Jurisdiction D DME MAC ADVISORY COMMITTEE
MEDTRADE MEETING WITH NORIDIAN/CMS AND CEDI
TUESDAY, OCTOBER 13, 2009
9:00 a.m. Central Time
Georgia World Congress Center, Atlanta, GA
DAC chairperson Sharon Nichelson welcomed everyone to the DAC meeting, and introduced the Executive committee (EC) for the DAC:
Chair:Sharon Nichelson
Past Chair:Barb Stockert
Vice Chair:Sheila Showalter-Roberson
Secretary:Gemma English
Treasurer:Connie Lind-Fraher
Attending from Noridian:
Jody Whitten – Provider Outreach and Education, Fargo
Peggy Sorge – Provider Outreach and Education, Fargo
Elizabeth Barton – Customer Service Team Leader, Fargo
Dr. Richard Whitten - Medical Director
Attending from CEDI:
Stacy McDonald
Sally Hopkins
Gemma English then completed the roll call of State representatives and A-team leadership.
Alaska – Kimberlie Rogers-Bowers
Arizona – Emmie Guinn
California – Laura McIlvaine
Hawaii – Violeta Arnobit
Idaho – Rick Graver
Iowa – Leila Wilkerson
Kansas – Sheila Showalter-Roberson
Missouri – Ron Burns
Montana – Sha Eppley
Nebraska – Sharon Nichelson
Nevada – Rick Graver
North Dakota – Barb Stockert
Oregon – Heather Hooper
South Dakota – Kay Johnson
Utah – Deanne Birch
Washington – Mark Pilley
Wyoming – Michelle McMahon
CEDI – Gemma English
Education/Communication/PCOM – Barb Stockert
HME – Leila Wilkerson, Sha Eppley
IV/PEN – Deanne Birch, Rosalie Weber
Medical Supp/Wound Care – Robert Clock, Teresa Brammer
Orthotics & Prosthetics (O&P) – Mark Pilley
Rehab – Rick Graver
Respiratory – Colleen McKenna-Shaw
National Supplier Clearinghouse (NSC) – Emmie Guinn
PDAC – Barb Stockert
Roll call of other attendees was conducted and they are listed at the end of the minutes.
Approval of the meeting minutes from August 7, 2009 Conference Call were approved, all were in favor.
CMS UPDATE:
Edward Lain was unable to attend the meeting; therefore, there was no CMS Update.
NORIDIAN UPDATE:
The fall 2009 DAC POE Update as reviewed by Jody Whitten at the meeting is attached to the minutes.
CEDI UPDATE:
Stacy McDonald provided information about the education session at Medtrade being conducted by CEDI as well as booth information. The enrollment team is within 3 to 5 days of processing for new applications. A new step is that they are now verifying that the signature on enrollment applications is authorized.
Discussion of PECOS new edits in place occurred. CEDI has been reporting the high volume of warnings to CMS. The first day of the edit resulted in 300,000 hits. The CEDI Help desk does not have any access to verify physician information in PECOS, CMS is working on a solution to that. The attendees had many questions in regards to this increasing urgent issue and Jody Whitten stated that she would bring the questions back to NAS/CMS.
REVIEW OF Q&A FROM A-TEAMS:
CEDI – Gemma English
No follow-up questions at this time
Education/Communication/PCOM – Barb Stockert
No follow-up questions at this time
HME – Leila Wilkerson
In regard to electronic prescriptions, asking that it continue to be reviewed by the Medical Directors to provide specific guidance as to what can be accepted.
Dr. Whitten suggested that if the prescription meets all the requirements and clearly indicates it is an electronically signed document, it should be able to be used. The ones to be concerned about is if it does not clearly indicate that it is an electronic signature.
IV PEN – Deanne Birch
This is a follow-up to a question from 8/7/09 teleconference meeting in regards to the requirements for a parenteral/enteral pump and the purchase option letter, if it is required at the 10 month rental or in the first month.
Jody Whitten responded that it is not a requirement to give the option to the patient on pumps, that they are working on edits with CMS direction, the option to purchase can be given at any time, they recommend doing it in the first month. Further clarification will be provided at a future time.
MEDICAL SUPPLIES – Bob Clock
Bob stated that the team had questions in regard to CERT documentation requests that Laura McIlvaine would like to explain further. Laura questioned when there is a clear medical criteria based on diagnosis outlined in the LCD and that requirement is met as well as the maximum quantity limit, why would there be a need for CERT to audit the item to provide proof of that.
Dr. Whitten responded that they are working with CMS on the CERT issues and that the examples we provided were helpful in that effort.
Orthotics & Prosthetics (O&P)– Mark Pilley
Regarding the use of the GA/GZ modifier, when they know it doesn’t qualify and is pending additional documentation, how can they later get paid when the additional documentation has been obtained? Jody Whitten responded that the appeal process should be used for individual consideration.
Also, if additional information is being used in consideration of review outside of the LCD, could that be communicated to suppliers? Jody Whitten requested examples be submitted of that scenario.
If an item is purchased and then sold under the supplier name, should it have to go through HCPCS validation on coding through PDAC again after the manufacturer already went through that process? Dr. Whitten requested that this information be submitted to him for review.
Rehab – Rick Graver
A further clarification on the response to question #2, the supplier who repaired the item does not have to have an ATP on staff if a different supplier originally provided the item and did have an ATP on staff?
Is it a requirement for a supplier to have an ATP on staff to provide repairs for Gr 3 motorized wheelchairs?
The coverage criteria for Group 3 PWC requires the supplier to employ a RESNA certified ATP to have in-person involvement in the wheelchair selection. Repairs are covered for patient owned items that are reasonable and necessary and meet coverage criteria. If a supplier is repairing an already covered Group 3 PWC that meets coverage criteria, an ATP is not required to be on staff.
Jody Whitten confirmed that it was correct but suggested that the supplier doing the repair verify that the original supplier did have an ATP on staff.
.
Respiratory – Colleen McKenna-Shaw
No follow-up questions.
National Supplier Clearinghouse (NSC) – Emmie Guinn
No follow-up questions.
PDAC – Barb Stockert
A letter was drafted with Jody’s help inviting PDAC staff to attend the meeting. We need to get them involved with all regions, similar to NSC.
Dr. Whitten replied that there is no funding for them to attend and suggested getting questions to them informally first.
New Business:
- ABN – Barb Stockert explained that there was recent discussion with NAS staff at the MAMES conference regarding whether a patient that originally signed an ABN and stated they did not want the provider to bill Medicare could later come back and change their option.
Dr. Whitten responded that the purpose of the ABN is to protect the beneficiary and that he understand that the beneficiary does have a year to make that change.
- PECOS –Barb Stockert asked that a physician education letter be developed by Dr. Whitten to assist.
Dr. Whitten responded that he is open to doing that and would be willing to review a draft.
- CERT –Gemma English asked Dr. Whitten if there was any follow-up to the examples provided in the document prepared by the DAC membership.
Dr. Whitten said that the examples are being used to further understand the CERT concerns for documentation and that specific responses to each would not be forthcoming. If recoupments occur on any of these, an appeal is recommended. If a later appeal is denied, communication on that would be important. They recognize the issues on the CERT requests and are working with CMS to control these.
- IV/PEN Proof of Delivery – Deanne Birch explained that there has been a change to the PIM in regard to billing dates specific to enteral and supplies. It had been removed in 2006 but is now back in the manual reverting to billing usage date. In 2001, there was a change request 2903 defining bill date for refills on consumable products. In 2004, efforts to change that began and it had been removed in 2006.
Dr. Whitten stated that providing the history would be helpful, all four MACs would be reviewing together and that this instruction does not make sense. Jody Whitten was in agreement.
Other Discussion
Miriam Lieber asked if Noridian could schedule their webinar education in the mornings.
With no further business to discuss, meeting was adjourned at 10:55a.m. Central Time.
Respectfully submitted,
Gemma English
Secretary, DAC Executive Committee
Other attendees:
Claudia Zacharias, BOC International, Associate Member
Teri Jamison, Preferred HomeCare
Mike Hayden, IV A-Team
Herb Langsam, IV A-Team
David Bryant, IV A-Team
Tom Hood, Rehab A-Team
Amy Schmidt, HME A-Team
KC Cooper, HME A-Team
Peggy Walker, NSC A-Team
Ron Merryman, RS Medical, Manufacturer Member
Birgit Sharrock, RS Medical, Manufacturer Member
Miriam Lieber, Lieber Consulting
Kay Martin, Med Supplies A-Team
Willie Danz, O&P A-Team
Jim Stephenson, Rehab A-Team
Jean Thompson, National Examining Bd of Ocularists