On January 01, 2016, CMS launched the QIC Telephone Discussion Demonstration project to determine if engagement between suppliers and the QIC could improve the understanding of the cause of appeal denials, and lead to increased proper claim submissions. The project was originally only limited to certain DME claims, however in October 2016, the projected was expanded to include all DME claim types, including orthotics and prosthetics, but only in Jurisdictions C and D.
CMS has recently announced that the Formal Telephone Discussion Demonstration has been expanded to include Jurisdictions A & B starting on November 1, 2018.
Participation in the telephone discussion demonstration is voluntary, but unfortunately there is no way to “sign up” for this program. Your claim(s) must be selected for review by representatives of the QIC, currently that contractor is C2C solutions. C2C Solutions reviews reconsideration requests to identify appeals that may benefit from participation in the telephone discussion process. Eligible suppliers are then offered the opportunity to engage in a telephone discussion with QIC prior to the issuance of the reconsideration decision.
This extra step allows suppliers to discuss the facts of the appeal directly with C2C medical review staff and to submit any missing documentation that may have been identified by C2C. Early results of the initial phases of the demonstration project proved to be very successful with a denial overturn rate approaching 86%.
Questions? Contact Joe McTernan at jmcternan@AOPAnet.org or Devon Bernard at dbernard@AOPAnet.org.