about $1.9 billion.
Now, however, CMS has declared that pre-approval requirements will go nationwide for all named devices on Sept. 1.
The national rollout will differ slightly. Items on the Required Prior Authorization List require prior authorization as a condition of payment. Without it, claims will be denied. Under the demo, requesting prior authorization had been optional, with claims submitted without prior authorization subject to prepayment review and a 25% reduction.
From the July 01, 2018 Issue of McKnight's Long-Term Care News
