Prior auth for Group 2 support surfaces squeezes hospital discharges

 - 
05/30/2019
Andrea Stark
reimbursement consultant, MiraVista

With CMS launching a new mandatory prior authorization program for group 2 support surfaces in July, suppliers are understandably concerned about accommodating patients with immediate needs for pressure support, particularly upon hospital discharge.

Discharge planners typically start care coordination when the doctor signs the order to go home. Suppliers point out that the authorization process takes time. Suppliers must gather supporting documentation from multiple sources, and contractors will scrutinize requests before approving them.

Unlike many other conditions requiring home medical equipment, those treated with group 2 support surfaces rarely develop overnight or go unnoticed by admitting clinicians. To avoid delays in delivery and extended hospital stays, coordination among hospitals and suppliers must begin at admission for beneficiaries in need of pressure support.

Patients qualify for group 2 support surfaces via three pathways:

  • Multiple stage II ulcers on the trunk or pelvis, with evidence of prior treatment for at least a month using a Group 1 support surface and a comprehensive ulcer treatment program.
  • Large or multiple stage III or IV ulcers on the trunk or pelvis.
  • Surgical procedure for a myocutaneous flap or skin graft.


Suppliers should:

  • Develop standard procedures to obtain prior authorizations.
  • Educate hospital staff about the new mandatory prior authorization program.
  • Request contact upon admission when ulcers or other qualifying conditions are present.


Though there is no published guidance at this time, authorizations should remain effective between one and six months after approval.