VGM seeks to streamline MA complaint process
By HME News Staff
Updated 10:59 AM CDT, Mon June 26, 2023
WATERLOO, Iowa – VGM & Associates encourages providers to supply the Office for Program Operations and Local Enforcement at CMS with examples of Medicare Advantage organizations denying prior authorizations and claims for several important categories of DME. “We understand the urgency surrounding these issues and have been talking with them about the best process to resolve them,” VGM stated in a recent bulletin. “In addition to those efforts, several of our members have asked for a mechanism through which they can report these issues and file complaints directly themselves. To that end, OPOLE staff has provided us with some guidance regarding the process through which formal complaints can be submitted.” VGM supplied a document that providers can use to streamline the process of submitting complaints. It outlines the complaint submission process, the data elements that must be included in the complaint, and the appropriate point person based on state/region. OPOLE is a division at CMS that provides a level of contract oversight and acts as a communication channel between CMS and MA organizations.
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