CMS PILOT PROGRAM
Centers for Medicare and Medicaid (CMS) set up an "invitation only" pilot program to affect regulations that are created within CMS. Their intention was for companies impacting healthcare to participate in these pilots as the proving ground for new ideas. However, after 15 years of effort, CMS found it difficult to make this program work. None of the pilots or companies were approved, until Topline Healthcare.
How We Became the First Company Ever to Successfully Lead and Complete a CMS PILOT
In the first pilot, we focused was on Power Mobility Devices and created the new prior authorization component (as well as the forms, procedures, and review process) that is now used in regulations at CMS. Our success was primarily due to basing our pilot objectives on the goals of CMS. For instance, their goal was to lower the error rate and speed up the process. With our pilot, it was very much about how the procedure was going to happen and what regulations were going to be wrapped around it. Therefore, we directed all of the appropriate information to the MAC for prior approval. They had seven days to respond, and the turn-around time for payment reduced by 40% since it was already approved. We proved interoperability by making sure that all of the components worked together electronically and technically to speed up the process and reduced the error rate from 57% to 1%. In short, we successfully proved our system, met CMS's goals, gained their approval, and ultimately affected change for the better.
CMS then invited us to continue our partnership with them. We led and completed a secondary pilot, which focused on the interoperability and treatment of patients with addiction issues. We advised on a third pilot regarding Durable Medical Equipment (DME) oxygen and prior authorization for the oxygen, which created new regulations that surround how oxygen is approved and paid for by CMS.
More importantly, CMS has asked Topline Healthcare to lead a highly desired pilot for Structured Notes, which will have a direct impact on how everything is submitted to CMS, from the format and content of each note to the requirements on how each note will be medically validated. They have put their faith in Topline Healthcare to successfully complete this and other pilots, not only for the benefit of CMS but also for the healthcare nation as a whole.
It all comes down to this:
Topline Healthcare is well-vetted and is endorsed by CMS. We were the first company to successfully complete a CMS pilot and continue our partnership with them. We are actively interviewing select companies to partner with us in these exciting projects. If you are interested in this opportunity or know a company who would like to partner with us, please contact:
Mark Kimmel, Ph.D.
CEO | Director of Development
Direct: (562) 822-5559