Form CMS-10633 DME Survey Screenshots

Supporting Statement A 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 D: Screenshots of DME Survey
Instrument

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