On September 1, 2012, the Centers for Medicare & Medicaid Services (CMS) will start a three-year demonstration for prior authorization of Power Mobility Devices (PMD). The demonstration is voluntary and encourages physicians and suppliers to submit prior authorization requests of scooters and power wheelchairs for beneficiaries residing in CA, IL, MI, NY, NC, FL or TX. CMS selected these states based on their high levels of fraudulent claims.
This demonstration would not create new documentation requirements for physicians or suppliers. Rather, it allows the information to be submitted to the DME Medicare Administrative Contractor (MAC) earlier in the claims process by the physician or supplier. Physicians must perform and document a face-to-face examination discussing the need for a PMD. As a reminder, all of the documentation requirements are outlined in the local coverage determination of your region.
The DME MAC will have 10 business days to either approve or deny the prior authorization request and written notification of the DME MAC's decision will be sent to the treating physician, beneficiary and supplier. If a request is denied, the ordering physician may resubmit the request (unlimited requests are allowed).
Under this demonstration, CMS will partially compensate physicians for the additional time spent in submitting a prior authorization request by allowing physicians to report HCPCS code G9156 to A/B MAC contractors along with the prior authorization tracking number for reimbursement.
Neurologists who order power wheelchairs for Medicare beneficiaries residing in the seven demonstration states should continue to check the CMS Demonstration website for the most up-to-date information. The demonstration is expected to end in the summer of 2015 and CMS believes that this demonstration will help to prevent waste, fraud and abuse.