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Archive for April, 2019

Additional HCPCS Codes Added to Prior Authorization List

Thursday, April 25, 2019 @ 01:04 PM  posted by jbuytaert

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courtesy of HomeCare Magazine
WASHINGTON, (April 18, 2019)T

The Centers for Medicare & Medicaid Services (CMS) has selected 12 additional items of Durable Medical Equipment (DME) to be subject to required prior authorization (CMS 6080-N2).

CMS is adding the following seven Healthcare Common Procedure Coding System (HCPCS) codes for power mobility devices (PMDs) to the Required Prior Authorization List: K0857, K0858, K0859, K0860, K0862, K0863 and KO864. Prior authorization for these PMDs will be implemented nationwide, beginning July 22, 2019.

CMS is adding the following five HCPCS codes for pressure reducing support surfaces (PRSS) to the Required Prior Authorization List: E0193, E0277, E0371, E0372 and E0373. Prior authorization for PRSSs will be implemented in two phases. Phase one will begin July 22, 2019. CMS will limit prior authorization to one state in each of the four DME MAC jurisdictions as follows: California, Indiana, New Jersey and North Carolina. Phase two will begin Oct. 21, 2019 and expands prior authorization of these codes to the remaining states and territories.

All HCPCS codes previously added to the Required Prior Authorization List will continue to be subject to the requirements of prior authorization.

In addition, CMS has provided the annual update to the master list of DMEPOS items that the Secretary determined, on the basis of prior payment experience, are frequently subject to unnecessary utilization (CMS 6078-N2). As noted in CMS 6050-F, the agency adjusts the payment threshold each year for inflation. This update adds the following four HCPCS codes to the master list because they meet the updated payment threshold and are listed in a CERT DME and/or DMEPOS Service Specific Report: E1390, E0466, E0784 and L0650.

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The April webinar Front Wheel Drive: Past, Present, and Future is this Friday April 12th. Register here!

Take the webinar and get an exclusive sneak peak of the all new 2019 F-Series, the power family of front wheel drive!

April 12th, 1:00pm – 2:00pm EST

Jennith Bernstein, PT, DPT, ATP/SMS
Regional Clinical Education Manager

Brandon Edmondson, OTR, ATP
Director of Clinical Sales and Outcomes BR Americas

Webinar Overview:

Drive wheel configuration is one of the many critical decisions one has to make when completing a power wheelchair evaluation. This Webinar will discuss the intended use of front wheel drive configurations, the impact that front wheel drive can have on functional mobility and the influence of drive wheel placement when completing MRADLs. We will also take a look at the history and intended use of the design as well as what is new in the ongoing development of the product with the launch of the Permobil F-Series for 2019.

Note: Since this entire webinar is discussing a specific product, according to CEU/CCU guidelines, no CEU/CCU education credits can be issued; however, a certificate of participation will be available for download.

People for Quality Care Launches Consumer Access Survey

Wednesday, April 3, 2019 @ 07:04 AM  posted by jbuytaert
Waterloo, Iowa – People for Quality Care launched a survey on April 1 asking end users of home medical equipment (HME) and supplies and family caregivers to evaluate the impact of Competitive Bidding on beneficiary access to care during the gap period of the program.

“Ensuring we understand the direct impact that Competitive Bidding is having on consumers and caregivers is critical in helping us communicate their issues to elected officials,” says Rob Duryea, director of People for Quality Care.

This survey is intended to help assess beneficiaries’ experiences obtaining HME supplies and services impacted by the Competitive Bidding program across former competitive bidding areas (CBAs), rural areas, and non‐bid, non‐rural areas. While primarily targeting Medicare beneficiaries, the survey is also open to those with other insurance who have been impacted by the ripple effect of the Medicare program. This nationwide survey will be open until Friday, April 26. Findings from the survey can aid in discussions with policy makers and shapers about the impact of the program and rates stemming from it.

Suppliers are encouraged to assist in raising awareness of the survey and share the survey link, available here, with their customers and local consumer groups.

“The 2016 Dobson DaVanzo patient access survey was an instrumental tool in uncovering some of the significant challenges that end users, case managers, and suppliers faced when Competitive Bidding expanded nationwide and helped pave the way for meaningful relief through the IFR and ESRD Final Rule,” recalled Ashley Plauché, legislative partner for People for Quality Care and manager of Government Affairs for AAHomecare.

“By adopting the basic principles of that survey into this new outreach effort,” Plauché explained, “we will get meaningful, current intel that highlights the real‐world impact this program is having during the gap period and beyond. This information is critical to legislators and regulatory bodies who are tasked with the responsibility of preserving beneficiary access to care under the Medicare benefit.”

“Our number one priority for conducting this survey is to hear from people who are struggling to get quality HME and supplies so that we can assist in sharing their story,” says Rose Schafhauser, state association partner for People for Quality Care and executive director of MAMES and SWMESA.

For more information, industry stakeholders may contact People for Quality Care by emailing or visiting the People for Quality Care website.

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