Providers of durable medical equipment are seeing great success under a CMS Medicare appeals experiment launched earlier this year.
In January, the CMS launched a demonstration that allowed DME suppliers to discuss by phone their appeals with a qualified independent contractor, a company hired by the CMS to assess claims.
Since the program launched, the contractor C2C has resolved 12,000 appeals. Preliminary data indicates the demonstration resulted in approximately 80% favorable outcomes for suppliers who participated in a discussion, twice the level experienced by suppliers who appealed in the traditional way.
The CMS did not provide dollar amounts for the appeals that were granted. DME suppliers could appeal claims that were denied on or after Jan. 1, 2013. The demonstration has been offered only in southern and western regions of the U.S., where more than 24 million fee-for-service Medicare beneficiaries reside, according to CMS data.
The agency also limited appeals requests to claims related to diabetic testing supplies and oxygen equipment because they make up the bulk of appeals.
To encourage broader use of the demonstration, the CMS is expanding the service to appeals of all durable medical equipment, prosthetics, orthotics and supplies. The demonstration's regional scope, however, will remain the same.