Most read stories: Will 2018 be the year of widespread prior authorizations?

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Tuesday, January 23, 2018

YARMOUTH, Maine – The big story in mobility for 2017 was CMS’s new prior authorization program for two complex rehab codes, K0856 and K0861.

Authorize this

Prior authorizations were the subject of two of the most read stories for 2017: “CMS announces first codes up for PA process” (No. 2) and “It’s a bumpy start for prior authorizations” (No. 4).

Mobility providers are no strangers to prior authorizations, which CMS already requires in 19 states for standard power wheelchairs as part of a demonstration project, but there are hiccups with any new program. In this case, stakeholders felt, at least initially, that providers didn’t have all the information they needed to comply with the program. It wasn’t until the last minute, for example, that they received an operational guide from CMS.

But by and large, stakeholders support this new program, as well as the demo. Complex rehab wheelchairs are costly to provide, and prior authorizations give providers a level of confidence that they’ll get paid for their work. Stakeholders have actually made the case for requiring prior authorizations for standard power wheelchairs in all states and for all complex rehab wheelchairs.

With the demo set to expire in August, CMS has the opportunity, stakeholders say, to do just that. Will 2018 be the year of widespread prior authorizations?

Accessible—and smart

Another subject that dominated the most read stories in 2017: home modifications. In the No. 1 story, “NSM sees ‘steady growth’ in home accessibility,” the national complex rehab provider provides an update on AccessNSM, which grew to 14 locations in 12 states in 2017.

Now that NSM and Numotion have consolidated much of the complex rehab market, they’re looking for additional ways to grow their businesses, and home modifications, which are needed by a similar customer base, fits the bill.

In the No. 3 story, “Group sets off movement for home modifications,” this niche business gets further play, with stakeholders organizing behind a bill in the House of Representatives that would give seniors a $30,000 tax credit for modifying their homes to help them age in place.

With the VGM Group also making a concerted push in this market (rebranding its Accessible Home Improvement of America to VGM Live at Home to expand its coverage to smart sensors and other home health technology), we’re also watching this space in 2018.