Helping Government Serve the People MAXIMUS Federal DME

Helping Government Serve the People® MAXIMUS Federal, DME QIC Danielle Mc. Partland & Erin Carey March 2020 1

Processing Durable Medical Equipment (DME) Appeals DME QIC Project MAXIMUS Federal Services, Inc. Medicare DME 3750 Monroe Avenue, Suite 777 Pittsford, NY 14534 720 -462 -7580 DMEInfo@MAXIMUS. com 2

MAXIMUS Federal DME QIC Contacts Jennifer Frantz Danielle Mc. Partland Project Director Project Manager Jennifer. EFrantz@Maximus. com Danielle. CMc. Partland@Maximus. com Dr. Mary Pascucci, Dr. Jo. Ellen Habas, Medical Director Assoc. Medical Director Mary. FPascussi@Maximus. com Jo. Ellen. Habas@Maximus. com Erin Carey, Nichols Fletcher, Business Analyst Policy Analyst Erin. MCarey@Maximus. com Nichols. SFletcher 2@Maximus. com 3

QIC Demo: Telephone Discussion Benefits ► Educate suppliers about DME regulations and coverage rules ► Provides an opportunity to discuss the appeal, offer oral testimony, request information, and address any outstanding issues in support of a favorable outcome ► Promotes accurate claim submissions on same/similar claims submitted to the DME MACs in the future 4

QIC Demo: Telephone Discussion Process ► Scheduling letter sent to supplier contact ► Electronic options for scheduling ► Supplier returns the participation form ► Confirmation email sent or reminder call made ► Call takes place ► Conference lines might be used (zoom for healthcare/audio only) ► Recording included as part of the case file ► Decision letter mailed 5

QIC Demo: Telephone Discussion Documentation Sample telephone response form Sample telephone selection letter 6

Telephone Discussion Response Form 7

Appeal Dispositions Comparison Participated in Telephone Discussion Standard Adjudication - No Telephone Discussion Unfavorable 25% Partially Favorable 2% Fully Favorable 35% Unfavorable 63% Fully Favorable 74% Partially Favorable 2% Fully Favorable Partially Favorable Unfavorable Fully Favorable *Data represents adjudicated cases between September 2019 - July 31, 2020 8 Partially Favorable Unfavorable

Response Rates to Telephone Discussion Offers Phone Discussion Response Rates 2000 1800 1600 1400 1200 1000 800 600 400 200 0 September October 2019 November 2019 December January 2020 2019 Accepted February 2020 Declined 9 March 2020 No Response April 2020 May 2020 June 2020 July 2020

QIC Demo: Reopening Process and Benefits ► Appeals pending an Administrative Law Judge (ALJ) assignment at the Office of Medicare Hearings and Appeals (OMHA) that may be found favorable ► Benefits: Reduce appeal backlog and resolve appeals in a timely manner ► Request information only on appeals that may be found favorable with receipt of documentation ► Assist suppliers in requesting withdrawal of appeal at ALJ level 10

QIC Demo: Reopening Documentation Sample reopening response form 11

QIC Portal benefits: ► Quickly submit an appeal, supporting documentation and telephone discussion response forms ► Receiving immediate on-screen acknowledgement that the documentation has been received by MAXIMUS Federal ► Receiving a follow-up confirmation email ► Reducing mail/shipping costs For more information, go to https: //QICAppeals. cms. gov. Users must submit a request for registration before being granted access to the portal. 12

QIC Portal – Appeal Form Beneficiary Section Requestor, Provider/Supplier Section 13

QIC Portal – Appeal Confirmation Appeal Submission Portal Confirmation Appeal Submission Email Confirmation 14

Trends in Appeals- Document Requests for Telephone Discussions Top Types of Documents Requested: Top Appeal Types with Document Requests 1. Medical Records 1. Oxygen 2. Face-to-Face Evaluation 2. Positive Airway Pressure Device 3. Detailed Written Order 3. Negative Pressure Wound Therapy 4. Certificate of Medical Necessity (CMN) 4. Surgical Dressings 5. Refill Request 5. Orthoses Top 5 Requested Documents 159 139 211 263 1922 Top 5 Appeal Types with Requests for Info. Medical Records Face-to-Face Evaluation Order: Detailed Written Order CMN (certificate of medical necessity) Refill Request 373 251 957 474 900 15 Oxygen Pos. Airway Pressure Device Neg. Pressure Wound Therapy Surgical Dressings Orthoses

Frequently Asked Questions Can I request a copy of a decision letter? § Yes, you can email this request to us at DMEOperations. Helpdesk@maximus. com § You can also call or write/fax. How can I confirm acceptance of a scheduled telephone discussion or request a reschedule of a telephone discussion? § In addition to returning the response form via mail or fax, you can also e-mail or call us. Info on next slide! Can I request certain dates and times for telephone discussions? § Yes, we will make every effort to accommodate your scheduling preferences. Can I request a demonstration of the QIC Appeals Portal? § Yes, you can request a demonstration of the QIC Appeals Portal. To do this, please call us or send us an e-mail. Is there a website that contains more information about the Demonstration? § Yes, please visit www. medicaredmeappeals. com Can I request a telephone discussion when I appeal? § Yes, please include that in your appeal request and we will attempt to honor the request when feasible. 16

Contact Us Mailing Address: DME QIC Project 3750 Monroe Avenue, Suite 777 Pittsford NY, 14534 -1302 Fax: 720 -462 -7580 Appeals Status: www. Q 2 A. com Telephone: General Supplier Inquiries: 585 -348 -3200 Telephone Discussion Inquiries: 585 -348 -3202 E-mail: Telephone Discussion Scheduling Inquiries: Discussion. Scheduling@maximus. com Decision Letter Inquiries: DMEOperations. Helpdesk@maximus. com DME Portal Inquiries: QICPortal. Support@maximus. com General Inquiries: DMEInfo@maximus. com Project Director: Jennifer. EFrantz@maximus. com Project Manager: Danielle. CMc. Partland@maximus. com 17