MAMES - Mississippi Association of Medical Equipment Suppliers MAMES
MAMES - Mississippi Association of Medical Equipment Suppliers

Mississippi Association of Medical Equipment Suppliers


Posted on: 06/09/2015
Description: <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;">On May 21, 2015, Rep. Marsha Blackburn introduced H.R. 2437, which will create a prior authorization process for durable medical equipment (DME)&nbsp; in the Medicare program. </span></p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;"></span>&nbsp;</p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;">As of December 2013, the Administrative Law Judge (ALJ)&mdash;the final level of appeal for Medicare claims&mdash;stopped taking new a<a name="_GoBack"></a>ppeals, including those from the durable medical equipment, prosthetics, orthotics and services (DMEPOS) sector. Currently, there are approximately 900,000 appeals before the ALJ, of which a quarter are from DMEPOS suppliers who have waited more than two years to get to the ALJ. These suppliers face an onslaught of audits from the Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Supplemental Medicare Review Contractors (SMRC), Recovery Audit Contractors (RAC) and the Comprehensive Error Rate Testing Contractor (CERT).</span></p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;"></span>&nbsp;</p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;">A way to address this growing problem is to create a prior authorization process for DMEPOS claims in Medicare.&nbsp; In this prior authorization process, DMEPOS suppliers would submit the necessary paper work for a Medicare claim and CMS would either approve or deny payment for it before the equipment is supplied.&nbsp; If CMS denies the claim, the agency indicates the reason why and allows the supplier to resubmit it with corrections or additional information.&nbsp; CMS has created a prior authorization demonstration project for power mobility devices in 19 states.&nbsp; The demonstration project has been a success and is supported by consumer and industry groups.&nbsp; This process is also used in the private sector to make the system more efficient, while not negatively impacting beneficiary access.</span></p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;"></span>&nbsp;</p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;">H.R. 2437 is a common sense approach to address the out of control audit process.&nbsp; This legislation will benefit the American taxpayers by ensuring DMEPOS claims are proper, beneficiary access will not be impacted, and suppliers will not have to wait years in the appeals process to know whether or not a Medicare claim will be paid.</span></p> <p class="MsoNormal"><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;"></span>&nbsp;</p> <p class="MsoNormal"><strong><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;">The Ask:</span></strong><span style="font-family: &quot;Cambria&quot;,&quot;serif&quot;"> <span style="color: black">Please contact your member of Congress, and ask them to contact Rep. Blackburn&#39;s staff to support this important piece of legislation by signing on as a co-sponsor. If</span> you have any questions or need additional information, please let me know.</span></p> <p class="MsoNormal"><span style="


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