PMD demo is working

BALTIMORE - Spending on power mobility devices (PMDs) continues to decrease in PMD demo states and non-demo states alike.

In a recent status update, CMS said that monthly spending on PMDs in the original seven demo states fell about 69%, from about $12 million in September 2012 to $3 million in June 2014. In non-demo states, spending also fell about 65%, from about $20 million in September 2012 to about $6 million in June 2014.

Medicare's PMD demo program requires providers in California, Illinois, Michigan, New York, North Carolina, Florida and Texas to submit prior authorization requests before supplying equipment.

CMS says the decrease in PMD expenditures is due to suppliers adjusting their billing practices nationwide and complying with CMS policies.

Industry consultant Martin Szmal concedes that submitting documentation before supplying equipment gives providers an opportunity to learn from denials and to make adjustments.

“When providers are reviewing documentation in-house, (they know who) qualifies based on what they've learned from previous authorization requests,” said Szmal, founder of The Mobility Consultants. “I think that has a lot to do with the decrease in spending.”

Szmal attributes the decrease in non-demo states to providers in those states reviewing the demo's operational guide, which outlines the documentation needed for prior authorization requests.

“I think non-demo states looked at it and followed suit—prescreening their clients and weeding out the ones that did not qualify under Medicare guidelines,” he said.

Though Szmal thinks there is room for improvement, including shortening CMS's 10-day turnaround time for issuing decisions, he also says the process is working.

“I think that the demonstration has shown itself to be useful for providers as far as understanding what Medicare is looking for,” he said. “It's also working for CMS in reducing the number of dollars spent on PMD.”