Emily Barnes from C2C Inc. recently attended Medtrade 2018 and shared some very encouraging stats regarding the processing Reconsiderations for Medicare DMEPOS claims.
C2C is a QIC, otherwise known as a Qualified Independent Contractor. They are contracted to perform second level appeals with the intention of improving the timeliness and accuracy of Medicare appeals. Charged with processing requests back to 2013, Emily shared that current processing data shows that 70% of Reopening’s are approved, and Reconsiderations via phone demonstration are up 80%.
Our take away from this update received in a DACD Committee Meeting was that for Providers in Regions C and D you are starting to see some results! If you have been hesitant to fight Medicare claims due to slow processing results in the past, it may be time to refocus your efforts. HDMS tools like Collection & Denial Management now provide billing specialists with a way to status claims that enter into an appeal and reports that leverage those status markers to see the effectiveness of those efforts.
Lisa Anderson, leading Education & Outreach for Universal shares, “All paid claims are not created equal, especially when it comes to Medicare dollars. If you are spending the time and manpower to fight denied claims, you are doing your business a disservice if you are not looking at your effectiveness metrics.”
The second noteworthy item clarified by C2C Inc is that Reconsiderations are responded on based on the contact info listed on the original request. Remember that as they work through a backlog from 2013, staff that originally submitted those documents may have changed. Be sure to get in touch with C2C Inc at the link below if you have open Reconsiderations and Reopening requests in Medicare Regions C&D if you have had address, email, or phone number changes!
We see good news shared with week by AAHomecare, indicating that CMS has expanded QIC telephone discussions and reopenings to Regions A & B except for diabetic testing supply claims. AAHomecare’s full article can be shared here: https://mailchi.mp/aahomecare/qic-expansion-alert?e=a76e5eda26
It was a pleasure to meet the C2C Inc Team!