WASHINGTON, D.C., April 19, 2013—AAHomecare and senior officials at the Center for Medicare & Medicaid Services (CMS) met recently to discuss documentation requirements for repairs to power mobility devices (PMDs), as well as the prior authorization demonstration project.
AAHomecare is working with CMS to develop a solution to a problem faced by providers who repair PMDs for beneficiaries whose original provider is unable to do the repair. The goal is to relieve the repairing provider from having to obtain medical necessity documentation from the original provider; rather, when making repairs, a new provider should have to show only that the repair is medically necessary.
In addition to the PMD repair issue, prior authorization demonstration project communication problems between the DME MACs and PMD providers were discussed. Some PMD providers are receiving letters that are postmarked after the required 10-day response timeframe. In many of these cases, the letter itself is dated within 10 days, but the postmark on the envelope indicates that it wasn’t sent until day 13, or even as late as day 17. This lag indicates that letters are sitting on someone’s desk or in the mailroom at CMS for days before they are mailed to providers.
During the meeting, CMS expressed concern about the delays and stated that they would like to use them as an opportunity to educate providers on esMD and other internet-based portals to improve the flow of communication.
Finally, AAHomecare raised the lack of consistency in reviewers between the four DME MACs as a significant problem for providers whose business extends across regions. CMS has already taken steps to remedy this problem. The Agency now requires contractors to provide a random sample of claims and prior authorization requests, which are checked for consistency and accuracy by CMS reviewers. AAHomecare will continue to work with CMS to address problems as they arise. Learn more at www.aahomecare.org.
