Region D DAC Teleconference with CMS/NAS/CEDI
Wednesday July 27th 3:00 PM CDT
DAC Chairperson Sheila Roberson welcomed everyone to the combined DAC meeting. Sheila reviewed DAC protocol.
Attendees from CMS/NAS/CEDI were as follows:
CMSLaurie Tan
Medical DirectorDr. Richard Whitten
NASGeri Lehr
NASElizabeth Barton
POECallie Brady
CEDIStacy McDonald
Barb Stockert, Administration completed roll call of the State Representatives,
A Team Leadersand Members. **Attendance List Attached to Minutes.
The meeting minutes from April 13th, 2011 were reviewed. Deanne Birch made a motion to approve the minutes and Bob Clock, seconded it. All were in favor. The minutes stand approved.
CMS Update
There was not a CMS update although Laurie Tan from CMS was on the call.
Medical Director Update:
Dr. Whitten provided the Medical Director Update.
Dr. Whitten commented on the following revised/draft policies, Compression Devices, Suction Machines, and Automatic Defibrillators. These will be released next week and he asked the DAC to review as they are hoping to receive comments on them.
Dr. Whitten assured the DAC that all 4 Contractors, CMS, Congress, and the OIG are all meeting regularly to look for and identify issues and problems that are occurring in regards to documentation requirements and lack of physician education.
They are concentrating on looking for compliance in both the LCD’s and NCD’s. CMS considers the IOM (Internet Only Manual) the most accurate so they would like to have everything reviewed and modified. It is their belief that this would clarify things and help to make everything more transparent. Other things they are looking at include use of the KX modifier, and issues with physician orders. They understand that these can be a problem.
Dr. Whitten assured us that he is meeting with the Program Directors at least once a week. They are also meeting regularly with the CERT Contractors. One of the things they recently found was that a CERT Contractor was not following the way the language in the policy reads so if you believe you have grounds to appeal please be sure to do so.
Dr. Whitten said that they have been meeting with a number of larger suppliers on some of these errors and have done joint calls with the supplier and physician’s if needed.
Other issues they are encountering are budget cuts and the loss of personnel these have caused. They understand that the education of staff could be a problembut are working to address this.
Dr. Whitten is trying to get Dr. Evans with the RAC, and Ed Lain from CMS to attend our upcoming meeting at Med Trade. He knows that this is beneficial to the DAC and would like to see this continued.
CEDI Update:
Stacy McDonald provided and released the following update from CEDI. These are attached to the minutes.
Noridian Update:
Jody Whittenwas not able to be present so Elizabeth Barton and Calli Brady presented the Noridian/POE Update. The update is attached to the minutes.
Review of Q & A
The A Team Leaders reviewed the Q & A.
The responses (if any) are included in the revised document.
RAC Update:
Sheila asked if it would be possible to have the DME Issues on the RAC Website listed in their own separate search.
Dr. Whitten encouraged her to send the request to Dr. Ellen Evans with the RAC to see if this could be added.
Sheila also asked if Noridian had heard if HDI had incorrect overpayments for Infusion and O&P. Dr. Whitten and NAS attendees had not heard anything on this so it was felt Jurisd. D was not involved.
Unresolved Issues:
- Diabetic Shoe Policy
Dr. Whitten stated that this is a restriction in the policy that would have to be changed legislatively. It is out of their hands to have this changed.
- Dynasplint
Larry Hodin, spoke on this issue and reviewed the issue at hand. Janet Malinowski, Assistant A Team Leader for the O& P Team followed up and said that she had seen where the POS had been changed from 31 to 33 on the explanation of benefits.
Dr. Whitten responded that it should not be the practice of Noridian to discuss other supplier’s billing processes. The DAC is to discuss policy related matters and not something like this. Noridian feels they have previously clarified that the Place of Services should not be changed, and believe the original question has been answered and resolved.
- Electronic Prescribing
Dr. Whitten explained that CMS is starting to release info to Physicians but it has not all been completed yet. Carolyn Koster (for Kimberlie Rogers-Bower) addressed Dr. Whitten and asked how Pen Pads are considered acceptable. Dr. Whitten said that these have to indicate who signed the order and the date.
Dr. Whitten stated they are releasing information on attestations and what is acceptable on a regular basis. They are also aware there are concerns on this. This will be revisited again.
Carolyn asked the following question: With the recent push by CMS to implement the 2011 Electronic Prescribing (eRx) Incentive Program for physicians, we have been inundated with requests from physicians to receive various prescriptions and CMNs which they are now generating using electronic software. Without asking the thousands of physicians whose patient’s we provide service to which software vendor they are using, we as a DME provider have no way of knowing whether or not the physician is using a “qualified” vendor.
Is it up to the DME provider to ensure that the physician is using a qualified software vendor for the purposes e-prescribing or will the onus be placed on the physician to be responsible for ensuring that his/her orders are in compliance with the eRx standards.
Dr. Whitten responded: It would be both… The Physician isresponsible…but providers are to be held accountable too, to make sure that everything is compliantand meets the necessary requirements.
- POD Update
Deanne Birch spoke on this topic. She asked Dr Whitten what the rationale was in allowing a longer time span for the contact and ship to beneficiary with recent CR 7452, and if this was a result of our efforts to make changes to POD?Dr. Whitten stated it certainly was, as the DMD’s &CMSdetermined the language needed to be better defined as to what was a reasonable time frame versus using the language “ approximately”. Deanne stated that she was happy to see part of this resolved, although there is still concern over the bill date must equal the ship date or delivery date, and now the issue is even compounded with the potential of greater number of overlapping days on claims. The denial issues that are occurring with secondary payers are a huge dilemma.
Dr. Whitten commented that perhaps the DMD’s could provide a letter regarding the POD requirementsfor bill date. Suppliers could use this for secondary claim denials.
Gemma English, Vice Chair asked if any of the recoupment’s that were done could be appealed based on this change. Dr. Whitten encouraged members to appeal in that the old language stated “approximately __ days, and the new language addresses the time period clearly.
New Business
Sheila spoke on Prepay Audits. She asked if it would be possible to get a written denial reason instead of just a CO-50 denial on an EOB. The Noridian staff said they would work on putting something together.
The pre-pay claims reviewer is denying medical records for not containing allof the elements required in the oxygen LCD. There are cases where these records exist as it is not just in one note or may not use the exact verbiage that the LCD lists. The physician’s are becoming frustrated because they feel like some auditor is telling them how to write their medical recordso and that oxygen is being denied for beneficiaries because the doctor did not follow the format. Dr. Whitten encouraged everyone to send these claims through the appeals process. He also asked that examples of these be faxed to him. (For this fax number, please contact the DAC Office).
Shelia informed the DAC that we need volunteers to step up to be on the Executive Committee for the next term. Elections will be held at Med Trade in October.
Sheila informed the DAC was informed by a member of a recent problem concerning an issue with the COB contractor and that a file from 2005 was pulled in error. This is causing claims to deny for another payer. To resolve the beneficiary has to contact the Medicare Beneficiary Line to get this corrected. This is taking 10-15 days to correct.
The next Region D DAC/Noridian/CMS/CEDI Meeting will be on October 26th, 2011 at Med Trade in Atlanta. The time of the meeting will be 10:00 am EST. The room number will be announced at a later date.
There being no further business the meeting was adjourned.
Respectfully Submitted,
Barb Stockert, Administration