WASHINGTON, D.C., Oct. 24, 2012—In an update issued Monday, CMS states that the DME MACs will have discretion to change a nonaffirmative prior authorization (PA) request to affirmative upon verification that the reviewer of the request made a clerical error without requiring the HME provider to resubmit.
AAHomecare had pushed to enable PMD providers to correct minor mistakes or point out material overlooked by the reviewer yet already contained in a PA package to ensure that consumers receive their power mobility device in a timely manner. If CMS had not made this change providers would be required to resubmit an entire PA, which would significantly delay an “affirmed” decision from the DME MACs.
The association is pleased that CMS was willing to make this change to the program and continue to monitor implementation. AAHomecare asks that those providers subject to the PA demonstration continue to report their successes and failures with this program.
Please share your experiences with AAHomecare at pmdclaimsdata@aahomecare.org. For more information contact Peter Rankin at (202) 372-0755 or peterr@aahomecare.org. Also visit www.aahomecare.org.
