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

Deadline To Comment On CMS' Proposed Rule Is Today thumbnail

Deadline To Comment On CMS' Proposed Rule Is Today VGM Group has submitted our comments on the CY26 CMS DMEPOS/Home Health Proposed Rule and encourages you to do the same (if you haven't done so already)!  Our comments provide key recommendations aimed at protecting patient access and supporting the HME community.  VGM's Key Recommendations Include:

CONNECT for Health Act Gains Bipartisan Telehealth Support thumbnail

CONNECT for Health Act Gains Bipartisan Telehealth Support On April 2, 2025, a bipartisan group of 60 senators reintroduced the CONNECT for Health Act, legislation that would expand patient access to telehealth services through Medicare while removing barriers to adoption. The bill would also make permanent the COVID-19 telehealth flexibilities currently set to expire Sept. 30. The lead sponsors of the bill are Sens. Brian Schatz (D-HI), Roger Wicker (R-MS), Mark Warner (D-VA), Cindy Hyde-Smith (R-MS), Peter Welch (D-VT), and John Barrasso (R-WY).

[Vlog] Important Updates Regarding NIPPV NCD thumbnail

[Vlog] Important Updates Regarding NIPPV NCD Watch below an important update from Ronda Burhmester, Sr. Director Payer Relations & Reimbursement, VGM & Associates, regarding non-invasive pressure ventilation.

Make Your Voice Heard On The Competitive Bidding Program thumbnail

Make Your Voice Heard On The Competitive Bidding Program “If the Competitive Bidding Program goes forward, it will be devastating—not just for providers like me but, most importantly, for the patients we serve,” said Jonathan Temple, owner of OxyMed LLC.

You Got the Contract! Part 2: Maintaining It thumbnail

You Got the Contract! Part 2: Maintaining It In our last article, we discussed the key provisions to be sure you know about your contract. It is critical to understand these provisions to help comply with the contract terms, fulfill your obligations as your business changes, and understand the payer's obligations and your rights under the contract. In this article we discuss some best practices for managing your contracts once you get them.

Industry Uncertainty & Advocacy: What You Can Do Now thumbnail

Industry Uncertainty & Advocacy: What You Can Do Now The proposed rule introduces broad structural changes without full clarity on implementation timelines or enforcement. Industry groups like VGM, AAHomecare, and CQRC are urging stakeholders to engage in advocacy to shape final rules. To prepare for the sweeping changes in the 2025 CMS Proposed Rule for DMEPOS, companies should take a multi-pronged strategic approach. Here is a breakdown of key preparation strategies:

Alabama Durable Medical Equipment Association (ADMEA) Seeks New Executive Director thumbnail

Alabama Durable Medical Equipment Association (ADMEA) Seeks New Executive Director The Alabama Durable Medical Equipment Association (ADMEA) is now accepting applications for the role of Executive Director. This is an exciting leadership opportunity for an individual with a passion for healthcare, industry advocacy, and association management.

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.

Give your business an advantage over the competition.

Become a Member