In a shift from the current system, Medicare is proposing to rule on seniors’ coverage for home medical devices before the supplies are delivered or claims for payment are submitted.
The Centers for Medicare and Medicaid Services (CMS) is planning to expand the use of “prior authorization” for power scooters and wheelchairs, and introduce the process for several other categories of medical goods used at home. Officials said the effort is targeting improper payments and fraud in the system, when Medicare foots the bill for products aggressively marketed to patients and doctors who do not need them.
The agency estimated its effort would save Medicare $100 million to $740 million over 10 years, and argued the change would not mean delaying medical services or imposing additional paperwork on seniors. “With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” CMS Administrator Marilyn Tavenner said in a statement.
Under current rules, Medicare usually determines whether to cover devices like power scooters after they have already been delivered to beneficiaries. Patients are responsible for the cost of the device if the program denies their claim. Now, seniors looking to obtain home medical devices will have to submit coverage, coding, and clinical documents for review prior to delivery of the supplies, rather than afterward.
Source: The Hill