Under a demonstration announced in November, Medicare will implement a prior authorization process for all power mobility device claims in 7 high risk states—California, Illinois, Michigan, New York, North Carolina, Florida, and Texas. The purpose of the project is to circumvent the ability to get fraudulent claims through Medicare's claims payment systems.
The project will occur in 2 stages. During the first stage, claims for power mobility devices will be on 100% prepayment review beginning for dates of service on or after January 1, 2012. The second stage will implement prior authorization for these claims in which the durable medical equipment Medicare Administrative Contractors will review the claims and postmark a notification of denial or approval within 10 days. For more information, physical therapists can view the resources created by the Centers for Medicare and Medicaid Services for the December 2 special open door forum on this issue.