DME MAC Program Manager Update - Workgroup Collaboration - April 25, 2024

In earlier articles, we shared how the Noridian and CGS Program Managers oversee a variety of operational and collaborative workgroups. These groups meet monthly to discuss opportunities for process improvements across the DME Medicare Administrative Contractor (MAC) jurisdictions. In this edition, we are pleased to share an update on our ongoing workgroup activities.

All workgroups review draft and final CMS Change Requests (CRs), during both the draft and final process, to ensure a common understanding of the requirements. This collaborative approach helps to make ensure all DME MACs implement the changes consistently.

Here are just a few workgroup highlights from 2023 and plans for 2024:

  • All workgroups proactively prepared for the end of the COVID-19 Public Health Emergency (PHE) by taking part in planning sessions with CMS, collaborating on system updates to ensure national consistency, and working closely on education for the supplier community.
  • To support our DMEPOS suppliers, the DME MACs also collaborate with the A/B MACs to produce educational webinars with a special focus on supporting the reduction in the Medicare Fee for Service error rate. This workgroup presents four webinars each year focused on prescribing practitioner documentation requirements for DMEPOS claims. In 2024, the webinar topics are:
    • Documentation requirements for ordering clinicians
    • Positive Airway Pressure (PAP)
    • Nebulizers
    • Lower Limb Orthoses
    We are pleased to report that the national 2023 DMEPOS CERT error rate of 22.5% continued its downward trend from 28.6% in 2021 and 25.24% in 2022.
  • The DME MAC Provider Outreach and Education (POE) teams also work together all year to deliver both collaborative and co-branded education for suppliers. We do this to make sure we educate the supplier community consistently. In 2024, we will continue our successful pattern of presenting webinars for suppliers on the same topics as the A/B MAC series noted above, but with a focus on the supplier documentation requirements. To increase the benefit of collaborative webinars for both prescribing practitioners and suppliers, our contact centers use the webinar material for Customer Service Representative (CSR) training. This enables our CSRs to help suppliers consistently across the DME MAC jurisdictions.
  • In 2023 the DME MAC Medical Director workgroup supported the supplier community by publishing 92 Joint DME MAC and/or joint Pricing, Data Analysis and Coding (PDAC) Publications. These included Local Coverage Determination (LCD) and Policy Article Revisions, Dear Physician/Clinician letters, correct coding and coverage, and open meeting announcements for Proposed LCDs.
  • Our Medical Review (MR) teams continued their collaboration on the Targeted Probe and Educate (TPE) and Prior Authorization programs, ensuring consistency in processes as the PHE ended.
  • Throughout the year, our Medical Review teams and Medical Directors take part in Inter-Rater Reliability (IRR) sessions with CMS and other review contractors. We perform IRR assessments on a sample of cases to measure the degree of agreement among reviewers. With multiple contractors performing medical record reviews, it is important to have consistent review practices. The DME MAC Appeals and MR Workgroups also continued their IRR sessions.

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Last Updated Apr 25 , 2024