tci Medicare Compliance & Reimbursement - 2016 Issue 2

Medical Supplies: Beware of 3 Possible Drawbacks to the New DMEPOS Rule

Why some stakeholders believe CMS is unfairly including leg prostheses. When the Centers for Medicare & Medicaid Services (CMS) finalized the prior authorization final rule for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) items, not all industry stakeholders were overjoyed. In fact, some organizations are expressing serious concerns over the rule, and here are the three major issues: 1. Prior authorization does not guarantee payment. One concern about the final rule is that prior authorization does not equate to a guarantee of claim payment, nor does it eliminate the exposure of the claim to additional audits, according to...

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