tci Medicare Compliance & Reimbursement - 2016 Issue 2

Compliance: Prior Authorization Final Rule Will Transform DMEPOS Reimbursement

Lower limb prosthetics could suffer unfair targeting by new regulation. Getting Medicare to reimburse your claim for certain medical equipment just got a little trickier, thanks to a new final rule requiring prior authorization. On Dec. 29, 2015, the Centers for Medicare & Medicaid Services (CMS) published a long-awaited final rule that establishes a prior authorization program for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items frequently cited as subject to unnecessary utilization. The final rule’s provisions are effective on Feb. 29, 2016. Which DMEPOS Items are in CMS’ Crosshairs? “The impetus for the rule...

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