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Prior Authorization to Ensure Beneficiary Access and Help Reduce Improper Payments

(Centers for Medicare & Medicaid Services) The Centers for Medicare & Medicaid Services [has] announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years…
The announcement builds upon lessons learned from the Medicare Prior Authorization of Power Mobility Device Demonstration.  Launched in 2012, the demonstration established a prior authorization process for certain power mobility devices. Based on September 2013 claims data, monthly expenditures for certain power mobility devices decreased from $12 million in September 2012 to $4 million in August 2013 across the seven demonstration states (California, Florida, Illinois, Michigan, New York, North Carolina, and Texas) with no reduction in beneficiary access to medically necessary items.  
CMS seeks to leverage this success by extending the demonstration to an additional 12 states.
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