CMS expands phone demo

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Tuesday, October 23, 2018

JACKSONVILLE, Fla. – CMS will expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases to jurisdictions A and B on Nov. 1.

The agency cited “strong support from the supplier community and the initial success of the demonstration” as reasons to expand the phone demo.

“Effective on or after Nov. 1, the DME QIC will offer telephone discussions and/or re-openings to DME suppliers within the DME MAC Jurisdictions A and B for all DME claim types, except claims for glucose/diabetic testing strip supplies and claims or suppliers that are already involved in another CMS initiative (e.g. prior authorization for power mobility devices),” CMS states in an announcement. “If selected and offered a telephone discussion, supplier participation remains voluntary. Current demonstration activities conducted within Jurisdictions C and D will continue as is.”

The phone demo removed some 81,000 claims from the backlog at the administrative law judge level in 2017 and as of September has removed 98,000 more claims in 2018, according to AAHomecare, a strong supporter.

CMS has slowly been expanding the phone demo. In 2016, it opened the demo to all product categories, except power mobility devices, in jurisdictions C and D.

C2C Innovative Solutions, the contractor running the phone demo as part of its gig as the Qualified Independent Contractor for HME, is currently appealing CMS’s decision to switch the contract to Maximus.