MINUTES

Committee: Region D DAC Only Meeting / Time called to order:
Date: 02.20.17 / Time adjourned:
Members present: See Attached List / Location: Teleconference
Chairperson: Gilbert Herrera, Chair
Recorder: Barb Stockert

AGENDA ITEM

/ DISCUSSION
CONCLUSION / RECOMMENDATIONS

OR ACTIONS

Call to Order / Gilbert Herrera, DAC Chair called the meeting to order. Introductions were completed and a review of the meeting protocols was done. /
  • Gilbert extended a thank you to Universal Software Solutions and Prometheus Group for their sponsorship of the conference line for the meeting next week. Gilbert also thanked Ronda with VGM for making the room available for us to use. All of their help and support is greatly appreciated

Approval of 11.01.16 Meeting Minutes / The minutes from the DAC Only Meeting11.01.16 were reviewed. /
  • Deanne Birchmade a motion to approve them and Ronda Buhrmester seconded it. The minutes were approved.

Treasurer’s Report / Kimberlie Rogers Bowers presented the Treasurer’s Report. Kimberlie reported that the DAC is currently solvent and meeting our budgeted expenses. We are still in the process of collecting dues and reminders will be sent to those who have not paid. Kimberlie thanked those who have paid and those that will be supporting us. Currently the DAC has collected $17,560.00 of the budgeted $27,660.00. /
  • Lelia Wilkerson made a motion to approve the budget and Natalie Roehlk seconded it.

Team Meetings / Gilbert asked for members’ feedback on the A Team meetings that are currently being held as well as this format for the DAC Only meeting. /
  • There were no comments from members received at the meeting so Gilbert asked that all feedback be submitted to the DAC office or the Executive Committee.

PECOS Update / Mary Stoner presented this. /
  • 02.29.16 Mary said she has worked very hard the last 2 years to help fix the problems that are being seen in PECOS. It comes down to the fact there are two types of programs that are being used and their program does not show what suppliers see when they are checking on a practitioner’s status of enrollment. Mary said we are using the tools that CMS gave us and suppliers should not have to pay the consequences. She will continue to work on this and bring it up again tomorrow at the meeting.
  • 11.01.16 Mary Stoner brought to the attention of the DAC the problems she is continually having with PECOS.
  • Mary said that Barb had sent an email to the members asking for them to contact the DAC Office with any PECOS denials they were seeing. Barb did not receive any responses to this.
  • Mary explained that she was seeing numerous denials and described the various situations where there are problems. The Contractors use the VMS system which is updated twice a week. Suppliers use the data.cms.gov website and that is only updated twice a week, so they are not looking at the same data. Some providers are showing up as inactive in one system and not in the other.
  • Mary also explained all of the inquiries she has made because of this problem and asked the members to please run reports to see if they are seeing any of these denials. If so please contact the DAC Office. Mary will also bring this up tomorrow at the meeting.
  • 02.20.17 Mary Stoner updated the membership. She said we are really no further ahead than we were on our last conference call. She said the PECOS registry is not accurate and CMS has said they are unsure how they will ever be able to correct it to be accurate.
  • Mary said the issue is not a huge one for the DAC but is the fact that this is really unjust to suppliers. A small company couldcheck the PECOS system and provide a power wheelchair based on the Physician eligibility andwhen the MAC receives the claim gets different information in their system causing it to deny.
  • Mary has spoken with Cindy White at Noridian and also Michael Hanna at CGS and they have told her there is no way for them to override this denial.
  • Gilbert told Mary that on behalf of the DAC he appreciated all of her work on this. Mary will continue to update the membership with information she receives.

Strategic Health Solutions Update / 02.29.16 Gilbert explained that ever since the teleconference he and Barb had been working to get SMRC involved. At first they were met with a lot of resistance but then Cindy with Noridian kind of got involved and they became more receptive. They eventually gave the okay to present questions to them and they will respond in writing to these. The questions were submitted to them last week and will be returned as soon as possible. Barb said she would send them out to all members when she receives them They were also invited to participate in the Combined meeting either in person or via phone but have not responded on this.
11.01.16 The questions we submitted last spring are still outstanding. Gilbert and Barb have been in communication with Strategic Health Care Solutions and a new contact person has been appointed. The questions have been sent to them to review and they are looking at them. We are hopeful that we will be able to get someone from there to attend one of our next meetings.
  • There is a lot of concern on the audit results that they are releasing. They are making many mistakes and are clearly not educated on the policies. A number of members have indicated they have to “train” them during the discussion period. Most of their denials end up being overturned.
  • Deanne Birch said that when question 1 was submitted on our Q & A it was not answered by the MAC. She will ask this tomorrow.
02.20.17
  • Barb reported she has not gotten an update from them. She continues to discuss with SMRC (Michelle PIlley) and is told they are waiting for CMS approval to work with us. Gilbert suggested we talk with Cindy next week to see if we can get them involved to help us.

Combined Meeting Update /
  • Barb told the group that our Combined meeting will be held next Monday February 27th at 2:00 pm PST. The meeting will be at the Mandalay Bay Convention Center. The room is Banyan D. Barb will email the call in number for those using the conference line when she receives it.

Meeting Timeline / Gilbert explained that our current timeline for meetings differs from the other Jurisdictions because they do not meet at Med Trade. The other Jurisdictions have quarterly meetings as well and this is how the timeline for the Q & A is determined.
Gilbert explained that we have our meeting next week but are not scheduled again until August for our next teleconference. He asked for the memberships thoughts on this. /
  • Discussion followed and many felt this was too long of a time to wait to meet with them. Gilbert proposed that we ask for a meeting in late April or early May. This could be done by teleconference and would align us back up with the Q & A schedule.
  • Don Hardin suggested sending them a “heads up” email prior to our meeting so they can start thinking about this. Barb will add this to the Combined Meeting revised agenda and report any feedback received to members.

O2 with Valid ABN / Sheila Roberson reported that they are having some significant problems where they provided O2 to a patient that did not meet the guidelines however they qualified on the CMN. Their company informed the patient up front and had them sign and ABN. /
  • 11.01.16 When the claim was processed Medicare paid the claim. They had to send the claim to redeterminations to have it adjusted and in the meantime the beneficiary is upset. They have had congressional inquiries regarding this and have also been contacted by the SACU.
  • This is a serious issue and needs to be addressed.
  • Kimberlie Rogers-Bowers explained that Jurisdiction B had a way to submit these claims to get the appropriate denial in their supplier manual but it was removed a couple of years ago. Kim Brummett also said this has been brought to each of the MAC’s but no one has taken the time to really research it or develop a solution. Sheila Roberson will bring this up for discussion tomorrow.
  • 02.20.17 Sheila expressed her concern with this because it still is not resolved. AA Homecare is working on it but is good to get other suppliers input too. This will be added to the revised Combined meeting revised agenda for next week.

O2 Denials / Suppliers are reporting receiving numerous denials for O2 when a patient is discharged from the hospital on antibiotics or with a diagnosis such as CHF. The explanation being given is the patient is not in a CSS or the CHF would not be considered long term since they do not know what is causing it. These denials are only occurring in Jurisd. D at this time so it is appearing this is only a Noridian issue. We specifically asked in January what had changed and were told there have been no changes in interpretation at all. /
  • These problems surfaced late last year and have been brought to Noridian’s attention at prior meetings. At the teleconference in January Dr. O’Neal was quite adamant that O2 is only covered for long term need situations and the patient has to be in a CSS.
  • Sheila pointed out today that she has 2 documents which contradict what we are being told. One is a Q &A document and the other is a Dear Physician Letter. She will forward these to all members. She also has two Physician Education letters that have been revised.
  • Barb will also add this issue to the revised Combined meeting agenda.

CO-50 Denials / Joni Moore (Lincare) reported they have been receiving CO 50 denials on audits when the Noridian staff has not had the chance to review the documentation submitted by the supplier. This documentation is submitted within the timeline. /
  • A lot of discussion followed and many wanted clarification that Noridian was denying claims CO-50 when the information for the audit was sent within the timeline and it was Noridian’s fault for not getting to it.
  • Wayne Van Halem explained that they can’t just deny claims in this manner that there should be a remark code attached. He said the MAC’s used to set up an automatic denial in their system for the claim to deny at 45 days. He is not sure if they ever extended that to 60 days. They used to use CO-226 but now it looks like it is only CO 50. Apparently Cindy is aware of this as Lincare has been working with her to resolve but they are still showing up. This is affecting all product categories.
  • The other concern is the original denial is not being corrected. Suppliers will go into the portal and see CO 50 but there are no notes attached to it, but the information will say it processed and paid.
  • Barb will also add this topic to the revised Combined Meeting agenda.

Rehab Concerns / Paula Koenig told the membership there are two concerns being monitored by the Rehab team. /
  • Prior Authorization for K0856 and K0861 is scheduled to begin in March. Jurisdiction B sent communication on this last week, Noridian sent communication today but Jurisdiction C has been silent. Will this be postponed?
  • Claims for wheelchair accessories billed in 2017 with the KU modifier. There has been discussion these are not paying correctly and are not being paid at the 2017 rates.
  • Both of these concerns will be added to the revised Combined Meeting agenda.

Next Meeting and Adjournment / No date/time has been set yet for the next meeting /
  • The next DAC Only meeting will be at Med Trade in Atlanta. More information will be forthcoming.
  • The meeting was adjourned.