New CMS Proposals Streamline Medicare Coverage for Innovative and New Diabetes Devices

Lately, CMS has proposed new changes to Medicare Durable Medical Equipment, Prosthetics, Orthotic Devices and Supplies (DMEPOS) coverage, and payment policies. These proposed new changes will streamline Medicare coverage for innovative and new diabetes devices and this brief will help you to understand “How”.

The proposed rule for innovative and new diabetes devices

New CMS proposals help innovators to understand a more predictable path about the kinds of products that Medicare will pay for.

For example – As per the agency, new changes that could expand Medicare coverage for continuous glucose monitors and insulin pumps. However, the current CMS rule only covers therapeutic CGMs or FDA approved for use in making diabetes treatment decisions, such as based on only CGM readings one’s diet or insulin dosage can be changed.

New CMS Proposals have expanded the interpretation regarding the appropriate use of external infusion pumps for use in the home and can be covered as DME under Medicare Part B. You will also find the main driver behind the proposed rule is to increase access to drug infusion therapy services in the home including insulin pumps as well as reduce administrative burdens.

These administrative burdens mainly occur due to complicated government coverage, coding processes, and payment which blocks innovators to provide their products to Medicare beneficiaries in a timely manner. But these problems are addressed in the proposed rule and you will understand it in the following brief.

Timely delivery of Innovative and New Diabetes Devices to Medicare beneficiaries

The new CMS proposed rule is beneficial for both manufacturers and patients as manufacturers can bring a new product to market and they can get a Medicare payment amount and billing code immediately. This speedy process will result in quicker access for Medicare beneficiaries to the latest technological advances and the most cutting-edge devices available.

The rule also reduced the time constraints of 18 months to 6 months for Medicare benefit classifications, pricing determinations, and creating billing codes for DMEPOS.

It is observed in the US that one is diabetic in every three Medicare beneficiaries and hence this proposal can be a boon for beneficiaries and physicians because both Medicare beneficiaries and their physicians can have a wider range of technology and devices to choose from while managing diabetes.

Lastly, the rule talks about higher pay of DEMPOS suppliers where CMS will continue to pay higher amounts to suppliers for DMEPOS items and services furnished in rural and non-contiguous areas to encourage suppliers to provide access and choices for beneficiaries living in those areas.

Hence we can say that the proposed rule will help CMS to establish a streamlined process for coding, coverage, and payment in regulation and puts patients first, and empowers them to choose the therapies that best meet their diabetes management needs.

We are keeping eye on every small development in the healthcare of the US and our HIPAA compliant billing experts will help you in your medical billing and coding so that you can get paid timely with no errors.