CMS Expands QIC Phone Demonstration Project

Starting Nov. 1, a demonstration project that lets providers work with QIC over the phone to reopen claims at ALJ will grow to incorporate Jurisdictions A and B.

CMS has expanded its Qualified Independent Contractor telephone demonstration project to most DME claims filed on or after Nov. 1, 2018 in DME MAC Jurisdictions A and B.

The program lets providers meet with QIC staff over the phone to provide additional documentation in support of a favorable determination in order to reopen claims sitting at the ALJ.

Formally known as the Telephone Discussion and Reopening Process Demonstration, CMS launched the project for specific claims in Jurisdictions C and D on Jan. 1, 2016. It then expanded the program on Oct. 1, 2016 to include all DME claim types in those jurisdictions.

The expansion into Jurisdictions A and B will cover nearly all types of DME claim, except those for diabetic testing strip supplies and for claims that are already involved in another CMS initiative (such as PMD prior authorization or  Settlement Conference Facilitation).

CMS reported it also plans to expand the demonstration project into Part A East QIC Jurisdiction, and will provide more information and timeframe in a forthcoming announcement.

The demonstration project is designed to:

  • Give providers an opportunity to verbally discuss their case with QIC before a decision is made.
  • Require QIC to show the supplier what documents are present in the QIC case file and what documents are needed and are critical to the outcome of a case.
  • Give the provider the opportunity to fax or securely transmit additional documentation to the QIC decision maker that supports a favorable appeals decision prior to making the reconsideration decision.
  • Assist and educate suppliers on CMS policies and requirements.

That effort has paid off, according to the American Association for Homecare, which released a statement supporting the exapnsion and quantifying the program’s success.

“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,” the statement read. “AAHomecare has advocated for this expansion for a long time and is pleased to see CMS move forward with this effective program.”

“We are thrilled to see the expansion of this demonstration project into the other jurisdictions,” said Ronda Buhrmester, VGM’s director of Reimbursement. “In August 2017, VGM and several members testified at a hearing with the Small Business Administration (SBA) proposing the program’s expansion to streamline the appeals process. At the federal level, SBA expressed a great deal of interest in establishing their support of the project, being involved in the process after the hearing.”

For more information, visit CMS’s Original Medicare (Fee-for-service) Appeals page, or the Phone Demonstration page from C2C Innovative Solutions Inc., the current QIC contractor.

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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