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CMS Rolling Out DRLS Pilot Program

Original story posted on: May 21, 2019

Outreach to providers on the topic continues.

From the same folks who brought you the Electronic Submission of Medical Documentation (esMD), there is a new initiative from the Centers for Medicare & Medicaid Services (CMS) known as the Medicare Fee-for-Service (FFS) Documentation Requirement Lookup Service (DRLS) pilot.

Melanie Combs-Dyer, who at the time of launching esMD was the deputy director of the CMS Office of Financial Management/Provider Compliance Group, appeared on Monitor Mondays on Aug. 22, 2011. esMD then went live Sept. 15, 2011.

Today, Combs-Dyer is director of the CMS Provider Compliance Group (PCG) Center for Program Integrity (CPI).

Last week, May 14, CMS hosted an open door forum to provide stakeholders with an overview of DRLS. This outreach is part of an ongoing effort to solicit participation in the pilot.

Although not quite ready for prime time, CMS reports that it has developed a DRLS prototype that would allow providers and consultants to give feedback to CMS. The overall objective, as CMS describes, is “to streamline workflow access to coverage requirements.”

According to CMS, the prototype involves the participation of two workgroups that will promote the development of standards to support DRLS. These workgroups include the Office of the National Coordinator (ONC) for Health Information Technology’s Fast Healthcare Interoperability Resource (FHIR) at Scale Taskforce (FAST) and a private sector entity, the Da Vinci project, hosted on the platform of Health Level Seven (HL7).

“By working with HL7, ONC, other payers, providers, and EHR vendors, CMS is helping define the requirements and architect the standards-based solutions,” CMS said in an announcement. “In parallel, CMS is preparing to support pilots testing the information exchanges for Medicare FFS programs and possibly coordinate pilots with volunteer participants to verify and test the new FHIR based solutions.”

The goals of the DRLS prototype, according to CMS, are to reduce provider burden, reduce improper payments and appeals, and improve "provider-to-payer" information exchange. The prototype will be populated with a) a list of items/services for which prior authorization is required, and b) the documentation requirements for oxygen and continuous positive airway pressure (CPAP) devices.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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