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Documentation Requirement Lookup Service (DRLS) Initiative

Description
Medicare only pays for items and services when the provider’s medical record documentation indicates that all coverage and coding requirements were met. The Medicare documentation requirements appear in various locations and on separate websites causing burden to providers who must navigate the various websites to find coverage requirements, including documentation and prior authorization requirements.

What is Medicare doing to streamline access to requirements?
CMS is collaborating with ongoing industry efforts to streamline workflow access to coverage requirements, starting with developing a prototype Medicare Fee for Service (FFS) Documentation Requirement Lookup Service. The prototype will be made accessible to pilot participants and will be populated with 1) a list of items/services for which prior authorization is required, and 2) the documentation requirements for Oxygen and Continuous Positive Airway Pressure (CPAP) devices.

DRLS is being implemented with the below Da Vinci Project Implementation Guides:
Coverage Requirements Discovery (CRD) - http://hl7.org/fhir/us/davinci-crd/2018Sep/index.html
Documentation Templates and Rules (DTR) - http://build.fhir.org/ig/HL7/davinci-dtr/
Start Date
06/13/2018
Projected End Date
08/01/2020
Project Tags
  • CDS Hooks
  • Coverage Requirements Discovery
  • CRD
  • Da Vinci
  • Documentation Templates and Coverage Rules
  • DTR
  • FHIR
  • HL7
  • Payer
  • SDC
  • SMART
  • US Core Data for Interoperability
Project Point of Contact: ldecellesremove@removemitre.org
Project Results
None