Plotting a Synchronized Journey in DME Prior Authorization

The final rule establishes a process for DME prior authorization through a two step process. The first rule creates a master list of DMEPOS items that can frequently lead to unnecessary utilization and are potentially subject to the process of prior authorization. The second rule creates a “required prior authorization list” which is a subset of items on the master list subject to prior authorization.

Before 60 days of implementation, the CMS has to inform the public of those items in the required prior authorization list by publishing a notice. Under the final rule, the master list contains 135 DMEPOS items. It is important to note that items remain in the master list for 10 years from the date the item gets added. An item can get removed from the list sooner than 10 years if the purchase amount drops below payment threshold.

It is quite clear that DME prior authorization is a complex process and has to be ensured with propriety. The biggest challenge is in creating the right action plan for enhancing the front end requirements. Creating the right ecosystem can be a huge blessing and it helps in effectively balancing your DME billing priorities by making your claim submission process cleaner with lesser denials in the long run.

Opportunity with Sunknowledge

Over the last few years, we have defined growth for DME providers and suppliers with our exclusive presence. Our versatility and ability to drive cash flow with our administrative, financial and other critical front-end efforts have defined reimbursements for some of the largest suppliers in the country.

When it comes to preauthorization for DME, we are uniquely positioned to help you with everything, right from start to finish. In fact, we have reduced operational expenses by almost 80% with our extended presence. Hire us if you are seriously looking for a complete revamp in your reimbursement possibilities like never other. At just $7 per hour, we make things happen for you and can transform your DME prior authorization practices with effective streamlining of your revenue cycle management demands.

Know more on why we are hailed as one of the top names in the entire revenue cycle management space. We are unique as we know how to work and assist you as a reliable extension in DME prior authorization. Right from initiating auth request, following up with the physician office, contacting the payers on the auth outcome, collecting additional documents if any, and finally updating the auth outcome in the practice management system of the client. Know more about our expertise over a quick chat on DME prior authorization services.