RevCycle Intelligence: CMS Wants to Streamline DMEPOS Reimbursement, Boost Rural Pay

“A new proposed rule from CMS is seeking to streamline how the agency determines if durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) qualify for Medicare reimbursement and coverage.”

“The proposed rule for the Medicare DMEPOS fee schedule released yesterday by CMS would codify changes to coding, coverage, and payment for new items. The changes made through sub-regulatory guidance that would be finalized in this rule include more frequent coding cycles, including timeframes for application submission and final decisions.”

“The changes implemented last year have reduced the process of making Medicare benefit classifications, pricing determinations, and billing code establishment from an average of 18 months to complete to just six months for some items, CMS stated in the proposed rule.”

“By finalizing the changes and making these actions more transparent, CMS intends to permanently streamline the process, enabling benefit classification and pricing decisions to happen on the same day the billing codes used for payment of new items take effect.”

“If finalized, the new process would be a ‘win-win for patients and innovators alike,’ CMS Administrator Seema Verma said in an announcement.”

“’With the policies outlined in this proposed rule, innovators have a much more predictable path to understanding the kinds of products that Medicare will pay for,’ added Verma ‘For manufacturers, bringing a new product to market will mean they can get a Medicare payment amount and billing code right off the bat, resulting in quicker access for Medicare beneficiaries to the latest technological advances and the most, cutting-edge devices available…’” Read the full article here.

Source: CMS Wants to Streamline DMEPOS Reimbursement, Boost Rural Pay – By Jacqueline LaPointe, October 28, 2020. RevCycle Intelligence.

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