Jurisdiction B News: Review and Prior Authorization Demonstration for PMD Call

Centers for Medicare & Medicaid Services

Special Open Door Forum:

Medicare’s Prepayment Review and

Prior Authorization Demonstration Project for Power Mobility Devices

Friday, December 2, 2011- 2:00pm- 3:30pm Eastern Time

Conference Call Only (201111-53)

The purpose of this Special Open Door Forum (ODF) is to provide an opportunity for suppliers to ask questions about the Demonstration.  

The Centers for Medicare & Medicaid Services (CMS) will conduct a demonstration that will implement a prior authorization process for certain medical equipment for all people with Medicare who reside in seven states with high populations of fraud- and error-prone providers (California, Florida, Illinois, Michigan, New York, North Carolina, and Texas).  This is an important step toward paying appropriately for certain medical equipment that has a high error rate.  This demonstration will help ensure that a beneficiary’s medical condition warrants their medical equipment under existing coverage guidelines. Moreover, the program will assist in preserving a Medicare beneficiary’s right to receive quality products from accredited suppliers.  

The Prior Authorization demonstration will be implemented in two phases. During the first phase (the first three to nine months), the Medicare Administrative Contractors will conduct prepayment reviews on certain medical equipment claims. The second phase, for the remainder of this three-year demonstration, will implement prior authorization, a tool utilized by private-sector health care payers to prevent improper payments and deter fraud.

To read more about the Demonstration visit: http://go.cms.gov/cert-demos.

Participants may submit questions prior to the Special ODF to pademo@cms.hhs.gov  by Thursday, December 1, 2011, 5pm ET.

We look forward to your participation.

Special Open Door Participation Instructions:

Dial: 1-866-501-5502 & Conference ID: 29840167  

Note: TTY Communications Relay Services are available for the Hearing Impaired.  For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Special Open Door Forum website at http://www.cms.gov/OpenDoorForums/05_ODF_SpecialODF.asp and will be accessible for downloading beginning on or around Tuesday, December 13, 2011.


For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/opendoorforums/ .

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