COVID-19: AN ADVOCATES GUIDE TO MEDICARE-RELATED CHANGES

From the Center for Medicare Advocacy: For More Info, Go Here…

ngd- Everything you need to know about the relaxation of Medicare rules in the new world, plus more...

For Example: 

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS)

If durable medical equipment, prosthetics, orthotics or supplies are lost, destroyed, irreparably damaged or otherwise unusable or unavailable, contractors can waive the following requirements:

• Face-to-face encounter
• New physician’s order
• New medical necessity documentation
• Suppliers must still include a narrative description on the claim explaining the reason the equipment must be replaced.
• Suppliers must maintain documentation indicating DMEPOS was lost, destroyed, irreparably damaged or otherwise unusable or unavailable as a result of the COVID crisis.

Medicare will cover a broader array of respiratory devices and equipment such as non-invasive ventilators, multi-function ventilators, respiratory assist devices, and continuous positive airway pressure devices. Medicare will also cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously, Medicare covered them under certain circumstances.

Prior authorization requirements are suspended for power mobility devices (PMDs) and pressure reducing support surfaces (PRSS). Also, the implementation of Prior Authorization (PA) of Lower Limb Prostheses scheduled to begin on May 04, 2020 is delayed.

Durable medical equipment

Medicare Administrative Contractors will continue to accept and review voluntary prior authorization requests for the affected HCPCS codes on the Required Prior Authorization List; however, claims associated with a non-affirmation decision or claims submitted without requesting prior authorization that would normally cause a payment denial will be processed for payment for the duration of the COVID-19 PHE. Claims bypassing prior authorization may be selected for post-payment review after the PHE has ended.

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