Centers for Medicare & Medicaid Services (CMS)

  • DME Billing Services
    DME Prior Authorization Programs - GAO

    DME Prior Authorization Programs – GAO

    According to the analysis of GAO, CMS’s prior authorization programs for durable medical equipment (DME) created an estimated $1.9 billion in Medicare savings. CMS’s prior authorization programs for durable medical equipment (DME) and mobility devices have controlled unnecessary spending, according to a new Government Accountability Office (GAO) report. This was created between $1.1 and $1.9 billion in Medicare savings from 2012 to 2017. Prior authorization is a payment approach used by private insurers that generally requires health care providers and suppliers to first demonstrate compliance with coverage and payment rules before certain items or services are provided to patients, rather than after the items or services have been provided. This approach may be used to reduce expenditures, unnecessary utilization, and improper payments. The Centers for Medicare & Medicaid Services (CMS) has begun using prior authorization in Medicare through a series of fixed-length demonstrations designed to measure their effectiveness and one permanent program. According to GAO’s analyses, expenditures decreased for items and services subject to a demonstration. GAO’s analyses of actual expenditures and estimated expenditures in the absence of the demonstrations found that estimated savings from all demonstrations through March 2017 could be as high as about $1.1 to $1.9 billion.…

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