Appeals Demonstration Expanded to Home Health & Hospice

From HomeCare Magazine:

On Jan.1, 2016, the Centers for Medicare & Medicaid Services (CMS) launched the Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration to test whether further engagement between durable medical equipment (DME) suppliers and the DME QIC would improve the understanding of the cause of appeal denials and, over time, result in more proper claim submission. Since the initial implementation, CMS further expanded the demonstration activities to include all DME claim types within DME MAC Jurisdictions A, B, C and D, with some exceptions.

Effective May 1, 2019, CMS further expanded the demonstration activities to the Part A East (PAE) QIC jurisdiction. Under the expanded demonstration, the PAE QIC is offering telephone discussions and/or re-openings to Part A, which includes home health and hospice providers in the PAE states. For home health and hospice providers, below are the following MACs and eligible states for the demonstration.

FFS Medicare Home Health and Hospice Appeals Eligible for QIC Demonstration

Palmetto—JM    Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas

CGS—J15         Colorado, Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia

NGS—JK          Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont

NGS—J6          New Jersey, New York, Puerto Rico, U.S. Virgin Islands

Reconsiderations for service termination, hospital discharge reviews and claims or providers that are already involved in another CMS initiative (e.g. SCF) are not eligible for telephone discussions and/or re-openings under the demonstration.

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