How will the DME prior authorization rule affect revenue cycles?

The latest DME prior authorization rule has some healthcare experts furrowing their brows, concerned the regulation's focus on cost control may come at the expense of efficient patient care.

Jordan Levitt, founding partner of revenue cycle solution provider PayorLogic, spoke with Becker's Hospital Review to discuss the rule's potential effects on healthcare revenue cycles.

Mr. Levitt believes the rule is a first step toward combatting an important issue in care reimbursement, but contends the "implications could be significant," especially during initial implementation stages.  

Under the final rule, CMS will require a certain subset of high dollar/high frequency durable medical equipment prosthetics, orthotics and supplies to be authorized prior to distribution rather than after the fact, according to Mr. Levitt. If the authorization process is successfully streamlined, Mr. Levitt believes the new timeline could certainly help reduce both fraud and payment related surprises for all parties involved. 

"However, the 10-day turnaround timeframe committed to by CMS is a bit long, especially considering the high volume and urgency of these items," says Mr. Levitt. Inefficiencies and care delays could adversely affect both providers and patients, for which patient care and patient satisfaction could suffer, Mr. Levitt adds.

"Applying a gate keeper before a process versus after a process clearly makes sense, but the process needs to be appropriately supported and understood by all stakeholders," says Mr. Levitt.

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