Minutes for Region D DAC Only Meeting
Tuesday March 31st, 2015 10:30 AM PDT
Med Trade
Islanders Ballroom
Mandalay Convention Center
Las Vegas, NV
Gilbert Herrera opened the meeting and welcomed everyone.
Introductions for the Executive Committee, DAC members and guests was completed. Gilbert thanked CAMPS for providing the room for the meeting.
Gilbert expressed his thanks to the DAC members for attending the meeting and said he was excited and looking forward to the meetings in the next couple of days. Gilbert said he wanted to remind everyone that the Executive Committee was there for them and if they have concerns or problems they should bring it to their attention. The meeting proto col was reviewed.
The meeting minutes from the DAC Only meeting on October 21st were reviewed. Laura McIlvaine made a motion to approve them and Rick Graver seconded it. The minutes were approved.
Cindy Coy, DAC Treasurer reviewed the Treasurer’s report and asked for any questions or if she could provide clarification on anything. Rich Pozesky made a motion to approve the Treasurer’s report and Rick Graver seconded it. The Treasurer’s report was approved.
Gilbert thanked everyone for providing input on the Coalition Articles and also thanked the committee that worked so diligently on them.
Gilbert provided an update on appeals forwarded to C2C Solutions this quarter. The numbers are down from where they were last year. VGM is also reporting a slow down on the ones they have received. Gilbert asked Barb to send a reminder to members that this tool is available for them to use.
For first quarter 2015: We have received a total of 47 reopening requests
25 will be reopened (53.2%)
15 are pending review (31.9%)
4 were denied to go to ALJ (8.5%)
3 were denied due to late filing (6.4%)
Deanne Birch commented that there has been an increase in RAC audits that started in February. Most of these are on infusion claims. Kim Brummett said that there are no new issues right now, and the ones suppliers are seeing are only those that have been approved.
Cindy Coy DAC Treasurer discussed the role of the A Teams and the DAC with the new Q & A format.
She said education on this process begins with the A Teams and reviewed the process of how the questions are handled once they are submitted to DAC Central. Paula Koenig reviewed the process of how Administration preps the questions, removes duplicates and presents to the Chairs. The Chairs review the questions and submit to the appropriate MAC. Each quarter the questions are rotated between the three MAC’s and submitted appropriately. Paula said we are aware that the Carrier has the questions for a longer period of time than we would prefer and hopefully we can reduce that down as time goes on. Currently the MACs want the questions 6 weeks prior to the meetings. Paula said that the Contractors are committed to this Q & A process so it is unlikely we would go back to the previous ways.
She also reminded everyone that Region D’s A Teams have always worked differently than B and C. B and C request questions directly from their members whereas D’s A Team’s meet and develop the questions as a group.
Cindy said it is very important for Leaders and members to make sure every team is engaged and that we appreciate and value the input they bring.
Gilbert said it is very important to remember that we have the ability to submit Noridian specific concerns directly to them at our meetings. Areas of concern and problems should be submitted so we can have these addressed as we are seeing them. Your recommendations are always considered and the information you bring forth is appreciated.
Gilbert said the number of questions have dwindled considerably and it is really important for the teams to bring their concerns forth so they can be resolved. Laura McIlvaine said that some questions are still coming back with different answers for different Jurisd. Mary Jackson said she has seen Noridian dig their heels in and not provide the same answer as the other Councils. This was brought to their attention but it took about a year to resolve and come back with one answer. Paula Koenig said this has been discussed at the individual council meetings but no definite examples have been brought forth. If anyone has these examples we need to present them to them.
Cindy said that times have changed and we need to adapt as best as we can to this. She said Dr. Whitten has encouraged CMS to be more involved, and we have 4 or 5 questions that were sent directly to them. Rick Graver asked where is CMS? Barb said that she had gotten 3 RSVP’s that they would be at the meeting on Wednesday.
Cindy said it is important to understand that we do have the ability to have a dialogue with NAS and that we are able to have these discussions. We have lost some ground but we have also gained some too.
CMS’s lack of attention was discussed. Rick asked if we couldn’t use Noridian to help us get the answers we need. Would they be able to encourage them to participate more? Barb said that the specific questions, agenda, as well as all attachments are routinely sent to them in hopes of getting a response..
The overall consensus was that we need to hold Dr. Whitten and Dr. Moynihan responsible to help us get the answers we deserve and need. Sheila Roberson asked if we could take this concern to Congress? Kim Brummett said this is an option but we would need to provide a lot of documentation showing the lack of a response on their part. Everyone agree that we need to keep pushing and document how many times we ask the questions.
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Gilbert presented the revised DAC Flyer and handed out copies to members. He asked that everyone hand out to the manufacturers on the show floor and ask for their support. We need more manufacturer members to support the organization. The flyer should also be used if you are recruiting members to the Council or discussing the Council at a Noridian seminar. The flyer will also be sent to Noridian so they can have it available for potential members.
Gilbert reminded everyone that the fall elections for the Executive Committee and NSCAC are right around the corner. This will be done at the annual meeting in October at Med Trade. A call for nominations will be done later this summer. He encouraged everyone to step up and become more involved.
Because the agenda for the Combined meeting is very full Gilbert asked for a review of the Jurisdiction Specific questions. This was completed and the member appointed to present each question was done.
With no other business at hand the meeting was adjourned. The next meeting will be the Combined teleconference on Wed. July 22nd at 2:00 pm CDT. Meeting documents will be sent out prior to the call.
Respectfully,
Barb Stockert
Administration