tci Medicare Compliance & Reimbursement - 2016 Issue 2
Medical Supplies: Beware of 3 Possible Drawbacks to the New DMEPOS Rule
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Article Overview
This article reviews concerns raised by industry stakeholders about CMS’s finalized prior authorization rule for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). It focuses on general policy issues affecting claim payment, prosthetics inclusion, and beneficiary access timing. The piece is relevant to Medicare suppliers, prosthetics and orthotics professionals, and others tracking CMS payment policy changes and administrative requirements.
Why This Topic Matters
The rule affects how certain DMEPOS claims are handled under Medicare and may influence supplier workflow, payment risk, and beneficiary access to prosthetic care. Understanding the concerns summarized here can help readers assess operational and compliance implications of the policy change.
What You Will Learn
- Why stakeholders object to aspects of CMS’s prior authorization rule for DMEPOS
- How prior authorization is discussed in relation to claim payment and review
- Why prosthetics inclusion in the policy is being questioned
- What concerns are raised about timing and access to care
Who Should Read This
- Medical coders
- DMEPOS suppliers
- Prosthetics and orthotics professionals
- Medicare compliance staff
- Healthcare administrators
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