Part A East Telephone Discussions
CMS received approval for a one-year extension of the QIC Telephone Discussion and Reopening Process Demonstration activities in the Part A East QIC jurisdiction. The Demonstration activities will now continue through December 31, 2021.
The Telephone Discussions give providers the opportunity to speak with reconsideration professionals in order to provide verbal testimony and additional documentation that could assist in a possible favorable determination. The Telephone Discussion Demonstration will yield the following benefits:
- Provides an opportunity for the provider community to verbally discuss the case with a decision maker before a QIC decision is made;
- Informs the provider what documents are present in the QIC case file and what documents are needed and are critical to the outcome of a case;
- Provides the opportunity to fax or transmit through other secured media additional documentation that supports a favorable appeals decision to the QIC decision maker prior to the reconsideration decision being made; and
- Assists and educates providers on CMS policies and requirements.
The service types under this Demonstration will include all claim types with the only exception to this opportunity being expedited appeals resulting from service terminations denials conducted by Quality Improvement Organizations (QIOs) and claims or providers that are already subject to another CMS initiative (e.g. the Settlement Conference Facilitation (SCF) process, etc.)
If an appeal is selected for the Telephone Discussion Demonstration, the QIC will notify the provider via mail with a scheduled time and date for the Telephone Discussion to be conducted. Participation in this demonstration is voluntary. In order to participate the provider will need to reply by returning the form enclosed with the election acknowledgement letter contact information form via mail or fax within the timeframe indicated in the letter. Note: The telephone discussion has a modified timeframe for the issuance of the decision. Under this Demonstration, the QIC shall have 120 days to process the reconsideration, rather than the existing 60-day standard.
If you have questions regarding the Telephone Discussion Demonstration, you may call us at (904) 224-7371.
C2C Innovative Solutions, Inc.
Part A East Telephone Discussion Demonstration
P.O. Box 45310
Jacksonville, FL 32232-5310
Telephone: (904) 224-7371
Fax: (904) 224-2732