Minutes for Region D DAC Teleconference with CMS/NAS/CEDI

Thursday July 24, 2014 3:00 PM CDT

Mary Stoner, Region D DAC Chair opened the meeting and welcomed everyone. Introductions of the Executive Committee, Noridian, and CBIC were done. A list of the attendees is attached to the minutes.

Mary reviewed all meeting protocol. The minutes from the Combined Meeting held in Las Vegas on March 12th were reviewed. Deanne Birch made a motion to approve them and Cindy Coy seconded it. The minutes were approved.

Stacy McDonald and Sally Hopkins with CEDI were not in attendance but they submitted the CEDI update. This was shared with all DAC members and will be posted on the website.

There was no CMS update provided as no one from CMS was present on the call.

There was no RAC update provided as Dr. Ellen Evans was not present on the call.

Phabian Barrett a liaison for the CBIC provided the CBIC update. This report was attached to the minutes. In addition to the minutes DAC members had a few questions.

Mary Stoner asked why was there a decrease in the length of the contract period? Phabian did not have an answer but said he would make note of it and check it out.

Mary also asked if there had been any communication from CMS on changing the definition of mail order and how it will work. Phabian said that when National Mail Order began, CMS was looking for feedback on how the program was going. This window was open for a very short time and CMS did not hear many complaints. Mary said that there had been many, many complaints from beneficiaries because they were unable to get the supplies they needed. It was a great inconvenience to the beneficiaries and she expressed her concern to Michael Keane with CMS. She expressed concern that even if shipping of supplies would be allowed most suppliers could not afford to provide this service with the decreased reimbursement and 2% sequestration. Phabian said he would bring these concerns back to CMS’s attention.

Deanne Birch asked several questions regarding modifiers and the clarification on these have been added to the CBIC update.

Violetta Arnobeit asked about a supplier in Hawaii that won the competitive bidding contract who was suspended. CMS wanted to add suppliers at their discretion to fulfill the contract and provide the service. Violetta was asking why there was no open bidding done. Since having an adequate number of suppliers available who can provide the contracted services is an essential need, CMS retains the right to appoint and award contracts to other suppliers if this service cannot be fulfilled by the contracted supplier. Phabian said that he was the liaison for Hawaii and felt it important to clarify that this supplier had not been suspended he was only in breach of contract. As this situation unfolded they found other suppliers on the mainland that could help provide these services so a distribution center was set up. This has worked very well and they are working behind the scenes to clear up this backlog.

Dr. Eileen Moynihan provided the Medical Director update. The vacuum erection device, tens, and tumor treatment policies have been revised and will go into effect 08/01/14. Immunosuppressive Drugs and Pressure Reducing Support Surfaces have also been revised and will be effective 10/1/14.

There has been an update regarding ICD 10 placed on the website. As a reminder this is still scheduled to go into effect in October, 2015.

Dr. Moynihan said that the DMD’s have been working on policies and many clarification articles. She understands that it is never possible to make it totally clear to everyone, but the articles that are being written will hopefully be an improvement for suppliers.

Dr. Moynihan was asked for clarification on questions 1 and 2 of the Q & A. Mary Stoner asked why we were receiving responses which were not uniform or that were different for each jurisdiction. Deanne Birch explained this is a situation that makes it very hard especially when suppliers may be dealing with more than one jurisdiction.

Dr. Moynihan said that since the three Jurisdictions have been working together it has been identified there are a number of differences and they are trying to resolve this. To coordinate all of this takes a tremendous amount of work and time to make it happen.

Deanne Birch thanked Dr. Moynihan for her thoughts but asked if the DMD’s could relook at the responses regarding the DIF in questions 1 and 2. Deanne said that Jurisdiction D makes the most sense. Since it is a CMS document it should be handled the same throughout each Jurisdiction. Since each Jurisdiction can process differently creates a teaching nightmare and is very difficult for suppliers.

Dr. Moynihan asked if Deanne has seen issues with this and Deanne replied that yes, indeed. What may pay in one Jurisdiction will deny in another. Deanne said this is definitely problematic. Dr. Moynihan will add this in her comments and take back to the DMD’s.

Jody Whitten said she understood the concern but felt we would understand and appreciate the answers if everyone understood the background behind them and why each Jurisdiction handled the way they do. Jody also made the comment that the LCD has guidance on how to do revisions for the pump, and Region D follows this guidance.

Deanne Birch added this is all the more reason there should be consistency among all 4 Jurisdictions to follow the LCD. Deanne thanked Jody for her clarification.

Dr. Barbara O’Neal was also in attendance but did not have an update at this time.

Jody Whitten provided the POE update. It is attached to the minutes.

Discussion of the responses to the Q & A followed.

Oxygen: Question 4 (a and b): Mary Stoner asked for clarification on what is considered the start date of the order. Mary said that many suppliers use the initial date as the date the service is provided to the beneficiary. Jody Whitten explained that this is incorrect and that the start date or initial date of the order is to be the date the order is written by the physician unless the physician indicates a different start date. Mary presented the following question: An order is written and signed by the physician on 6/29 but the equipment is not set up until 7/20. What should our initial date on the CMN list? Jody responded that 6/29 should be listed as the initial date.

Additionally, this allows for an item to be dispensed within 3 months of the initial date.

Rehab: Questions 13 and 14: Paula Koenig asked for assistance in reminding CMS that the CB modifiers for Round 2 are still pending their direction. She reported this is causing numerous problems for suppliers and hopes that this can be brought back for their instruction.

Audit Subgroup: Mary Stoner asked about the status of the report on the audits that was presented to Noridian. Mary said that the DAC understood that Dr. Whitten would take our results back to the other Medical Directors. She asked Dr. Moynihan if this had been done? Mary also asked if the information was helpful that was provided and what we should do from this point on? Both Dr. Moynihan and Jody said that the information was very helpful and they have made changes in some of their processes because of it. We do need to know that they are unable to review anything from other Jurisdictions so they are unable to comment on that. Dr. Moynihan said that she was not sure where this stands but would get back to Barb with the information.

Mary Stoner asked about denials suppliers are receiving on providing catheters which are over the limit in order to prevent UTI’s. Mary explained that many times patient’s will not have the documentation in their records of recurring UTI’s because when they are able to use more than the allowed amount it prevents infections from occurring. In these situations suppliers are unable to provide documentation to show this. Dr. Moynihan asked that examples need to be submitted where claims were actually denied because this documentation was not submitted to Noridian or the auditor. Mary said that she would present these.

Kimberlie Rogers-Bowers asked a question regarding the POE update on Proof of Delivery. Kimberlie said that often beneficiaries do not tell us they are traditional Medicare until well after the fact. She asked that if we perform a maintenance check and the patient attests that the supplier performed a check of the equipment and tthat it was in working order, that this would be sufficient documentation for delivery. Jody said that yes, this would be sufficient and would just need to be signed and dated by the beneficiary.

With no further business at hand the meeting was adjourned.

The next meetings for the DAC will be as follows:

Tuesday, Oct. 21st, 2014 02:30 PM EDT DAC Only Meeting Med Trade Atlanta

Wednesday, Oct. 22nd, 2014 08:00 AM EDT DAC Combined Med Trade Atlanta

Respectfully,

Barb Stockert

Administration