The Final Rule and Its Effects on DME Prior Authorization

Top Quote The DME Prior Authorization service providers are working tirelessly to balance out the uncertainty created with the introduction of the Final Rule. End Quote
  • New York, NY (1888PressRelease) October 28, 2017 - 1st July, 2017 was an important date in the calendar of the medical and healthcare industry as CMS introduced the Final Rule. According to it, prior authorization for DME (selected), prosthetics, orthotics, and supplies (DMEPOS) are subjected to a competitive bidding program. It can be concluded that DME prior authorization has received a shot in the arm with this implementation. In a gist the Final Rule is aimed to stop any further creation of clinical documentation requirements, make the process transparent, and check the rising price to an extent.

    The Final Rule has resulted in the creation of a Master List of 135 DMEPOS items identified as being frequently subject to unnecessary utilization. Items that meet criteria are included on the Master List and subject to DME prior authorization:
    Items on the DMEPOS Fee Schedule with an average purchase fee of $1,000 or more
    Items on the DMEPOS Fee Schedule with an average rental fee schedule of $100 or more

    Items in the Master List have a validity of 10 years. However, those can be removed earlier if the purchase amount drops below the payment threshold. After 10 years, items can remain on the list or be added back to the list if subjected to certain conditions.

    In this scenario, the process for prior auth for DME, to be precise the DMEPOS items would require more checks and reviews. This will make life harder for the in-house staff the physicians, hospitals, labs, healthcare centers etc. The DME prior authorization process requires the adherence of applicable coverage, payment, and coding rules before the request gets approval. Patients might face fear of waiting for approval during any critical stage. The time consuming process of DME prior authorization and the technicalities make things worse.

    Keeping these problems in sight, more and more providers are outsourcing their DME prior auth to professional prior authorization services. Some companies like PriorAuth ONLINE, which is a part of the reputed Sun Knowledge stand out as experts in this situation. These DME prior auth service providers charge very low for their services (PriorAuth ONLINE charges only $5) but are fast, efficient, and have high accuracy level. Quality service guarantees like 100% HIPAA compliance increase the reliability quotient of these DME prior auth services. These services also provide end-to-end practice management and cater to different specialties apart from DMEs. So, even if the Final Rule has some question marks, the presence of DME prior authorization services save the day by answering those.

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