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

President Trump Pauses Implementation of Tariffs for One Month thumbnail President Trump Pauses Implementation of Tariffs for One Month On Monday, Feb. 3, President Donald Trump suspended his threat of imposing 25% tariffs on Mexico and Canada at the last minute, agreeing to a one-month pause in exchange for concessions on border security and crime enforcement. Impact Of Tariffs On The DMEPOS Industry thumbnail Impact Of Tariffs On The DMEPOS Industry President Donald Trump announced on Thursday that he will impose 25 percent tariffs on Canada and Mexico starting Saturday, Feb. 1. Sens. Blackburn and Duckworth Introduce S.247 - Carbon Fiber/Titanium Wheelchair Upgrade Bill thumbnail Sens. Blackburn and Duckworth Introduce S.247 - Carbon Fiber/Titanium Wheelchair Upgrade Bill Senators Marsha Blackburn (R-TN) and Tammy Duckworth (D-IL) have introduced the Choices for Mobility Act, S. 247. This legislation aims to improve access to titanium and carbon fiber wheelchairs for Medicare beneficiaries. MAMES Succeeds In Improving Coverage For Breast Pumps And Lactation Services In Nebraska thumbnail MAMES Succeeds In Improving Coverage For Breast Pumps And Lactation Services In Nebraska MAMES has successfully advocated for enhanced coverage of breast pumps and lactation services in Nebraska. Working closely with the Medicaid Director, MAMES ensured the implementation of these changes would be effective and beneficial. The new coverage aligns with other Medicaid programs in the Midwest. A Tribute to John Gallagher: A Journey of Dedication and Memories thumbnail A Tribute to John Gallagher: A Journey of Dedication and Memories When I started working for John Gallagher 12 years ago, I often heard the phrase, “baptism by fire.” I quickly learned what that meant. At the time, the team consisted of John Gallagher, Mark Higley, and Tom Powers, and they were all constantly on the road. I would get a phone call from John saying, “The ESRD was just released, look it up and write up a summary, we need to get this to our members ASAP. I'm hopping on a plane…get it out before the end of the day.” Rep Mariannette Miller-Meeks Introduces The Veterans Supporting Prosthetics Opportunities and Recreational Therapy (“SPORT”) Act thumbnail Rep Mariannette Miller-Meeks Introduces The Veterans Supporting Prosthetics Opportunities and Recreational Therapy (“SPORT”) Act Rep. Mariannette Miller-Meeks (R-Iowa), who, along with proving to be a champion of DMEPOS related legislation, serves as chair on the House Veterans Affairs Subcommittee on Health. Recently she introduced H.R. 9478, The Veterans Supporting Prosthetics Opportunities and Recreational Therapy (“SPORT”) Act. Congress Passes, President Signs Continuing Resolution thumbnail Congress Passes, President Signs Continuing Resolution As you know by now, Congress passed a Continuing Resolution (CR) to keep the government operating for another three months. Signed by President Joe Biden, this resolution will only fund critical government operations through March 31, 2025. Breaking: Year-End Package Update thumbnail Breaking: Year-End Package Update As lawmakers race to avert a government shutdown ahead of this Friday's deadline, we have learned that the provision to reinstate and extend the 75/25 blended rate will not be included in the proposed continuing resolution that is expected to fund the federal government until March 14, 2025. Despite exhaustive bipartisan efforts from all reaches of the HME community, including providers and stakeholders, there was not enough support to get it included in the package.