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Listen below as Ronda Buhrmester breaks down the new prior auth list, requirements, and the phases to implementation. 

Click here for the update master list of items subject to face-to-face and WOPD and/or prior auths.

And register for Ronda’s upcoming Live Chat, Wednesday, January 20th at 11am central as she covers PHE waivers, and disects the new master list. Register for her Live Chat! Seats are limited!

 

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Long awaited with keen interest by industry stakeholders, CMS released on December 21, 2021 its final rule (CMS-1738-F) relative to post-pandemic DMEPOS fee schedule adjustments, in addition to making certain benefit category and payment determinations for new items, classification of adjunctive continuous glucose monitors as DME under Medicare Part B and finalized certain DME payment provisions that were included in two interim final rules (CMS-1687-F and CMS-5531-F).

However, the main...

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November 13th CMS announced that Medicare Part B premiums and deductibles will see the largest hike in the program's history next year.

Seven issues of concern…

The CMS rule boosts the standard Medicare Part B premium to $170.10 a month, up $21.60, or 14.5 percent. It also increased Part B standard deductibles by $30, up 14.8 percent to $233 in 2022
  The increase translates to nearly $14,000 in annual costs for the wealthiest senior couples.
  Despite...

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CMS has announced they identified and corrected errors that were made when calculating and publishing the fee schedule that they released on December 11, 2020. Changes have been made to 920 code/modifier combinations (not 920 individual codes), and the majority of the changes are less than 1%. However, for roughly 70 code/modifier combinations (approximately 8% of the total combinations impacted), most of which use the KE modifier, the changes are more significant, ranging from a 30% decrease...

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The following is an excerpt from the offical “CMS Round 2021 DMEPOS Competitive Bidding Program Single Payment Amounts and Contract Offers” announcment. 

The Centers for Medicare & Medicaid Services (CMS) competed 16 product categories in 130 competitive bid areas (CBAs) in Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP), although the product category for non-invasive ventilators was removed...

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Providers who applied for and received advanced payments from CMS will now have 1 year to pay back those loans, instead of the 3 months they initially were given to do so. In late March of this year, and as a result of the COVID-19 pandemic, The Centers for Medicare & Medicaid Services (CMS) revised their already existing Accelerated and Advance Payment Program (AAP). This was one of many programs designed to minimize the financial burden that healthcare providers are currently faced with in the...

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