Tip From The Trenches

Date Published: December 11 2013

How is the prior authorization demonstration helping DME providers?

As the industry average prior authorization denial rate remains a consistent 51 percent, we believe it's better to know sooner rather than later if power mobility equipment qualifies for reimbursement. 

DME providers who subscribe to DMEevalumate are currently operating at a 99 percent approval rate for prior authorization approval. The reason is simple. When providers succeed in getting their practitioners to use the web-based face-to-face evaluation program to determine what PMD equipment, if any, a patient qualifies for, they know immediately if the medical necessity required by Medicare has been met. The algorithmic program doesn't guarantee that a patient will get the equipment they are requesting, it analyzes information provided by the practitioner and accurately determines if all 63 elements of the coverage criteria have been met. If all 63 elements have not been met, the program recommends alternatives such as canes and walkers.

For up-to-date stats about the Medicare prior authorization demonstration project, click on the following link or visit

This information is brought to you by Tips from the Trenches, a weekly response to FAQs from our customers. For more information, contact us at 

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