CMS finalizes rule on prior authorization for durable medical equipment, supplies

Editor's Note

The Centers for Medicare & Medicaid Services (CMS), on December 30, 2015, published a final rule that establishes a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies to help reduce unnecessary and fraudulent claims.

Under the final rule, the same information necessary to submit claims in the past will now be provided earlier in the process and subjected to approval before reimbursement.

The final rule includes a master list of 135 items that are often used in fraudulent billing, a required prior authorization list, and a prior authorization process.

The rule goes into effect February 29, 2016.

These regulations are effective February 29, 2016. Maria Ciccanti, (410) 786-3107. Jennifer McCormick, (410) 786-2852. Lynne Zaccaria, (410) 786-2485. 1.