Stakeholders fear QIC switch

‘It could exacerbate the situation at the ALJ, which is already untenable’
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Friday, April 20, 2018

YARMOUTH, Maine – Stakeholders are not happy that C2C Innovative Solutions appears to be losing its gig as the Qualified Independent Contractor for HME.

Jacksonville, Fla.-based C2C has popularized a demonstration project that allows HME providers to speak with reconsideration professionals by phone to try and resolve their cases. In 2017, 64% of claims that were involved in the demo were found fully favorable and 3% were found partially favorable, AAHomecare recently reported.

“C2C has been great to work with,” said Ronda Buhrmester, a reimbursement specialist with the VGM Group. “They’re following CMS’s directives, but they see the issues, and they want to help.”

AAH also reported that, in 2017, the demo had reopened 54,128 claims and withdrew 27,132 claims from the backlog at the administrative law judge level.

The word on the street is that CMS is switching the QIC contract from C2C to Reston, Va.-based Maximus to save money.

“When you provide excellent customer service and tools like C2C does, it costs money,” said Mary Stoner, president of Electronic Billing Services Inc. “It’s all about the money, and it’s too bad.”

Stakeholders say C2C is protesting the decision, and they’re crossing their fingers.

“They’re trying to get their expenses down to come up with a better price,” Buhrmester said. “We’re waiting to see what the outcome of that is.”

If the contract stays with Maximus, stakeholders fear they’ll have a lot of work to do, as they say the company has little, if any, experience with DME. Maximus currently holds one QIC contract for the West Jurisdiction for Part A, while C2C currently holds five QIC contracts, including for HME and the HME Phone Demonstration.

“We’re going to have to provide education (to Maximus) on how to process claims,” Stoner said. “We’ve notified CMS and we’ve been assured that they’re watching this.”

Switching the contract to Maximus may also create instability in an already unstable audit and appeal environment, stakeholders fear.

“It could exacerbate the situation at the ALJ, which is already untenable,” said Andrea Stark, a reimbursement consultant with MiraVista.