Part B Insider (Multispecialty) Coding Alert

Published on Sat Oct 30, 2004 PDF

But will the new QICs provide an easier process?

Many providers believed Fair Hearing Officers weren't always fair, and experts speculate whether Qualified Independent Contractors (QICs) will live up to their name better.

The Centers for Medicare & Medicaid Services has named eight QICs to replace the carriers' "fair hearing officers" for Part B providers. The contractors, which include carrier First Coast Service Options, will be able to bid on different provider workloads.

The other new QICs are Integriguard, Q Administrators, Island Peer Review Organization, Rivertrust Solutions Inc., Computer Sciences Corp., Maximus, and Permedion.

Some experts are cautiously optimistic that the new appeals contractors will be fairer than the FHOs were. The QICs could prove beneficial to providers, predicts Tammy Tipton, president of Appeal Solutions in Blanchard, OK. That's because an independent voice generally is more likely to hear both sides of the story than an in-house reviewer.

"Because they're focusing more on appeals and not on claims processing and all the other things the carrier is focusing on," the QICs will do a better job with appeals, Tipton hopes. The QICs may be more educated about Medicare laws and quicker to apply them to the providers' benefit.

"Hopefully, the QICs will make the appeals process smoother, but the industry is waiting to see whether the change will result in more even-handedness," says Joyce Jones, office manger with Memorial Health Clinic in Aurora, NE.

But not all experts are happy to see the FHOs go. "Medicare has been pretty fair," says Michelle Logsdon with Cash Flow Solutions in Cherry Hill, NJ. The process is "probably going to be worse with an independent company," which may think more like a private insurer, she fears.

CMS aims to complete its overhaul of the Medicare appeals system by Oct. 1, 2005. Changes will include a new system allowing parties to track their appeals online in real time, a 60-day decision deadline, and improved first-level appeal notices indicating the specific reasons for the determination.