CMS addresses reimbursement for new technology

 - 
Tuesday, July 30, 2019

WASHINGTON – CMS is proposing a rule to establish methodologies to modernize pricing of new DMEPOS items and services, the agency announced July 29.

“The proposed rule would provide greater transparency for innovators regarding how CMS determines if new items and services are comparable to older items and services for Medicare pricing,” CMS states. “The proposed rule also promotes competition and innovation in DMEPOS by setting Medicare payment for new items based on commercial pricing data.”

CMS says greater transparency as to how it establishes fee schedule amounts for new technology, a gap-filling methodology that recognizes the cost differences between new and older items, and potentially using additional sources of market-based pricing to establish such gap-filled fee schedule amounts should foster improvements and innovations in DMEPOS technology and ensure more competitive prices.

CMS is also proposing:

  • Streamlining requirements related to face-to-face encounters, written orders prior to delivery and/or prior authorizations to reduce provider confusion.
  • Revising the existing DMEPOS competitive bidding program regulations to recognize that changes of ownership may occur on shorter timeframes, and revising the submission of a hearing request in notices of breach of contract.


CMS is soliciting comments on these proposals until Sept. 27.