Physician Decision Letter Can be Included in DMEPOS Prior Authorization Process

—Via AAHomecare—WASHINGTON, D.C. (August 16, 2017)—Last year, CMS finalized the rule to move forward with expanding the prior authorization (PA) program. Although the program has great support from the industry, AAHomecare expressed concern with the lack of physician involvement in the correspondence of the PA decision. Unlike the PMD Demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision. However, based on AAHomecare’s feedback, last week CMS shared that a prescribing physician can contact the DME MAC for a copy of the PA decision letter. The DME MACs will not be automatically sending a copy of the decision letter, but referring providers will be allowed to request to be included in the communication.

CMS has updated the DMEPOS PA website to note this change and also included a sample letter physicians could use to request a decision letter. AAHomecare thanks CMS for the opportunity to provide feedback and for implementing a crucial modification to the program.

You can find the announcement and sample decision request letter here.

Visit aahomecare.org for more information.