CMS Publishes FAQ For DME Prior Authorization Process

Visit the CMS webpage: Prior Authorization Process for Certain Durable Medical Equipment, Prosthetic, Orthotics, Supplies (DMEPOS) Items - Centers for Medicare & Medicaid Services:

"CMS Finalizes Rule Creating Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Items (CMS 6050-F)

Update: 12/30/15

OVERVIEW
The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that would establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This prior authorization process will help ensure that certain DMEPOS items are provided consistent with Medicare coverage, coding, and payment rules.  CMS believes the final rule will prevent unnecessary utilization while safeguarding beneficiaries’ access to medically necessary care."

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You'll be interested in their FAQs and other pertinent documents:

Downloads

• 6050 FINAL RULE FAQs [PDF, 62KB]
• 6050-FINAL RULE-12-30-15 [PDF, 523KB]
• 6050 FINAL RULE Fact Sheet [PDF, 31KB]
• FINAL RULE MASTER LIST of DMEPOS Subject to Frequent Unnecessary Utilization [PDF, 68KB]
• 6050 PROPOSED RULE 05-28-15 [PDF, 324KB]

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CMS Final Covered Outpatient Drug Rule Addresses Many Industry Concerns | The National Law Review

Read this very detailed analysis: CMS Final Covered Outpatient Drug Rule Addresses Many Industry Concerns | The National Law Review:

. . . "on January 21, 2016, nearly four years after publishing its proposed rule, CMS finalized the rule, which will take effect April 1, 2016.[1] The Final Rule implements changes to AMP that the ACA required, replaces the calculation methodology for AMP in the withdrawn Deficit Reduction Act (DRA) rule,[2] and provides additional rules for determining Best Price (BP) reported for innovator drugs and biological products."

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