Citing “strong support from the supplier community” as well as initial success in DME MAC Jurisdictions C and D, CMS today announced expansion of the Telephone Discussions & Re-Openings Demonstration into Jurisdictions A and B, starting November 1, 2018. The full announcement on CMS’ Original Medicare (Fee-for-service) Appeals page reads as follows:
10/22/2018: Given the strong support from the supplier community and the initial success of the Demonstration, CMS is expanding the Demonstration into DME MAC Jurisdictions A and B. Effective on or after November 1, 2018, the DME QIC will offer telephone discussions and/or reopenings to DME suppliers within 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 (PMDs), Settlement Conference Facilitation (SCF), etc.). If selected and offered a telephone discussion, supplier participation remains voluntary under the expanded Demonstration. Current Demonstration activities conducted within DME MAC Jurisdictions C and D will continue as is (i.e., all DME claims types will remain eligible for telephone discussions and/or reopenings and the exclusion of glucose/diabetic testing strip supplies does not apply).
The Demonstration has removed 81,000 claims from the ALJ backlog in 2017 and as of September the Demonstration has successfully removed about 98,000 claims this year. AAHomecare has advocated for this expansion for a long time and is pleased to see CMS move forward with this effective program.