Skip to main content

VGM & ASSOCIATESHealthcare MSO

Search GO

Search GO

VGM & ASSOCIATESHealthcare MSO LEARN ABOUT VGM

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

From Our Experts

2025 CMS Proposed Rule Challenges and To-Dos thumbnail

2025 CMS Proposed Rule Challenges and To-Dos The 2025 CMS Proposed Rule for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) introduces several significant changes that present both operational and financial challenges for DME companies.

You Got the Contract! …NOW WHAT?! A Short Series thumbnail

You Got the Contract! …NOW WHAT?! A Short Series Congratulations! You FINALLY got the contract you've been working so hard on all these months. Now that you have it, what are the critical next steps you need to take to maintain and implement the contract and generate ROI? Welcome to the first of a short series of articles to help you accomplish just that.

NAAOP Hosts First Ever In-Person Legislative Fly-In thumbnail

NAAOP Hosts First Ever In-Person Legislative Fly-In Last week, 33 stakeholders, advocates, and leaders from around the O&P industry convened at the offices of Powers Pyles Sutter & Verville PC in Washington, D.C., as part of The National Association for the Advancement of Orthotics and Prosthetics's (NAAOP) first ever in-person legislative fly-in. Co-sponsored by OPGA, the fly-in kicked off with an in-depth discussion and strategy session surrounding several legislative priorities affecting O&P providers and patients.

VGM Government Relations Unveils Grassroots Advocacy Toolkit to Empower DME Champions of Change thumbnail

VGM Government Relations Unveils Grassroots Advocacy Toolkit to Empower DME Champions of Change The VGM Government Relations team is proud to announce the launch of its Grassroots Advocacy Toolkit, thoughtfully crafted to support durable medical equipment (DME) professionals, caregivers, industry partners, and patient advocates in advancing legislative initiatives that impact home medical equipment and services.

Featuring Two Champions Of Change: Robert Beard of YD Home Medical & Rob Minicucci Jr. of Health System Services thumbnail

Featuring Two Champions Of Change: Robert Beard of YD Home Medical & Rob Minicucci Jr. of Health System Services Today, we're proud to spotlight two outstanding durable medical equipment (DME) champions whose advocacy efforts are making a meaningful difference: Robert Beard of YD Home Medical of Alabama and Rob Minicucci Jr. of Health System Services of New York. These individuals took time out of their busy schedules to personally connect with elected officials, demonstrating how local action can spark national change.

Survey: Share Your Thoughts on Proposed Accreditation Rule Changes thumbnail

Survey: Share Your Thoughts on Proposed Accreditation Rule Changes CQRC, VGM, and AAHomecare are requesting your feedback on a new proposed rule that could significantly impact accreditation procedures. Under the proposal, accreditation organizations would be required to conduct site visits every year—a major shift from the current once-every-three-years schedule.

WEBINAR: Navigating New CMS Guidelines: Unlocking Opportunities in NIPPV and RAD Coverage for COPD Care thumbnail

WEBINAR: Navigating New CMS Guidelines: Unlocking Opportunities in NIPPV and RAD Coverage for COPD Care The Centers for Medicare & Medicaid Services (CMS) has revised the NCD for Noninvasive Positive Pressure Ventilation (NIPPV) in the home setting for treating Chronic Respiratory Failure (CRF) due to Chronic Obstructive Pulmonary Disease (COPD). The changes aim to establish clear coverage policies for devices such as Respiratory Assist Devices (RADs) and home mechanical ventilators (HMVs), potentially expanding access to these critical therapies for eligible patients. Adapting to new CMS guidelin

Bipartisan Medicare O&P Bill Introduced thumbnail

Bipartisan Medicare O&P Bill Introduced In a timely move ahead of next week's NAAOP Legislative Fly-In, a bipartisan group of lawmakers introduced the Medicare Orthotics and Prosthetics Patient-Centered Care Act, a bill aimed at improving access to high-quality orthotic and prosthetic care for Medicare beneficiaries. The Patient-Centered Care Act seeks to address critical gaps in Medicare coverage for orthotic and prosthetic (O&P) services. Under current rules, beneficiaries may receive devices without the necessary clinical services

Give your business an advantage over the competition.

Become a Member