CMS contractor expands phone demo

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Friday, November 4, 2016

JACKSONVILLE, Fla. – C2C Innovative Solutions, the contractor handling the second level of the Medicare appeals process, has received the green light from CMS to expand a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases.

C2C, CMS’s Qualified Independent Contractor or QIC, received word from the agency on Nov. 1 that it can open the demo to all product categories, with the exception of power mobility devices, Daniel Roach, phone demo project manager, told HME News at Medtrade.

“The demo will still only apply to Jurisdictions C and D, and it will still only apply to claims from Jan. 1, 2013, up until current claims,” he said.

To date, C2C has been randomly selecting up to five claims per National Provider Identifier or NPI for two product categories: diabetes testing supplies and oxygen equipment.
C2C has conducted more than 4,000 calls and has re-opened close to 10,000 cases as of the end of October, Roach said.

“That’s 10,000 claims that have been removed from the ALJ,” he said. “They have been re-opened and made favorable.”

More providers could be taking advantage of the phone demo. Right now, only 60% of providers agree to go through the process when C2C notifies them by mail with a scheduled date and time for a phone conversation.

“That is increasing because of the outreach we’re doing,” said Emily Stroupe, education and outreach specialist.

For providers who outsource their billing to third parties, there has been confusion about who should be participating in the phone demo.

“Now we’re going to start working with the third parties directly,” Stroupe said.

C2C is not surprised CMS has decided to expand its phone demo.

“They’ve wanted to get more reversals done,” said Janet Lawrence, medical director for C2C.