Who at CMS oversees LCDs created by MACs?

I'm needing some direction as to whom at CMS (department, address, name, email or even title - but not home address as I'm not a stalker) that I can approach to finds out if a particular MAC has overstepped their boundaries in a specific LCD. Without going into too much detail (I don't want to bore you fine folks who are busier than a one legged man in a butt kicking contest - but I will go into detail if you ask), I have a particular MAC in mind that handles Part B for 11 states. They have added something to one of their LCDs requiring eligibility in a specific certification of subspecialty for doing any of several diagnostic tests that are routinely performed today. There are, to my understanding, less than 50 physicians in the USofA that meet that eligibility. Less than 50 and we have 12,630,664 Medicare Part B patients (as of 2015 CMS numbers for these 11 states). Oh yeah - only a few of those 50 doctors are in these 11 states from what I can determine.

So - who at CMS would you fine folks recommend that I reach out to? Any ideas?

Thanks in advance. Oh yeah - as my wife and I are running around the country in an RV, holler at me if you know we're coming near you. We normally spend 8 to 10 months a year crossing the country in the RV consulting and I love to get to meet people from all over. Later this year, I think we're gonna make an extended trip (2 1/2 months) up to CT, NH, VT and Maine to see how their roads handle a 43 foot 5th wheel and a 24 foot long dooly pickup, and I'd love to meet you folks in person. if you ever want to see where we are - friend me on FB as that is where I document the trips and plans.


Don
Don Self & Associates, Inc

305 Senter Ave, Whitehouse, TX 75791
903 871-1172 fax 480-247-5650
donself@donself.com web: www.donself.com
books & webinars at https://shop.donself.com

DISCLAIMER: Don’t read this. It means absolutely nothing. Attorneys and people who think too much of themselves waste their time telling you that if you read something you’re not supposed to, then you’re required by some fictitious law created by an idiot elected by other idiots, but that fictitious law doesn’t exist. I can’t believe you’re still reading this. Email disclaimers mean nothing - but take up space on your screen. So - quit reading this or you will be in violation of USC 501.9103.4 which says nothing because it doesn’t exist either.

Comments

  • Don,

    I have always appreciated your wisdom and humor. I would have liked to have attended your webinar but I will be a forced participant at my husband’s family reunion. ☺ Great to see you supporting a life changing charity as well. If you are ever in Eastern WA, I would love to get a cup of coffee.

    Safe travels,

    Lisa

    e.
  • edited June 2
    Lisa,

    if you donate any money to that cause for those girls, let me know and I'll send you a movie file of the webinar you can watch after you get home from the reunion. it's a good cause. By the way - how did you hear about it?

    Don
    Don Self & Associates, Inc

    305 Senter Ave, Whitehouse, TX 75791
    903 871-1172 fax 480-247-5650
    donself@donself.com web: www.donself.com
    books & webinars at https://shop.donself.com

    DISCLAIMER: Don’t read this. It means absolutely nothing. Attorneys and people who think too much of themselves waste their time telling you that if you read something you’re not supposed to, then you’re required by some fictitious law created by an idiot elected by other idiots, but that fictitious law doesn’t exist. I can’t believe you’re still reading this. Email disclaimers mean nothing - but take up space on your screen. So - quit reading this or you will be in violation of USC 501.9103.4 which says nothing because it doesn’t exist either.

    Let me show you how my own Marketing review system works. Complete the data here on this link and within an hour later, check your email or text and you'll see how I get positive reviews and feedback as you will be asked to review us.

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  • Don:



    You want the CMS Regional Office that would be responsible for the area where the MAC is located and the patients/providers it serves.



    https://www.cms.gov/about-cms/agency-information/regionaloffices/regionalmap.html



    Enjoy your travels
  • Don, I'm looking into this. In law it seems the ALJ level of Medicare appeals applies:

    https://www.law.cornell.edu/cfr/text/42/426.400

    But I'm not sure whether you have to go through the whole rigmarole of redetermination/reconsideration first, or what kind of evidence you have to prepare to present -- I assume it's different from just appealing a regular denial.

    Anyway, I'm looking into it.

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