Washington Disputing, clarifying or protesting a Medicare Part B claim determination by a Durable Medical Equipment Regional Carrier may be getting easier, thanks to a new proposed final rule issued by the Health Care Financing Administration.

The new rule, effective Feb. 1, 2000, will allow providers, beneficiaries and suppliers to request by phone a review of a DMERC's initial claim determination in writing. Currently, a request for the DMERC review is to be made only in writing and filed with HCFA, a DMERC or the Social Security Administration.

HCFA said it decided to allow phone requests, in addition to written requests, because it "recognized that both physicians and beneficiaries often call the [DMERC] to dispute a determination, ask for clarification or protest a denial" anyway. It also admitted that "the current review process requiring a party to submit a written request for a review can take considerable time and effort," and added that it can be difficult to ask a question, answer a question or properly explain a problem in writing.

Also, HCFA added, "a written request provides no opportunity for the dialogue that allows parties to discuss the issues and provide explanations."

A major benefit of the new rule is that questions can be answered more quickly. "In many cases," the rule states, "telephone reviews will be handled at the time of the call." However, HCFA also said that some DMERCs do not have dedicated lines to handle only telephone reviews. In this case, when parties call in, "someone will take the information from the caller, then pass that information to the section that will return the call. When possible, the review will be performed at that time." If it can't, the rule says that the return call would be about one to two days after the initial call.

Telephone reviews will be limited to providers that are on assigned claims, according to the rule. It also says that a nonparticipating provider may use the service only if the beneficiary gives it the right to represent him or her and supplies the DMERC with a signed copy of the Appointment of Representative form or a signed letter enabling the nonparticipating provider to pursue the claim on behalf of the beneficiary.-J.P.P.