The Access & Care Coalition (ACC) recently sent a letter (attached) to four DME Medicare Administrative Contractors (MACs) who are responsible for handling Medicare Part A and Part B claims on behalf of CMS. The ACC has requested a formal review of the current ostomy HCPCS codes and allowable quantities to increase/adjust
as necessary as the quantities have not been changed since 2000. In addition, the letter asks for the MACs to re-examine their appeals process for those beneficiaries who exceed the maximum allowable quantities and need more supply based on medical necessity. Often times this appeals process is cumbersome and can lead to lengthy delays in patients obtaining supplies, or the claims are outright denied.

 

The mission ACC is to counter restricted access to medical supplies under Medicare, Medicaid and private insurance for suppliers, manufacturers, clinicians and consumer and disability advocates. ACC members include companies and organizations such as United Spinal Association, United Ostomy Associations of America, Inc., Wound Ostomy & Continence Nurses Society, the Wound Ostomy Continence Certification Board, Association of Rehabilitation Nurses, Spina Bifida Association, Coloplast, Hollister, Wellspect and many others.