CMS announcement for durable medical equipment suppliers

The Centers for Medicare & Medicaid Services (CMS) announced updated guidance regarding several emergency waivers related to Medicare and Medicaid policies and regulatory updates during this pandemic for durable medical equipment suppliers. The CMS very likely will continue to announce supplemental guidance on the blanket waivers.

Here we have a detailed summary of the relevant waivers that will affect durable medical equipment suppliers, prosthetics, orthotics, and supplies (DME) and are projected to prepare the American healthcare system with maximum flexibility to respond to the public health emergency.  These temporary changes will remain in effect across the U.S. healthcare system for the duration of the pandemic emergency declaration.

By enacting these waivers, CMS hopes to “put patients over paperwork” to give some relief from vast documentation work, reporting, and audit requirements. Now providers and regulators can focus on providing required care to Medicare and Medicaid beneficiaries impacted by coronavirus.

Prior Authorization

CMS waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to release the administrative load of compliances during public health emergencies. In normal conditions, DME suppliers are required to undergo a prior authorization process to make sure that applicable coverage, payment, and medical coding rules are met before the durable medical equipment supplier delivers DME supplies to beneficiaries.

According to CMS announcement, CMS is pausing this national prior authorization program for certain DME suppliers to ease the administrative burden.

Lost and Damaged DME

If DME is damaged or lost, DME Medicare Administrative Contractors now have the right and flexibility to waive certain replacement requirements, normally such requirements are required by Medicare. According to CMS, for a face-to-face encounter, new medical required documentation, new physician order, which normally are required to support reimbursement for a replacement item, are waived during the public health emergency.

Though CMS has relaxed this regulation but it cautioned durable medical equipment suppliers that they should still include a narrative description on the claim explanation why the durable medical equipment must be replaced. This incident must be properly documenting the loss or damage of equipment. CMS announced this ‘documentation waiver’ retroactive to include ‘Dates of Service’ on or after March 1, 2020.

Increase in DME Payment

As it is essential by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, CMS will continue to regulate the fee schedule payments for equipment and services furnished in non-contiguous and rural, non-competitive bidding areas based on a fifty-fifty blend of adjusted and unadjusted rates for the remainder of the coronavirus pandemic.

Specifically, to durable medical equipment suppliers, CMS will provide higher payment for certain durable medical equipment and services furnished in non-competitive bidding areas within the contiguous United States with dates of service on or after March 6, 2020, through the remainder of the COVID-19 public health emergency as required by the CARES Act.

CMS is probably to announce supplementary guidance on these regulatory changes and Medical Billers and Coders will continue to monitor coronavirus pandemic related developments and provide updates.

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