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November 2, 2021

A DME MAC Program Manager Update

In previous articles we shared how the Noridian and CGS DME MAC Program Managers oversee a variety of operational and collaborative workgroups that meet monthly to discuss opportunities for DME MAC process improvements across all four DME MAC jurisdictions. In this article, the Program Managers share examples of recent workgroup highlights:

  • The A/B/DME MAC CERT Education Workgroup is comprised of all MACs. The workgroup identifies lessons learned from the Medicare FFS Improper Payment Data product category error rates and uses that knowledge to enlist the support of prescribing practitioners in reducing the error rates related to insufficient documentation in medical records. Through Quarter 3, the webinars were presented to over 700 attendees on the topics of lower limb orthosis (LLO), therapeutic shoes for persons with diabetes (TSPD), and continuous positive airway pressure (PAP) devices.
  • DME MAC Collaborative Webinars address the critical need for collaboration and consistent education. The four DME MACs work together to create this education for our suppliers and conduct quarterly collaborative webinars. The 2021 quarterly webinars have been extremely popular, as evidenced by over 800 attendees for the webinars through August (Competitive Bid – Orthoses, Therapeutic Shoes for Persons with Diabetes, and Positive Airway Pressure [PAP]).
  • The Overpayments Workgroup reviewed the requirements of the Continuing Appropriations Act, 2021 and Other Extensions Act, which set favorable terms for repayment of accelerated and advance payments issued to providers and suppliers, as defined by Social Security Act §1861 (u) and (d) respectively, during the COVID-19 PHE, to ensure consistent processes.
  • The DME CERT Education Task Force conducted a collaborative Surgical Dressings webinar that focused on common CERT errors for surgical dressings. The webinar was well attended, with 380 attendees logged in (not counting additional shared listeners). Additional clinical staff from all four DME MAC jurisdictions were available to answer the multitude of questions received.
  • The Claims Workgroup reviewed CMS Change Requests for a shared understanding of implementation requirements, and they continued the ongoing review of claim processing workflows to ensure consistent processing across jurisdictions.
  • The Appeals and Medical Review Workgroup continued their Interrater Reliability Reviews (IRRs). With multiple contractors performing medical record reviews, it is important have consistent review practices. These IRRs support consistent review practices across contractors.


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