New Medicare Rule Requires Prior Authorization for Certain Medical Equipment

A new Medicare rule requires prior authorization for certain covered durable medical equipment and it starts the end of this month. The Centers for Medicare and Medicaid Services (CMS) published this final rule on Dec 29, and, as with other efforts, like the Competitive Bidding Program, CMS is trying to find that happy medium of reducing fraud, on the one hand, and ensuring beneficiary access, on the other. We, among our our partner advocates are concerned the new prior authorization requirements may limit or delay beneficiaries’ access to DME. An outside group AdvaMed will monitor CMS’ implementation of the new rule and its affect on beneficiary access.

Below are links to a CMS fact sheet and two articles for more information.