For one, CMS has directed contractors to limit their scope in appeals to the original denial reason. That means no new surprises or issues to fight as a case moves up the ladder.
For another, CMS will now accept orders from previous suppliers when a beneficiary simply changes suppliers. When a new supplier obtains documentation from a competitor, the customer won't have to undergo a new face-to-face or get a new order from their physician - just because they choose a different supplier. The significance of this change is far reaching and is welcome news for suppliers contemplating acquisition activity.
Also on the appeals front, CMS has started to pilot a program where the QIC is authorized to overlook and mitigate simple errors that do not impact medical need for a product.
These are powerful changes and are indicative of a new day for HME providers!
On May 4, MiraVista will explore these developments along with other meaningful changes affecting the Medicare appeals process (including the new pilot program that is delivering a reversal rate of more than 80% for suppliers that harness this opportunity). Register today for this upcoming event titled: Medicare Appeals - New Initiatives Make the Process Relevant Again.