QIC demo sets ‘different tone’

Friday, May 13, 2016

Kansas City, Mo. – Able Care Health Equipment in Kansas City, Mo., was recently selected to take part in a new demo project that provides a more interactive process for resolving claims at Medicare’s second level of appeals.

The demo, launched in January by C2C Innovative Solutions, Medicare’s Qualified Independent Contractor or QIC, allows providers to speak with a reconsideration professional by phone to try and resolve their cases.

Jason Hood, CFO of Able Care Health Equipment, spoke to HME News about his experience.

HME News:What made you want to go through this process? 

Jason Hood:We reached out to Andrea Stark (a reimbursement consultant with MiraVista) to see what she had heard about this and she said, “Yes, this is absolutely a good thing. It’s going to relieve some of the administrative law judge cases sitting there waiting to be heard.” The current system is kind of slow, so any way that you can speed that up is worth a shot.

HME:What was the claim in question about?

Hood:Ours was an oxygen patient. It was a simple error. We needed a physician to sign off on a change that was made. He didn’t do it—one of his office staff did. So we sent the corrected documentation, along with our acceptance form to participate in the demo. We waited about a week and a half before (C2C) called. It was pretty cut and dry as far as, “This is what we were missing, but you’ve got it now.” In 10 days, I had a decision letter in my hand that they accepted the documentation and the claim was going to be paid.

HME:Is this a viable alternative to the ALJ?

Hood:I think this could definitely help alleviate the ALJ (backlog). If you can talk this through instead of sending a bunch of faxes back and forth, it really expedites the system and it’s something that could help both sides look better. I think the other side is definitely reaching out. It’s a different tone and I think it’s a tone that everyone can work with.

HME:Does the program have any other benefits?

Hood:From what I understood on the phone, if at all possible, they’re going to try to (pair you with) the same auditor, for lack of a better word, so there’s a chance to build up a rapport and for them to learn about you and your company, and make their own decision whether you are a good, quality, ethical company. I think that’s a smart move. It’s a step in the right direction.