Documentation Requirement Lookup Service (DRLS) Initiative

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) - https://build.fhir.org/ig/HL7/davinci-crd/
Documentation Templates and Rules (DTR) - https://build.fhir.org/ig/HL7/davinci-dtr/