Region D DAC Combined Meeting Minutes
Committee: Region D DAC Combined MeetingMed Trade Atlanta / Time called to order: 9:00 am
Date: 11.02.16 / Time adjourned:
Members Present: Attendee List Attached to the Minutes / Location: Georgia World Congress Center
Contractor Attendees:
NAS: Dr. Peter Gurk, Cindy White, Dr. Barbara O’Neal (phone)
CEDI: Stacy McDonald
CBIC: Elaine Hensley
C2C: Emily Stroupe, Daniel Roach, Dr. Janet Lawrence
CMS: Laurie Tan (phone) / Chairperson: Gilbert Herrera
Recorder: Barb Stockert, Administration
Purpose: Quarterly Meeting Update
AGENDA ITEM
/ RECOMMENDATIONSOR ACTIONS
General Business / · Gilbert Herrera reviewed the meeting protocol. Roll Call of the Executive Committee, A Team Leaders, and State Reps was completed. A list of the attendees is attached to these minutes.· Gilbert thanked Universal Software Systems and Prometheus for providing the teleconference line. He also thanked VGM for providing the room for our meetings. These contributions by these members play a huge part in allowing us to have face to face meetings.
Review of the August 2016 teleconference meeting minutes / · Deanne Birch made a motion to approve them and Rick Graver seconded it. The minutes were approved.
CEDI Update / · Sally Hopkins presented the CEDI Update. This is attached separately to the minutes.
CBIC Update / · Elaine Hensley provided the CBIC Update.
· Yesterday information for Round 1 2017 contract winners was posted. Disqualification letters were also mailed to those not securing a bid. If someone was not awarded a contract Elaine encouraged them to file an inquiry to find the reason for the rejection. They can also call customer service. Mistakes can be made. She is not sure if additional contracts will go out but if you were not awarded a contract please check on it.
· If additional information needs to be resubmitted, Elaine said it should be sent in on single pages. Do not submit information using the front and back of the sheets. These can be easily missed. Paula Koenig asked about a turnaround time to resubmit information. Elaine thought the letter said 2 weeks but they are aware this can take time. She concluded that they will process everything that is submitted.
· Round 2 Recompete is currently underway. She did not have a lot to report on this. The program is running smoothly.
· Elaine said that the complaints are about the same as they were before. It is nice that the cpap supplies do not have the issue that they did and they are not hearing many complaints about CPAPs and supplies. They average about 1 or 2 complaints a month. Most of these come from 1-800 Medicare.
· The biggest thing right now is to get ready for Round 2019 when they will be rebidding both Rounds 1 and 2 at the same time. She said suppliers would not be submitting two bids months apart.
· The final rule was released on Friday. This rule updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for ESRD services provided on or after January 1, 2017. The rule also includes surety bond and breach of contract information. The next adjustment to the rural fee schedule will be in January 2017. The bidding prices of rounds 1 and 2 will be taken into consideration
· Bill Noyes asked if there will be two rounds or just one in 2019. This was talked about in the past but we have not heard anything for a while. Elaine said she would ask and let everyone know.
· Kimberlie Rogers-Bowers asked since Round 1 was really a demonstration project, there really could be two separate rounds of bidding next year, correct? Elaine confirmed that next year both rounds are up for bid and they could be bid as two separate rounds because Round I is a demonstration project and products could be added; however, she is not 100% sure how it will work. There will be 130 CBAs to bid on but there could be separate contracts. Elaine said Round I has always been considered a demonstration project which allows products to be added to it at any time.
· Elaine also noted that we would only have to submit one set of financials, etc.
· Kim Brummett said it would be great if the fee schedule could be downloaded to their website. Currently we must search for it.
· Contract terms should go back to 3 years. This will be favorable.
C2C Solutions / · Dr. Janet Lawrence, Dan Roach, and Emily Stroupe updated the DAC on the current 5-year demonstration process on appeals.
· Results thus far have been very favorable. There has been a significant reduction in appeals at the ALJ level. They have already conducted over 4000 phone calls and reopened over 7000 cases. The response has been terrific. Maria Ramirez with CMS has been very involved and promotes the project.
· Kim Brummett asked about expanding the project to Jurisdictions A and B as she has heard from many suppliers they want to be involved. At this time, it will be left in Jurisd. C and D. Members were encouraged to make comments on their website at . All comments are reviewed and this would be an excellent place to mention they would like this project expanded. Kim said she would try to get all the Councils involved so that feedback can be provided.
· Suppliers should be on the watch for scheduling letters from C2C. These letters are sent to suppliers and C2C must receive the contact information back before they can attempt to contact someone. They need to have the name of the people involved.
· Dr. Lawrence reported good news to the group. They have now removed the requirement to have a formal telephone discussion and that you could just send in the required documentation. She also reported the product category has been expanded to include all products except any product which is currently in a demonstration project such as powered mobility. Kim Brummett asked if pmd’s that are not within the demonstration states can be included? She did not know but will check on this and get back to us.
· Members were reminded that this process is for claims that have been denied at the reconsideration level but are still within the timeline. If anyone has appeals that are at the ALJ level it was suggested to let them know and the can pull them back. This will be particularly helpful for those large suppliers with lots of appeals. They will qualify as long as they have not met the 60-day window timeframe. Members were assured that they would not lose their place in line. The form is located on the website however if you have a large volume of claims please contact Emily directly at www.c2c.com.
CMS Update / · Laurie Tan was present on the teleconference line from the CMS Seattle Office. She updated the members to prepare themselves on the Social Security initiative. Please go to this website for information on how this will be implemented and rolled out. We will be given information on how to check to see what a beneficiary’s new number is. https://www.cms.gov/Medicare/SSNRI/Index.html
· New numbers will become available at the end of 2017 and released on Medicare remits for 15 months with full implementation by Dec. 2019.
· Performant Recovery has been awarded the new Recovery Audit Contractor Contract.
Medical Director Update / · Dr. Peter Gurk was present at the meeting. Dr. Barbara O’Neal was in attendance on the phone.
· The JA transition went very well. There was not a change in the Medical Director for JA. It is still Dr. Wilfred Mamuya. He has been around quite a bit. Dr. Gurk encouraged members to reach out to him if they see him because he is very interested in what you have to say.
· A lot of time and effort is being spent on the Surgical Dressing policy. They have received lots of feedback on this and are trying to work through it.
· Kimberlie Rogers-Bowers asked about Audit activity and if there were any new plans to focus on any particular product category? Dr. Gurk did not have any details but indicated that remains high and they have increased their efforts to align the processes and policies JA. They are continually trying to work through it all and will continue with the prepay audits.
· Mary Stoner asked if they are working on added a modifier tool on to their website to add with power mobility claims? This was a huge help to suppliers when NHIC has this available when they were the contractor. Cindy White replied that they are looking at this. Mary asked that they update Barb with any changes or updates so she can share with members.
· There was a lot of discussion on changing the delivery date back to the actual delivery date vs. the shipped date. Dr. Gurk said he has been involved in discussions about this. Paula Koenig said this would cause huge software issues for suppliers. Another concern was the fact that suppliers have educated other payers to the Medicare process. To change it again would be very difficult and extremely disruptive. A suggestion was made to accept either a ship or delivery date. Would that be possible? Dr. Gurk said he would look at this and take it back. It was also mentioned that this was a concern noted at every Council meeting this fall. Please see more information regarding this on the attached POE Updates.
· Kim Brummett asked about an update that was shared on their website regarding delayed discharges and that information needed to be added on what the actual discharge date was. This was not released on the B or C website. Dr. Gurk said he did not know for sure and could not answer for the other Jurisd. Dr. Gurk or Cindy did not think this was a directive from CMS. They will check on this and report back.
· Paula Koenig reported numerous processing problems after Oct. 1st on capped rental claims. This has also been reported in Jurisd. B. Some suppliers are getting paid when they change the modifiers to NUKHRB which does not make sense. Cindy said she would take this back so it could be reviewed.
· Deanne Birch reported that as of July 1st some suppliers were receiving denials on IV Poles E0776 on PEN or enteral nutrition. The claims are submitted with RR BA KE. It was suggested that the problem could be that the KE modifier was discontinued in July for some products. She will take this back and check on it.
· Numerous problems were presented on how suppliers should bill for O2 when a patient does not qualify. On occasion a beneficiary may have a valid test but not qualify by the guidelines. The claim is submitted with the GA modifier but the supplier gets paid. This is sent to redeterminations to reprocess and this can take quite a bit of time on everyone’s part. One supplier reported SACU and congressional problems because of this because the beneficiary wants their money back. The suggestion was made for information to be placed in NTE segment such as not stable state on the first O2 claim. This suggestion is being made to all DME MAC’s. Dr. Gurk and Cindy said they would look at this and the supplier should send the examples to them.
· The other concern on O2 was when a beneficiary does not qualify but a secondary payer will pay for the service. Kim Brummett said that Jurisd. B used to have a process to use that was very favorable with suppliers but it was removed from the NGS website a couple of years ago. This will be looked at as well.
· Enteral/Parenteral IV Therapy Clarification on question 1 from Oct. 2016 questions.
· Bill Noyes had a question for the QIC asking if they could look at all documentation and deny for a different reason than the original denial. C2C responded that a supplier only must support the reason for the denial. They are allowed to only look at the initial denial reason but if there is more pertinent information needed the supplier should resubmit with it.
· Med Supplies Clarification on question 17 from Oct. 2016 questions.
· Mary Stoner suggested that perhaps the question was misunderstood. She asked what process we should use when we are trying to submit one line on the claim showing the beneficiary met the need and another line with the GA modifier. What is the best way to do this because currently claims are rejecting with a B20 or CO45 denial and have to go to appeals to resolve? Dr. Gurk and Cindy said they would take back and research this.
· Mary Stoner brought up the continued problem with PECOS. There are two different files being used. The Contractors file (VMS) is updated daily, whereas the website suppliers use (data.cms.gov) is updated bi-weekly. The contractors use the VMS system and suppliers use the data.cms.gov website. The VMS system will show the practitioner inactive if they are active in one state but not in another. The data.cms.gov site shows practitioners active in ANY state. Suppliers are also unable to see if a practitioner’s number has been revoked (which would not allow the +13 months billing for active rentals). Suppliers also cannot get practitioner's activation, deactivation or revocation info from the Medicare contractor either...so providers really have no way of knowing why a practitioner is no longer in PECOS to determine if the +13 months applies or does not apply.
· Lauri Tan is asking CMS to hold a conference call to discuss internally. Lauri asked Mary to forward her the communication email she received from CMS. It has been reported to the DAC that one company has received thousands of denials. This needs to be resolved.
· Mary asked Cindy if practitioners are deactivated during the time from when the provider dispensed services to the time the claim is actually processed, will the claim deny? Cindy thought that it WOULD deny (meaning the claims are reconciled based on the current PECOS enrollment at the time of claims processing and NOT based on the date of service of the claim. This could be a huge problem for suppliers.