March 21, 2025
DME MAC Program Manager Update – Workgroup Collaboration 2025
In earlier articles, we shared how the Noridian and CGS Program Managers oversee a variety of operational and collaborative workgroups. These groups meet monthly to discuss opportunities for process improvements across the DME Medicare Administrative Contractor (MAC) jurisdictions. In this edition, we are pleased to share an update on our ongoing workgroup activities.
All workgroups review draft and final CMS Change Requests (CRs) to ensure a common understanding of the requirements. This collaborative approach helps to ensure all DME MACs implement the changes consistently.
Here are just a few workgroup highlights from 2024 and plans for 2025:
- All workgroups proactively prepared for the coverage of compression garments under the new Lymphedema Compression Treatment benefit category.
- Workgroups proactively prepared for the transition of Intravenous Immune Globulin (IVIG) from a demonstration to a covered policy.
- To support our DMEPOS suppliers, the DME MACs continued collaborations with the A/B MACs to produce educational webinars with a special focus on supporting the reduction in the Medicare Fee for Service error rate. This workgroup presents four webinars each year focused on prescribing practitioner documentation requirements for DMEPOS claims. In 2025, the webinar topics are:
- Urological Supplies
- Surgical Dressings
- Wheelchair Options and Accessories
- Parenteral Nutrition
We are pleased to report that the national 2024 DMEPOS CERT error rate of 21.41% continued its downward trend from 25.24% in 2022 and 22.5% in 2023.
- The DME MAC Provider Outreach and Education (POE) teams also work together all year to deliver both collaborative and co-branded education for suppliers. We do this to make sure we educate the supplier community consistently. In 2025, we will continue our successful pattern of presenting webinars for suppliers on the same topics as the A/B MAC series noted above, but with a focus on the supplier documentation requirements. To increase the benefit of collaborative webinars for both prescribing practitioners and suppliers, our contact centers use the webinar material for Customer Service Representative (CSR) training. This enables our CSRs to help suppliers consistently across the DME MAC jurisdictions.
- In 2024 the DME MAC Medical Director workgroup supported the supplier community by publishing 58 joint DME MAC, and Pricing, Data Analysis and Coding (PDAC) Publications. These included Local Coverage Determination (LCD) and Policy Article Revisions, Dear Clinician letters, correct coding and coverage, and open meeting announcements for Proposed LCDs.
- Our Medical Review (MR) teams continued their collaboration on the Targeted Probe and Educate (TPE) and Prior Authorization programs, ensuring consistency in processes.
- Throughout the year, our Medical Review teams and Medical Directors take part in Inter-Rater Reliability (IRR) sessions with CMS and other review contractors. We perform IRR assessments on a sample of cases to measure the degree of agreement among reviewers. With multiple contractors performing medical record reviews, it is important to have consistent review practices. The DME MAC Appeals and MR Workgroups also continued their IRR sessions.
MAC Customer Experience (MCE) Survey – We Value Your Feedback
We encourage you to take the survey each time the opportunity presents itself. Whether you see a survey pop up on the website or portal, or you receive a survey invitation after a Provider Outreach and Education (POE) event, please take a few minutes and share feedback.
Surveys give you a direct way to let us know what works well and where we have room for improvement. We are genuinely interested in your comments, and we review every survey response to help us develop initiatives that better serve you.