Minutes for Region D DAC Teleconference with CMS/NAS/CEDI
Wednesday, June 26th, 2013 3:00 PM CDT
Conference Call 712-432-0111 Pin 911011#.
Region D DAC Chair, Leslie Rigg opened the meeting.
Roll Call was completed prior to the beginning of the call and Administration reported those in attendance. The list of attendees is attached to the minutes.
NAS/CEDI attendees were: Dr. Whitten, Jody Whitten, Cali Brady from Noridian, and also Stacy McDonald and Sally Hopkins from CEDI were in attendance.
Leslie reviewed the meeting protocol, and asked for any questions before the meeting began.
The meeting minutes from the March 20th Combined meeting in Las Vegas were reviewed. Mary Stoner made a motion to approve them and Bob Clock seconded it. The minutes were approved.
Stacy McDonald from CEDI provided the CEDI update. It is attached to the minutes.
There was no CMS update provided since CMS was not in attendance at the meeting. Additionally, the questions presented to CMS were not addressed at this time and will be held until CMS provides clarification on them.
Dr. Ellen Evans from the RAC was not in attendance so no RAC update was provided.
Dr. Whitten provided the Medical Director Update.
F2F Evaluations: Dr. Whitten explained that these requirements were from an expanded rule that was written in the Affordable Care Act. The Jurisdiction Medical Directors held several meetings to discuss and clarify these requirements. These should be posted and released within the next couple of days. Please watch for them.
Kimberlie Rogers-Bowers said that the instructions we received were very vague. She said the industry needs more time and instruction so they can educate physicians and beneficiaries on this. She asked if they would consider a delay? Dr. Whitten responded that he has no authority on this but felt the article the Medical Directors worked on would clarify many of the questions and lessen the confusion in the industry.
Kimberlie said that the time frame that was given was very short and the article very confusing. She said we hope they understand that time is needed to properly educate everyone. Dr. Whitten said he empathizes with us and understands the situation we are in, however he is comfortable with the clarification that has been done by the Medical Directors.
Sheila Roberson asked if it would be possible to provide a Physician Letter on the F2F requirements especially on those involving Glucose Monitors. Dr. Whitten suggested waiting and seeing what clarification is provided in the article. He thinks it will be satisfactory and if not to let him know. He said the letters were developed by suggestions from this council so if we feel more needs to be done to let him know.
Dr. Whitten asked for feedback on the letters regarding the signatures that are on them. He said that on the physician letters provided in Jurisdiction A, Dr. Hughes is the only signature listed on them. Does the Council feel that this is adequate or would it be better to have the signatures of all the Medical Directors listed? He would like feedback from us on this.
Barb Stockert asked the following question regarding the F2F evaluations: Will all the items that require a F2F evaluation require a Written Order Prior to Delivery (WOPD), or will it be limited to the items that currently have this requirement? She said that there has been conflicting information given regarding this from Industry Advisors. Dr. Whitten said he agrees this is confusing but this will be clarified in the article the Medical Directors have compiled.
Prior Auth Program: This program has worked out extremely well, in fact much better than anticipated. Much better documentation is coming from physicians. Requests have been made that this should include accessories to the PMD’s too but nothing has been announced on this. Discussion is also being held on expanding this to other areas and other products but nothing definite decided yet.
Valid Signature: Dr. Whitten reported that he has had several meetings with Medical Review as recently as this morning. There is quite a bit of discussion regarding Medical Records and what is an appropriate signature. Compliance requires that the note from the physician must correspond with the date the service is supposed to start. A note that has a typed date on the top with no signature and date on the bottom will not constitute a valid signature. A valid signature is a dated signature.
ABN’S: Dr. Whitten reported that some suppliers are using their own ABN’s. He believes this is okay if the exact format from the ABN is used. This form and the way it is written cannot be extrapolated. Follow up from the ABN Instruction:
OMB-approved ABNs are placed on the CMS website at: http://www.cms.gov/BNI. Notices placed on this site can be downloaded and should be used as is, as the ABN is a standardized OMB-approved notice. However, some allowance for customization of format is allowed as mentioned for those choosing to integrate the ABN into other automated business processes. In addition to the generic ABN, CMS will also provide alternate versions, including a version illustrating laboratory-specific use of the notice. (JLW 08.29.13)
The Jurisdiction Medical Directors have tried to modify a number of the LCD’s with standardized language. Dr. Whitten asked if we identify something that is not uniform or is not in line with others to please let them know. They welcome feedback from us.
Deanne Birch said this is a big concern with providers that deal with multiple Jurisdictions and gave the following scenario where different instructions/responses received from the different MAC’s. Dr. Whitten asked that everything be compiled and he will bring this to the Jurisdiction Medical Directors Meeting. This example is attached to the minutes. (Revised Q. regarding MOA ROA Enteral DWO 06.26.13).
Jody Whitten gave the Provider Outreach and Education update. This is attached to the minutes.
The Q & A portion of the meeting followed with A Team Leaders leading the discussion. This is discussion is included within the Q & A document.
The next DAC Only meeting will be held on Tues. October 8th, 2013 at 3:00 PM EDT at the Orange County Convention Center in Orlando, Fl.
The next combined meeting will be held on Wed. October 9th, 2013 at 10:00 AM EDT at the Orange County Convention Center in Orlando Fl.
With no further business at hand the meeting was adjourned.
Respectfully,
Barb Stockert
Administration