In February, the Centers for Medicare & Medicaid Services (CMS) announced that it was moving forward on two demonstrations, Prior Authorization of Power Mobility Devices (PMD) and the Recovery Audit Prepayment Review, aimed at strengthening Medicare by reducing improper payments. The demonstrations were expected to begin on or after June 1, 2012.
CMS expects to begin the demonstrations later this summer, after the Paperwork Reduction Act process is complete. CMS will provide providers and suppliers with 30-days notice before the start of the demonstrations.
Background on Demonstrations
The Prior Authorization of Power Mobility Devices (PMD) demonstration would implement a prior authorization process for PMDs for Medicare beneficiaries who reside in seven states with high incidences of improper and fraudulent claims (CA, IL, MI, NY, NC, FL and TX).
The Recovery Audit Prepayment Review demonstration will conduct prepayment reviews on certain types of claims that historically result in high rates of improper payments. These reviews will focus on seven states with high incidences of improper and fraudulent claims (FL, CA, MI, TX, NY, LA, and IL) and four states with high claims volumes of short inpatient hospital stays (PA, OH, NC, and MO) for a total of 11 states.
For more information on the demonstrations, please see: https://www.cms.gov/CERT/02_Demonstrations.asp
If you have any questions about this announcement, please feel free to contact me. Thank you.
Greg A. Jones
Office of Legislation
Centers for Medicare & Medicaid Services