Two CMS anti-fraud programs, whose Jan. 1 launch was scrubbed because of provider concerns, will start in June instead, according to the agency.
A pilot program to require prior authorization for scooters and power wheelchairs prescribed for Medicare beneficiaries was supposed to launch Jan. 1, but the CMS announced shortly before the scheduled start date that it was temporarily suspending the program.
The agency announced that a “significantly” redesigned version of the program will launch in seven states—including several with the largest Medicare populations and highest rates of erroneous billing—on June 1.
In response to objections from both providers and suppliers, the pilot in California, Florida, Illinois, Michigan, New York, North Carolina and Texas was modified from its original design in several ways, including deletion of a requirement for 100% pre-payment review.
But at least one advocate for such suppliers was doubtful that any tweaks to the program would prevent negative unintended consequences.
“The big issue is the welfare of the patients,” said Liz Moran, executive director of the Medical Equipment Suppliers Association, which represents affected companies in Texas. Although she had not reviewed the changes in the program's design, she said any such program will add delays to patients receiving needed equipment.
The other pilot project that had a January launch moved to June 1 will allow recovery audit contractors to review claims before they are paid, focusing on the types of claims historically associated with high rates of improper payments in seven states (California, Florida, Illinois, Louisiana, Michigan, New York and Texas) and claims with high volumes for short inpatient hospital stays in four states (Missouri, North Carolina, Ohio and Pennsylvania).
There were no major changes to the RAC pilot program, according to a CMS official.
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