An upcoming policy change will soon make it mandatory nationwide to submit prior authorization for Pressure Reducing Support Surfaces. Prior authorization is a process through which a request for provisional affirmation of coverage is submitted for review before an item is provided to a Medicare patient and before a claim is submitted for payment. This process helps to ensure that all applicable Medicare coverage, payment and coding rules are met before an item is provided. As of October 21, 2019, when planning for discharge for patients that you believe may need a Pressure Reducing Support Surface (PRSS), you will need to submit a prior authorization.
WOC nurses must act to educate, collaborate and advocate with other medical professionals, case managers and DME companies about this process to ensure patients receive the appropriate medical equipment for their condition. The WOCN® Society has created an FAQ documentto help our members comply with these new requirements. We encourage you to review this resource and share it with your colleagues, regardless of care setting, as this new policy change does not just affect one area of health care.
Please contact us if you have any feedback or have witnessed concerns about this policy change in your work environment.
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