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April 12, 2021 - Updated: 11.08.21

Reconsiderations: Formal Telephone Discussion Demonstration

Update: All activities related to the DME Qualified Independent Contractor (QIC) Telephone Discussion and Reopening Process Demonstration will end on December 31, 2021.

In 2016, CMS launched a Formal Telephone Discussion Demonstration with Durable Medical Equipment (DME) suppliers that submit Medicare Fee-For-Service claims. The demonstration provides selected suppliers that have submitted reconsiderations (second level appeal requests) the opportunity to participate in a formal recorded telephone discussion with the DME Qualified Independent Contractor, MAXIMUS Federal Services.

The demonstration is extremely beneficial, offering

  • Supplier education on Medicare coverage policies and the root causes of denials.
  • Dialog between the supplier community and expert reconsideration reviewers to allow for an exchange of information, as well as a detailed review of regulations and policies applicable to the appeal.
  • Identification of documentation that may result in favorable decisions at reconsideration.
  • Identification of appeals previously closed with unfavorable reconsideration decisions that can now be reopened and resolved favorably under this demonstration.

Additional information on the demonstration is available at MAXIMUS Federal ServicesExternal Website.


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