Prior Authorization Update

Prior Authorization: per CMS : (https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Prior-Authorization-Initiatives/Prior-Authorization-of-Non-Emergent-Hyperbaric-Oxygen.html)

The Prior Authorization Model for Non-Emergent Hyperbaric Oxygen Therapy will end as scheduled on February 28, 2018, based on date of service. Facilities and beneficiaries may continue to submit prior authorization requests after February 28, 2018 for treatments occurring prior to March 1, 2018. The independent evaluation of the model is ongoing. Results will be available once completed.

Targeted Probe and Review is starting to ramp up. This is a CMS mandated transition from Medical Review to TPE.  (https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Targeted-Probe-and-EducateTPE.html)

Here is the link to the information sheet: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/Downloads/What_Is_TPE-Infosheet.pdf

Each MAC may choose what they will audit. These change day to day, so this is the most recent search. You should check your own intermediary regularly.

MAC Part A (G0277) Part B (99183/G0277) DME other
NGS no no yes yes
Noridian no no yes no
Palmetto GBA yes no ? yes
WPS yes yes ? yes
CGS no no ? yes
First Coast no info no info no info no info
Novitas pending no no info no info

If you get a pink envelope with notification, please notify either ACHM administration (admin@achm.org) or Helen Gelly, MD (helengelly@gmail.com).

Thank you.

 

By | 2018-02-16T01:21:20+00:00 February 16th, 2018|Uncategorized|0 Comments

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