DME MAC Program Manager Update - JA DME

In previous articles, we shared how the Noridian and CGS Project Managers oversee a variety of operational and collaborative workgroups that meet monthly to discuss opportunities for DME MAC process improvements across the DME MAC jurisdictions.

We are excited to introduce the newest member of the project manager group, as well as showcase recent workgroup initiatives that support the DMEPOS supplier community.

Tina Breiland is the new JD Project Manager at Noridian.

Below are the DME MAC Jurisdictions’ Project Managers:

The items below represent several recent workgroup highlights:

• All workgroups continue to review CMS Change Request (CRs) to ensure consistent understanding of implementation requirements. This focused practice ensures that processes are consistent across all jurisdictions.
• The A/B/DME MAC Education Workgroup is comprised of all MACs. The workgroup identifies lessons learned from the Medicare (Fee-For-Service (FFS) Improper Payment Data product category error rates and uses that knowledge to enlist the support of prescribing practitioners to reduce error rates related to insufficient documentation in medical records. After a successful 2021 with well-attended webinars, the workgroup’s 2022 quarterly webinar topics will be:
• Q1-Orthotics
• Q2-Medical Documentation
• Q3-Glucose Monitors and Supplies
• Q4-Respiratory
• The Provider Customer Service Program Workgroup continued their successful collaborative webinars and planned the DME webinar topics to align with the A/B/DME topics noted above.
• Multiple teams, including the DME MAC medical directors, worked closely with CMS on Q&As for the Phillips Respironics recall.
• The Appeals Workgroup reviewed their processes for handling redeterminations related to break in billing for capped rental items. The assessment showed that all jurisdictions had consistent processes.
• The Medical Review Workgroup worked closely to ensure consistency with the resumption of the Targeted Probe and Educate (TPE) program. The group recommended enhancements to the DMEPOS Prior Authorization Coversheet Requirements, which CMS accepted.
• The Appeals and Medical Review Workgroups continued their Interrater Reliability Reviews (IRRs). These IRRs support consistent review practices across contractors and will continue to do so in 2022.
• In November, the Comprehensive Error Rate Testing (CERT) Education Task Force presented a webinar focused on knee orthoses to over 400 attendees. The major focus of questions revolved around joint laxity and the information reviewers look for in the medical record. In addition to the webinar, the group jointly published an article to further communicate information on specific errors and data related to knee orthoses.