tci Medicare Compliance & Reimbursement - 2016 Issue 2
Compliance: Prior Authorization Final Rule Will Transform DMEPOS Reimbursement
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Article Overview
This compliance article covers a CMS final rule that changes how certain durable medical equipment, prosthetics, orthotics, and supplies are reviewed before Medicare payment. It explains the purpose of the prior authorization program, how the master and required lists are handled, the general review timelines, and the potential operational effects for suppliers, prosthetic and orthotic stakeholders, and other Medicare-focused providers. The article is relevant to billing, compliance, and reimbursement staff tracking Medicare policy changes affecting DMEPOS processes.
Why This Topic Matters
The rule may affect reimbursement workflows, documentation readiness, and claim processing for Medicare DMEPOS items. Readers responsible for compliance and revenue cycle operations need to understand the general structure of the program and its implementation implications.
What You Will Learn
- The purpose and scope of the CMS prior authorization framework for selected DMEPOS items
- How CMS uses lists and notices to phase in the program
- The general review and resubmission process described in the rule
- Why suppliers and prosthetic stakeholders are watching the rule closely
- The types of operational and compliance changes organizations may need to prepare for
Who Should Read This
- DMEPOS suppliers
- Medical billing and coding professionals
- Compliance officers
- Revenue cycle managers
- Prosthetic and orthotic providers
- Medicare reimbursement staff
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