VGM & ASSOCIATESHealthcare MSO
Full Menu Search

CORRECTION: VGM Government and OPOLE Create A Guide to Submitting Medicare Advantage Organization (MAO) Complaints

Published in Government Relations on June 26, 2023

Due to the significant number of reports that we have received over the past several months regarding the tactics being employed by several Medicare Advantage Organizations (MAOs) to deny both authorization requests and claims for several important categories of DME, VGM is collaborating with OPOLE to provide you with some helpful resources regarding MAO related complaint submission. OPOLE (Office for Program Operations and Local Enforcement) is a division within CMS which provides a level of contract oversight and acts as a communication channel between CMS and MAOs. VGM has been actively communicating with OPOLE and has provided them with examples of MAO auth and claim denials. We understand the urgency surrounding these issues and have been talking with them about the best process to resolve them. In addition to those efforts, several of our members have asked for a mechanism through which they can report these issues and file complaints directly themselves. To that end, OPOLE staff has provided us with some guidance regarding the process through which formal complaints can be submitted.  

Attached to this message, you will find a couple of resource documents aimed at streamlining the process for submitting complaints regarding MAOs to CMS staff. The documents outline the complaint submission process, the data elements which must be included in the complaint, and who the point person is for your complaint based on your state/region. Your timely complaint submission will contribute to better and more timely healthcare for the patients that you serve. Together, let’s drive positive change! 

External Provider Complaints Rule

 OPALE State Association Contacts


 

Get Connected

Stay up-to-date on the latest resources and news provided by VGM & Associates.

Sign Up for Email

From Our Experts

PAMES Raises Critical Concerns Over Sole-Source Supply Shift thumbnail PAMES Raises Critical Concerns Over Sole-Source Supply Shift PAMES and DME suppliers across Washington are taking an important stand on behalf of both providers and patients. The Tacoma Daily Index recently reported on the state's plan to move to a sole-source contract for incontinence and urological supplies. Under this decision, the Health Care Authority intends to transition all Medicaid recipients to receiving these products from a single vendor. CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98 Million a Year thumbnail CMS Rule Phases Out Fax Machines, Snail Mail to Save Taxpayers $781.98 Million a Year As reported by CMS: “The Centers for Medicare & Medicaid Services (CMS) is slashing wasteful spending and antiquated paperwork by swapping out faxing and mailing for streamlined electronic transactions. This action lets providers spend less time on administrative hassle and more time caring for patients. SBA Advocacy: Your Input Matters thumbnail SBA Advocacy: Your Input Matters Make your voice heard about how the CBP has affected your business. New Bipartisan Senate Bill Aims to Improve Access to Diabetes Technology & Education for Medicare Beneficiaries thumbnail New Bipartisan Senate Bill Aims to Improve Access to Diabetes Technology & Education for Medicare Beneficiaries U.S. Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME), Cochairs of the Senate Diabetes Caucus, have introduced the Diabetes Interventions Addressing Barriers to Enrollment, Technology, and Education Services (DIABETES) Act, S.4037. VGM Reintroduces the Fraud, Waste & Abuse Reporting Resource Center thumbnail VGM Reintroduces the Fraud, Waste & Abuse Reporting Resource Center VGM Government Relations is proud to announce the reintroduction of its Fraud, Waste & Abuse (FWA) Reporting Resource Center—a newly refreshed online hub designed to protect the integrity of the DMEPOS industry and reinforce our unwavering commitment to ethical, compliant care. Celebrating Another DME Champion of Change: Thom Harvill of Above and Beyond Medical thumbnail Celebrating Another DME Champion of Change: Thom Harvill of Above and Beyond Medical We're proud to once again recognize a true Champion of Change in the DME industry: Thom Harvill of Above and Beyond Medical in Tennessee. Thom has dedicated many years to the DME community—consistently showing up, speaking out, and pushing the industry forward. He's the kind of advocate who never stops asking, “Who else can I reach out to about this?” Federal Actions This Week Signal The Administration Is Doubling Down On Its Goal To Eliminate Fraud Waste And Abuse thumbnail Federal Actions This Week Signal The Administration Is Doubling Down On Its Goal To Eliminate Fraud Waste And Abuse This week, the Trump administration, through the Centers for Medicare & Medicaid Services (CMS), announced a significant deferral of federal Medicaid matching funds to Minnesota alongside the release of a new Request for Information (RFI) tied to the administration's Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative. These actions along with the changes to DMEPOS accreditation and enrollment signal the administration's aggressive posture on Medicaid and Medicare... VGM Response To CMS Moratorium On New DMEPOS Provider thumbnail VGM Response To CMS Moratorium On New DMEPOS Provider The federal moratorium on new DME suppliers presents a defining moment for us as an industry—an opportunity to demonstrate that the VGM members serving patients are the gold standard. We have long shown that our members operate with integrity, excellence in compliance, and unmatched commitment to service, efficiency, and patient outcomes. Now, we must elevate that message.

Give your business an advantage over the competition.

Become a Member