Form CMS-10633 Key Informant Interviews

Supporting Statement B for the
QIC Demonstration Evaluation Contractor
(QDEC): Analyze Medicare Appeals to
Conduct Formal Discussions and
Reopenings with DME Suppliers and Part A
Providers
(CMS-10633/OMB control number: 0938-1348)

Attachment B: Key Informant Interview
Instrument and Recruitment Materials
June 1, 2020
Centers for Medicare & Medicaid Services
Center for Medicare (CM)
Medicare Enrollment and Appeals Group (MEAG)
Division of Appeals Operations (DAO)
7500 Security Boulevard
Baltimore, MD 21244

Table of Contents
Attachment B: Key Informant Interview Instrument and Recruitment Materials ......................... 1

Appendix A. DME Key Informant Interview Invitation ......................................................... 1
Appendix B. DME Key Informant Interview Guide .............................................................. 3
PRE-FORMAL DISCUSSION ........................................................................................... 4
FORMAL DISCUSSION ................................................................................................... 4
WRAP UP ........................................................................................................................ 6

Appendix C. Part A Key Informant Interview Invitation........................................................ 7
Appendix D. Part A Interview Guides................................................................................... 8
PRE-FORMAL DISCUSSION ........................................................................................... 8
FORMAL DISCUSSION ................................................................................................... 9
WRAP UP ...................................................................................................................... 10

i

Appendix A. DME Key Informant Interview
Invitation

[CONTACTNAME]
[SUPPLIERNAME]
[SUPPLIER ADDRESS]
[SUPPLIER CITY], [SUPPLIER STATE] [SUPPLIER ZIP]
[Date]
Dear [CONTACTNAME],
Our records show that you participated in a telephone discussion related to a Medicare durable
medical equipment (DME) claim on [DISCUSSIONDATE].
The Centers for Medicare &Medicaid Services (CMS) has contracted with IMPAQ International
to evaluate the Formal Telephone Discussion Demonstration and Reopenings Process
Demonstration (the Telephone Demonstration). As part of the evaluation, IMPAQ International
is conducting follow-up interviews with a group of suppliers to better understand your
experiences with formal discussions and your opinions about the Demonstration overall.
We would like to schedule a telephone conference with a representative of your firm who is
most knowledgeable about the formal discussion in which you participated. The call will take
less than 30 minutes, and your responses will be shared only in summa ry, general form. Your
identity will remain confidential to IMPAQ, and will not be shared with CMS.
Your participation will help us provide CMS valuable information to help assess how well the
Demonstration is working and how it can be improved.
A member of our team will be in touch with you soon to identify a convenie nt time for a short
interview.
In the interim, if you have any questions please contact the Evaluation Team at [email protected]. If you wish to confirm that our efforts are CMS-sponsored, please
contact the CMS Contracting Officer’s Representative, Lynnsie Kelley, by email at
[email protected].

1

Sincerely,
Guido Cataife, Ph.D.
Project Director
IMPAQ International
PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is [NUMBER], Expiration Date: [DATE] .

2

Appendix B. DME Key Informant Interview
Guide
Hello, my name is [interviewer name] from IMPAQ International. We are a research firm,
located in Columbia, MD, that conducts evaluations of policies and programs. Thank you again
for agreeing to be interviewed today. I am joined today by [note-taker name] from IMPAQ, who
will be taking notes for the interview.
We are part of a team evaluating CMS’s Demonstration that involves telephone discussions and
reopenings related to DME claims.
Our evaluation of the Formal Telephone Demonstration is focusing on helping CMS understand
what is working well with the Demonstration and what could be working better.
As part of this evaluation, we are interested in hearing about your experiences with the
telephone discussion in which you participated.
Review informed consent:
Let me take a minute to review the informed consent for the interview and how we will handle
the information you provide:


We will use the information you share with us for research purposes only.



All of your responses will be kept confidential.



No one, except the research team, will have access to the specific information you provide,
and we will only report summary information from our full set of interviews.



You can stop the interview at any time for any reason, and you should feel f ree to decline
to discuss any topic that we raise.



This interview will last approximately 30 minutes.

Now that we have gone through the informed consent information, do you agree to be
interviewed?

Yes

No
With your permission, we would like to audio-record the interview to ensure that we record and
analyze your remarks accurately. Only the research team will have access to the recording.
Would it be okay to audio-record the interview?
[If Yes, start recording by pressing RECORD *7, then continue]
The recording has started, for the record can you confirm that you agree to have this interview
audio-recorded?
3

Do you have any questions about the interview before we begin?
[If YES, answer any questions]

PRE-FORMAL DISCUSSION
1. Thinking about the claims process before the telephone discussion, what are the
challenges you faced as a supplier in navigating the CMS claims process for DME
claims?
Now let’s discuss preparations for the telephone discussion.
2. What information or materials did you receive from the QIC prior to the telephone
discussion?
3. Did the QIC provide enough information before the discussion so that you could
adequately prepare? Probe: What else would have been useful to know before
participating in the formal discussion?

FORMAL DISCUSSION
Now let’s talk about the telephone discussion itself
4. Approximately how many telephone discussions have you participated in?
5. What were you expecting from the formal discussion process? How did it meet your
expectations or differ from what you expected?
6. Next, I would like to ask you about some specific components of the demonstration that
CMS is interested in and I’d like you to think about in what ways did the following work
well or not work well?


Opportunity to present verbal testimony



Understanding the original denial by the MAC. Probe:

During your discussion call, how clearly did the QIC explain why the claim
was originally denied by the Medicare Appeals Contractor (MAC)?

After your discussion call, did you feel that you have a better overall
understanding of how the MAC’s decision on your case was reached?

(If yes) what was most helpful to understanding how the MAC
reached its decision?

4



(If no) what, if anything, could have helped you to learn more about
the claim denial?



Opportunity to learn more about Medicare policies and requirements applicable to
the case. Probe:

How are Medicare policies or requirements presented/discussed during
telephone discussions?

What, if anything, would have helped you to learn more about policies and
requirements?



Identification of required documentation, and/or the o pportunity to provide
additional documentation. Probe:

What kinds of additional documentation were needed?

How did you submit the documentation?

In what ways could the submission process be improved?



Speed of resolving the case compared to going through the OMHA?

[If this is an interview driven by satisfaction survey results, ask next item. Otherwise skip]
7. We noted that your survey responses indicated you were dissatisfied with [fill item or
items from survey where the survey responses indicated dissatisfaction]? Is this right?

Can you tell us why you were dissatisfied?


How could this aspect of the formal discussion be improved?

8. Are there any other ways that CMS could improve the formal discussion?
9. What are some best practices that you’d recommend?
Next, let’s discuss billing practices. CMS is interested in how the telephone discussions may
improve submission of brand new claims.

10. Now that you’ve taken part in a telephone discussion, what changes, if any, have you
made to your billing and documentation practices on new DME claims? Probe:
a. (if no) What are some reasons why you have made no changes?
b. (if yes) Have you received fewer denials because of these changes?
Next let’s discuss reopenings. It is our understanding that there several types of reopenings
that a supplier can initiate with their respective MAC. We are referring to a reopening related

5

to the formal telephone discussions process, where the QIC looks into appeals that are
currently in the queue at OMHA or the ALJ level.”
11. Did the QIC talk about reopenings while on the line with you?
12. How did the QIC describe the reopening process? Did the QIC offer to reopen any
pending cases at OMHA as part of your formal discussion?
13. What materials about reopenings did you receive after your telephone discussion, if
any? Were they helpful? How could they be improved?
14. Have you attempted to have cases reopened? Why or why not?
15. What could have gone better with the reopenings?

WRAP UP

16. Is there anything that we haven’t asked you about that you would like to tell us?

6

Appendix C. Part A Key Informant Interview
Invitation

[CONTACTNAME]
[PART A PROVIDER NAME]
[ADDRESS]
[CITY], [STATE] [ZIP]
Our records show that you participated in a formal telephone discussion related to a Medicare
Part A claim on [DISCUSSIONDATE].
The Centers for Medicare and Medicaid Services (CMS) has contracted with IMPAQ
International to evaluate the Formal Telephone Discussion Demonstration and Reopenings
Process Demonstration (the Demonstration). As part of the evaluation, IMPAQ International is
conducting follow-up interviews with a group of providers to better understand your experiences
with formal discussions and your opinions about the Demonstration overall.
We would like to schedule a telephone conference with a representative of your f irm who is
most knowledgeable about the formal discussion in which you participated. The call will take
less than 30 minutes, your responses will be shared only in summary, general form. Your
participation will help us provide CMS valuable information to help assess how well the
Demonstration is working.
A member of our team will be in touch with you soon to identify a convenient time for a short
interview.
In the interim, if you have any questions please contact the Evaluation Team at [email protected]. If you wish to confirm that our efforts are CMS-sponsored, please
contact the CMS Contracting Officer’s Representative, Lynnsie Kelley, by email at
[email protected].
Sincerely,
Guido Cataife, PhD
Project Director | QIC Demonstration Evaluation Contractor (QDEC)
IMPAQ International
PRA Disclosure Statement According to the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is [NUMBER], Expiration Date: [DATE].

7

Appendix D. Part A Interview Guides
Hello, my name is [interviewer name] from IMPAQ International. We are a research firm,
located in Columbia, MD, that conducts evaluations of policies and programs. Thank you
again for agreeing to be interviewed today. I am joined today by [note-taker name] from
IMPAQ, who will be taking notes for the interview.
We are part of a team evaluating CMS’s Demonstration that involves formal telephone
discussions and reopenings related to Part A claims.
Our evaluation of the Formal Telephone Demonstration is focusing on helping CMS
understand what is working well with the Demonstration and what could be working better.
As part of this evaluation, we are interested in hearing about your experiences with the
formal telephone discussion in which you participated.
Review informed consent:
Let me take a minute to review the informed consent for the interview and how we will
handle the information you provide:

We will use the information you share with us for research purposes only.

All of your responses will be kept confidential.

No one, except the research team, will have access to the specific information you
provide, and we will only report summary information from our full set of interviews.

You can stop the interview at any time for any reason, and you should feel free to
decline to discuss any topic that we raise.

This interview will last approximately 30 minutes.
Now that we have gone through the informed consent information, do you agree to be
interviewed?

Yes

No
With your permission, we would like to audio-record the interview to ensure that we record
and analyze your remarks accurately. Only the research team will have access to the
recording. Would it be okay to audio-record the interview?
Do you have any questions about the interview before we begin?
[If YES, answer any questions]
PRE-FORMAL DISCUSSION
1. Thinking about the claims process before the formal telephone discussion, what
are the challenges you face as a provider in navigating the CMS claims process
for Part A claims?
8

Now let’s discuss preparations for the telephone discussion.
2. What information or materials did you receive from the QIC prior to the telephone
discussion?
3. Did the QIC provide enough information before the discussion so that you could
adequately prepare? Probe: What else would have been useful to know before
participating in the formal discussion?
FORMAL DISCUSSION
Now let’s talk about the telephone discussion itself.
4. Approximately how many telephone discussions have you participated in?
5. What were you expecting from the formal discussion process? How did it meet
your expectations or differ from what you expected?
6. Next, I would like to ask you about some specific components of the
demonstration that CMS is interested in and I’d like you to think about in what
ways did the following work well or not work well.


Opportunity to present verbal testimony



Understanding the original denial by the MAC. Probe:

During your discussion call, how clearly did the QIC explain why the
claim was originally denied by the Medicare Appeals Contractor
(MAC)?

After your discussion call, did you feel that you have a better overall
understanding of how the MAC’s decision on your case was
reached?

(If yes) What was most helpful for helping you to understand
the MAC’s decision?

(If no) What, if anything, could have helped you to learn more
about the claim denial?



Opportunity to learn more about Medicare policies and requirements
applicable to the case. Probe:

How are Medicare policies or requirements presented/discussed
during telephone discussions?

What, if anything, would have helped you to learn more about
policies and requirements?

9



Identification of required documentation, and/or the opportunity to provide
additional documentation. Probe:

What kinds of additional documentation were needed?

How do you submit the documentation?

In what ways could the submission process be improved?



Speed of resolving the case compared to going through the OMHA?

[If this is an interview driven by satisfaction survey results, ask next item , otherwise skip]
We noted that your survey responses indicated you were dissatisfied with [fill item or items
from survey where the survey responses indicated dissatisfaction]? Is this right?

Can you tell us why you were dissatisfied?

How could this aspect of the formal discussion be improved?
7. Are there any other ways that CMS could improve the formal discussion?
8. What are some best practices that you’d recommend?
Next, let’s discuss billing practices. CMS is interested in how the telephone discuss ions
may improve submission of brand new claims.
9. Now that you’ve taken part in a telephone discussion, what changes, if any, have
you made to your billing and documentation practices on new Part A claims?
Probe:

(if no) What are some reasons why you have made no changes?

(if yes) Have you received fewer denials because of these changes?
Next let’s discuss reopenings.
10. Did the QIC talk about reopenings while on the line with you? Did the QIC offer to
reopen any pending cases at OMHA as part of your formal discussion?
11. How did the QIC describe the reopening process? Did the QIC offer to look into
any open cases for you?
12. What materials about reopenings did you receive after your telephone discussion,
if any? Were they helpful? How could they be improved?
13. Have you attempted to have cases reopened? Why or why not?
14. What could have gone better with the reopenings?
WRAP UP
15. Is there anything that we haven’t asked you about that you would like to tell us?
10