Amid Opposition, CMS Moves Toward Prepayment Reviews

Despite opposition from the HME industry, the Centers for Medicare & Medicaid Services is moving forward with Phase 1 of a demonstration project to require “prepayment reviews” of most power mobility claims submitted beginning Jan. 1, 2012, in seven states — California, Florida, Illinois, Michigan, New York, North Carolina and Texas.

CMS conducted a Special Open Door Forum conference call last week to take questions from suppliers and physicians. A transcript and audio recording of the sessions is scheduled to be posted to the Special Open Door Forum website and will be accessible for downloading on or around Tuesday, Dec. 13.

The American Association for Homecare wants to stop the project because it will ration access to medically necessary power mobility products since few, if any, providers will be able to wait more than three months to begin receiving monthly rental payments. The organization also believes the project will result in more falls for patients, which among other things will increase healthcare costs.

For more information from CMS about the project, visit their website.