Össur’s Empower Practice and Workflow Management system (Empower by Össur) now seamlessly complies with new prior-authorization requirements announced by the U.S. Centers for Medicare and Medicaid Services (CMS) for some commonly prescribed knee and spinal orthoses.
“Although CMS has previously enacted prior authorization requirements, the new standards can create authorization challenges for patients with urgent medical needs and the clinicians who care for them. It is important that clinicians comply with the new regulations to avoid payment delays or clawbacks for claims already paid,” said Mark Tymchenko, Össur’s Vice President, Americas Bracing & Supports.
“The good news is that Empower has addressed these prior authorization requirements so that clinicians can provide care without delays when clinically required while also remaining compliant with Medicare standards. This new functionality builds on last year’s updates that ensure customer compliance with CMS’ Competitive Bidding practice requirements mandated for off-the-shelf spine and knee bracing,” he added.
Empower by Össur is a fully automated, fully customizable web-based solution that helps physician practices, durable medical equipment, and prosthetic and orthotic suppliers (DMEPOS) with day-to-day practice management solutions by combining reimbursement, real-time inventory management and consulting services within a single paperless platform. Össur is a global innovator in prosthetic and non- invasive orthopedic technologies.
Prior Authorization Requirement Rolls Out Across US in 2022
According to Tymchenko, CMS’s new prior authorization requirements also currently require a face-to- face (F2F) patient encounter and written order, and directly apply to five of the most frequently prescribed knee and spinal cord orthoses (L-1832, L-1833, L-1851 and L-0648 and L-0650, respectively), as well as a prefabricated upper orthosis frequently prescribed for a patient’s shoulder, elbow, wrist and hand (L-3960). They were introduced in select U.S. geographies in April and will be implemented across the country in a phased schedule throughout 2022.
The first medical practices required to comply with the new requirements were based in New York, Florida, Illinois and California. The second phase of the regulations, which take effect on July 12, 2022, involves medical practices from Maryland, Pennsylvania, New Jersey, Michigan, Ohio, Kentucky, Texas, North Carolina, Georgia, Missouri, Arizona and Washington state. All remaining states and U.S. territories must comply by the start of the third and final phase of the regulations beginning on October 10, 2022.
Empower by Össur Helps Practices Navigate Orthopaedic Operating Environment
Empower by Össur offers various resources to help medical practices address the challenges of today’s operating environment, whether it’s helping practices comply with the new prior authorization requirements, recently introduced competitive bidding standards, or gaining access to valuable online reimbursement and regulatory (R&R) newsletters and bulletins, key terminology and HCPCS L-Code guidance documents. Medical practices that are enrolled in Empower by Össur also can receive hands- on benchmarking of their practices with the help of dedicated Business Solutions Managers, as well as unlimited consulting, auditing and compliance reviews for all aspects of DMEPOS business practices and procedures.
Empower by Össur is fully HIPAA compliant and compatible with HL-7 data sharing standards. The team at Empower by Össur has over six decades of practice management consulting experience, with a dedicated account manager assigned to provide support and service to each practice on an ongoing basis. To date, the team has processed nearly 4 million orders and supported over 87,000 physicians in over 4,800 billing locations, collecting more than $350 million in reimbursements.
“As we’ve seen with CMS’ new requirements, the orthopaedics space is constantly evolving, and the newest prior authorization requirements, as well as other reimbursement and policy changes by CMS, can increase the complexity for medical practices and DMEs seeking to successfully navigate considerable operational and financial issues,” Tymchenko said.
“Fortunately, Empower by Össur was developed to help clinicians focus on their priority: patient care,” he continued. “With Empower by Össur, clinicians can be assured that their practice is prepared and compliant, regardless of the regulatory, operational or reimbursement challenges they may face. We also provide personalized account support, so clinicians can work with Empower’s experts to ensure their practices are remaining compliant regardless of these various changes.”