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Prior auth update: No involvement from ATP trips some providers

April 28, 2017Liz Beaulieu, Editor

WASHINGTON - CMS gave insight into how providers are doing with a new prior authorization process for two complex rehab codes during the third in a series of Special Open Door Forums on April 25.During the forum, Dr. Robert Hoover, the chief medical officer for CGS Administrators, the DME MAC for Jurisdictions B and C, cited top non-affirmation reasons for K0856 and K0861 so far. An issue that has popped up in both jurisdictions: no evidence that an ATP had direct, in-person involvement in the selection...

Complex Rehab, Dr. Robert Hoover, K0856, K0861