Present:
Region D DAC Executive Committee Members: Chair: Rich Pozesky; Secretary: Rick Graver; Treasurer: John Kenney and Past Chair: Troy Paz.

Centers for Medicare and Medicaid Services (CMS): Lauri Oneil

CIGNA Medicare/DMERC: Nashville: Dr. Robert Hoover, Tricia Luna, Kim Largent, Mary Rheinecker, Donna Gibbs, Ellen Edenfield, David Smith and Barbara Douglas. Boise: Doug Frazier, Cathy Grako, Kathy Brock, Miranda Kyles, Jody Whitten, and Jefferson Jenkins.

Region D DAC Participants: Donna Bunyard, Steve Treinen, Wade Hendrickson, Velma Goertzen, Dave Hosman, Janna Jurovich, Ed Erickson, Barb Stockert, Sha Eppley, Deanne Birch, Kay Johnson, Carlos Reyes, Mary Jackson, Zena Jacobi, Sandy Carden, Connie Lind-Fraher, Mike Hayden, Pat Spanel, Mary Turner, Sharon Nichelson, Leslie Rigg, and Joe McKnight.

1. Introductions:
a. Region D DAC Chairperson Rich Pozesky opened the meeting reminding the participants of the protocols for the conference call. Introductions of the DAC Executive Committee, CMS, DMERC and a roll call of DAC participants ensued.

2. General Business:
a. Approval of the October 27, 2004 CIGNA/DAC meeting minutes: Wade Hendrickson made a motion to approve the meeting minutes as written, seconded by Troy Paz. Motion carried.

3. Medical Director Update: Dr. Robert Hoover:
a. Wheelchair codes: There is a CMS interagency workgroup working on this. Look to the CMS website for an opportunity for public comment. The wheelchair codes are being developed by the SADMERC. Codes should be released around the time of the National Coverage Determination.
b. Knee Orthosis: Still being reviewed and at this time there is not an anticipated publish date.
c. Chairperson Rich Pozesky thanked Dr. Hoover for his help in assisting with the Noridian Policy.

4. Medicare Beneficiary Information Provider Access: Lauri Oneil, CMS:
a. Ms. Oneil is working with customer service (CS) staff on an issue when a patient goes into a skilled nursing facility (SNF) and a claim is submitted and denied. The CS staff does not have location of SNF, but can provide with the provider number. There will be a website that will list the facility. She will let the DAC know the website address for this.
b. Today is CMS Open Door Forum for Home Health & Hospice.
c. Troy Paz thanked Ms. Oneil for email correspondence. He asked if the information from Part A would be available to put out on the Interactive Voice Response (IVR). Ms. Oneil responded it would be hard to put on IVR. Right know the call goes to CS.
d. Rich Pozesky thanked Ms. Oneil her for answers to the questions from the DAC. Wade Hendrickson to send issue with the Common Working File (CWF) to Ms. Oneil.

5. POE Update: – Doug Frazier, Provider Outreach and Education (POE) Department:
a. Finalizing spring series "Building on Basics of Medicare". A flyer will be available first part of February.
b. Webinar: This Thursday there will be a Webinar on the 1500 form. CIGNA will also be adding a refractive lenses Webinar.
c. Currently developing Netcourses: 17 are now available and working on 5 new ones: reviews, CR documentation, external breast prosthesis, ABNs, and Guide to Express Plus free billing software. Should be available within the next 4-6 weeks.
d. Melissa Atwood is no longer at CIGNA. The department will be back looking for her replacement.
e. Implementation of CR3376: This change request (CR) has been put on hold. The DMERC will advise the DAC when they receive an update.
f. Implementation of CR3288: Doug is participating in Indian Health Services (IHS). He is doing conferences in May and June. CIGNA will be the only DMERC participating in education of the IHS Outpatient (freestanding) clinics.
g. Kathy Brock took over the management control of EDI in Boise, help desk and POE guidance. Kathy updated the DAC that they are working on the registration process to accept credit card applications for the $25 charge.

6. New Business:
a. Next DAC meeting will be in Las Vegas on 4/5/05 from 4:00pm to 6:00pm. There has been conversation with Doug Frazier that the CIGNA/DAC meeting will be on 4/6/05, but have not established a time. Our members would like to not have the meeting be during education. Mr. Frazier indicated that 10:00am to 12:00pm would be a good time. The DAC Executive Committee will decide and communicate.
b. Mike Hayden from the V A-Team thanked Dr. Hoover for helping with the issue on enteral nutrition products billing.

7. A" -Team Leaders review answers provided by CIGNA:
a. EDI/EMC: No further clarification needed.
b. Education/Communication/PCOM: No further clarification needed.
c. HME: Barb Stockert, A-Team Leader:
· Q5B. Why would a PR denial not be given in all circumstances? Why must we go through the extra step of a re-determination to receive a PR denial?
1. Answer: The items that specifically list the requirement of having to have a written order prior to delivery would generally always receive a CO denial. This is because the written order prior to delivery is mandated for these items and to provide it without should only cause a CO denial. For all other items, we should receive the PR denial.
· Q6. Could you please clarify who/what the Correspondence Department is? How do we contact or mail them? How long is it estimated before we would receive an answer from any review?
1. Answer: Leslie Sandstrom is the contact person for the Correspondence Department in Nashville. However she is presently out on leave. Documentation should be sent to Tricia Luna "Corresondence" until further notice. There is no time limit estimated for CMS to review each different case. Each individual case is dependent ion the circumstances involving it.
d. Infusion Therapy: No further clarification needed.
e. Medical Supplies: No further clarification needed.
f. Orthotics and Prosthetics: Sharon Nichelson A-Team Leader:
· Q14: The A-Team did not feel that they received the answer that they were looking for, and that they will submit a rephrased question for the next round of questions.
· Question was asked to Dr. Hoover about a previous submitted question regarding Inherent Reasonableness (I.R.) and the fees for custom artificial eye prosthesis with codes V2623 and V2627. Is there an update regarding this issue?
1. Dr. Hoover responded not at this time. They are still working on it.
g. Rehab: Leslie Rigg A-Team Leader:
· Q15: ABN on assigned claims and supplier having ABN: The A-Team was hoping for a clear response.
1. Dr. Hoover responded who does the DMERC go back to when requesting an overpayment and the supplier has an ABN? CIGNA would come back to supplier and the supplier would collect from beneficiary.
a. This issue will be pursued with CMS.
· Q17: The A-Team will work on getting examples. Concern is that still not able to bill for repairs.
· Q18: ADMC transfer between regions?
1. The response is yes they do, but DMERCs do not communication ADMC to other regions. CIGNA was not sure if other regions do this. It is an issue that has not been addressed by CMS or the DMERCs.
a. The Rehab A-Team will discuss further.
· Q19: On Class 3 wheelchairs, are there other wheelchairs in there?
1. Dr Hoover responded he did not think there was. Barbara Douglas from CIGNA indicated this is the only chair so far that has been identified by class 3.
h. Respiratory: No further clarification needed.

AdjAdj
10:45 – 11:00am
New Business

REGION D DAC
MEETING with CIGNA Government Services LLC
Meeting Minutes
Date: October 27, 2004June 28, 2005
Location: Via Orange County Convention Center,Teleconference
Orlando, Florida
Room: TBA
Time: 9:00 to 11:00 am Pacific Standard Time (PST)

Present:
Region D DAC Executive Committee Members: Chair: Rich Pozesky; Vice Chair: Val Taylor; Secretary: Rick Graver; Treasurer: John Kenney and Past Chair: Troy Paz.

Centers for Medicare and Medicaid Services (CMS): Elaine Knapp

CIGNA Government Services LLC/DMERC: Dr. Robert Hoover, and guests Dr. Dan Duval – Part A Medical Director, Dr. Sanders – Q Source out of Memphis. Nashville: Mary Rheinecker, Tricia Luna, Kim Largent, Ellen Edenfield, and Barbara Douglas. Boise: Doug Frazier, Kathy Brock, Cathy Grako, Miranda Kyles, Jody Whitten, Shaswati Cates and Catie Stroh.

Region D DAC Participants: Kimberlie Rogers-Bowers, Maureen Hanna, Laura McIlvane, Wade Hendrickson, Dave Hosman, Sharon Nichelson, Yvonne Cordoza, Barb Stockert, Sha Eppley, Deanne Birch, Zena Jacobi, Cindy Coy, Mike Hayden, Leslie Rigg, Sandy Carden, Connie Lind-Fraher, Mary Turner. Administration: Rose Schafhauser.

Meeting opened at 9:04 am PST.

Present:
Region D DAC Executive Committee Members: Chair: Rich Pozesky; Vice Chair: Val Taylor; Secretary: Rick Graver; Treasurer: John Kenney; and Past Chair: Troy Paz. Administration: Rose Schafhauser.

Centers for Medicare and Medicaid Services (CMS): Lauri Tan, Elaine Knapp

CIGNA Medicare/DMERC: Dr. Robert Hoover, Doug Frazier, Mary Rheinecker, Kathy Brock, and Miranda Kyles.

Region D DAC Participants: see enclosed listing.

Meeting opened at 4:05 pm.

1. Introductions:
a. Region D DAC Chairperson Rich Pozesky opened the meeting reminding the participants of the protocols for the meeting. Introductions of the DAC Executive Committee, CMS, DMERC and a roll call of DAC participants ensued.

2. General Business:
a. Approval of the January 25, 2005 CIGNA/DAC meeting minutes: The meeting minutes have not been distributed therefore will be approved at the next CIGNA/DAC meeting.

3. Medical Director Update: Dr. Robert Hoover:
a. Wheelchair Seating National Coverage Determination (NCD): The Medical Directors are working with CMS on the NCD. The "In the Home" requirement is still in the NCD, but expects it to be clearer. Look for this to come out within days via list serve. Also, working with the Office of Management and Budget (OMB) on the CMN to parallel with the NCD. Dr. Hoover expects it will not be ready before January of 2006. There will be a transition plan in place on the use of the CMN and the transition from old to new CMN.

b. Comprehensive Error Rate Testing (CERT): Information is in the DMERC Dialogue that lets providers know what the DMERC will focus on.
· Support Surfaces Group II: Documentation and coverage criteria are not being met. The ICD-9 code for the location of the Decubitus Ulcer is not being used. The ICD-9 codes changed to add 2 additional digits that identify the location of the ulcer that ties into the coverage criteria. As of July 1 ^st claims will be denied unless one of the qualifying ICD-9 codes is utilized.
· Ostomy letters: In the past few seeks, supplier letters on HCPCS code A9270 went out in error and are being corrected.
· Informational letters also went out to suppliers of Refractive Lenses, CPAPs and Immunosuppressive drugs.
· Diabetic supplies related: Data analysis revealed almost 19,000 unique UPINs associated with ordering over $500 for non-insulin dependent beneficiaries. Letters will also be sent out to these 19,000 targeted doctors educating them about the ordering of glucose testing supplies. This letter should go out at the end of April.
· In relation to the errors found in CERT, Dr. Hoover recommends utilizing the Home Blood Glucose Documentation check list.
· Dr. Hoover indicated that these are educational projects based on CERT results and will not necessarily lead to provider-specific probes.

c. Physician Education: There are two types of education occurring for physicians: General and Policy.
· Created a MD Corner on the main page of the CIGNA website ( www.cignamedicare.com - not on the DMERC page). It includes articles Dr. Hoover has written. We can use these for educational tools to doctors.
· Literature is also available: i.e., glucose monitors – there are 35 articles on testing of type II patients.
· The first half of the physician packet is now on the Corner.
1. The DAC suggested that a "How to Fill of a CMN" to go on the MD Corner. To educate further, suggested developing a CMN Net Course designed for the doctors.
2. Suggestion was to add a place a request for feedback on the MD Corner.
Dr. Hoover indicated this was already in place on the site.

d. CMN update: The OMB in process of reviewing CMNs. So far, approved changes are:
· Immunosuppressive drugs – DIF eliminated. (Post meeting note: The DIF elimination will be delayed. See July’s DMERC Dialogue for more details.)
· Parenteral Nutrition – converted to DIF.
· Hospital bed CMN maybe eliminated.

e. Competitive Bidding for DMERCs: Included in the 911 section of the MMA, all four DMERC regions, the NSC and SADMERC are up for bid.
· Medicare Part A & B contracts will no longer be separate. Will replace the current contracting authority to administer the Medicare Part A and Part B, with the new Medicare Administrative Contactor (MAC) authority. CMS plans to compete and award contracts for 15 Primary A/B MACs servicing the majority of all types of providers (both Part A and Part B), four specialty MACs servicing the home health and hospice providers, and four specialty MACs servicing durable medical equipment suppliers. For specific details, there is an A/B MAC jurisdictions map. Region D DMERC jurisdiction will not change. Minor state changes to the other 3 regions. Visit the CMS website for the map and further details, http://www.cms.hhs.gov/medicarereform/contractingreform/.
· CMS will be surveying over 7,000 providers. They will use the survey as part of their evaluation process in awarding the new DME MAC contracts. If you receive a survey, Dr. Hoover urged you to complete it and return to CMS.
· RFP will be coming to the DMERC in a few weeks and are due in May. Expect the bid to be awarded at the end of year and to be effective by mid-year 2006.

f. The DAC had a question if the customer service moving to Technical staff – 3 tier system?
· Dr. Hoover was not sure. He is getting questions addressed to him.

4. Medicare Beneficiary Information Provider Access: Lauri Tan, CMS:
a. Ms. Tan is working with customer service (CS) staff on an issue when a patient goes into a skilled nursing facility (SNF) and a claim is submitted and denied. The CS staff can provide with the provider number of where the beneficiary resides, but does not have the location of the SNF.
· There will be a website that will list the facility. She will let the DAC know the website address for this. She will email the address to Doug Frazier to get out to the DAC. This will be public information and should help in regards to consolidated billing problems.
1. CMS Follow-up: When a supplier receives a denial on a claim indicating the bene is in a covered Part A stay. The customer service representative can see the Part A provider number in CWF. They can give the provider number to the supplier and the supplier can go to the following website and look up who it is: http://www.healthcarehiring.com/ they can select from the left hand side Hospital, Nursing home and Hospice to name a few. Then select the State and then do a find for the provider number, once found it will show the name and address of the facility.
· CMS will put in writing the protocols for customer service.

b. Other CMS Updates:
· Ms. Oneils last name has changed to Tan. The email address will be changed as well.
· Change in oxygen rates: there is issues with the effective date of the new oxygen allowables in regards to collecting co pay’s at upfront. CMS could not respond to the issue.

· Interactive Voice Response (IVR): the question was asked if the beneficiary information will be on the IVR. CMS referred back to CIGNA.
1. Mary Rheinecker responded that it was not possible because the information is located on CWF. However, she will double check. CIGNA is still looking into advanced IVR per Doug Frazier.

CIGNA Medicare Response: At this time our IVR is not equipped to provide this information while adhering to the Privacy Act and HIPAA Privacy Rules. However, we are looking into transitioning to a new more sophisticated IVR system and may consider this option in the future.

5. Provider Outreach and Education (POE) Department Update: – Doug Frazier:
a. "Building on Basics of Medicare" summer seminars: most have be completed. Jodie Whitten and Cathy Grako are conducting the seminars.

b. Webinars: Holding 2 times a month. Currently doing Refractive Lenses and Glucose Monitors.

c. Netcourses: 19 are now available and working on 3-5 more that are in production.

d. Indian Health Services (IHS): Education is being provided for 22 free standing clinics. Doug Frazier has completed 5 so far. Hopes to complete the education by July.

e. Shasawati Cates has just been hired. She will be out in the fall. The department will be hiring another person as well.

f. Other:
· The DAC asked for an update on the implementation of CR3376. Per the DMERC, this change request (CR) is still on hold. The DMERC will advise the DAC when they receive an update.
· The DAC asked for an update on the status of CR1133. Per the DMERC, it is a funding issue.

6. New Business:
a. New oxygen allowables: The DMERC had no further comments. However, the DAC had the following questions:
· What should the CMN reflect for allowables from Jan 1 to April 8?
1. Mary Rheinecker responded that nothing needs to be done with those CMN’s. Providers do not need to go back and get a new CMN. The ones you already have are ok.
· What if providers have collected deductible and co-payment up front for 2005 services based on 2004 fee schedule amounts then the claim is paid with the new 2005 fee schedule amount?
1. Mary Rheinecker responded that providers are bound to collect the actual amount owed at the time the claim was processed. However, she will verify at the office. Members further clarified that some of the collected in excess of the amount that should have been collected is less than $1.00 and they prefer a means of reconciling the over-collected amounts without having to refund the beneficiary directly.
CIGNA Medicare Response: This issue has been forwarded to CMS for guidance.

· Administratively this is an issue for providers who collected payments in Jan through April at the 2004 allowables. The claims get submitted in April and the co pay has now changed. Do providers have to refund the difference? The DAC would like to see that the allowable would be effective by the date of the service than the date the claim was submitted.
1. Mary Rheinecker responded that the pricing buckets are on a calendar year and changing it maybe a programming issue. She will verify if providers will have to refund the difference of the co pay amount.

7. A" -Team Leaders review answers provided by CIGNA:
a. EDI/EMC: No further clarification needed.

b. Education/Communication/PCOM: Connie Lind-Fraher, Assistant A-Team Leader.
· Q3. The A-Team will be submitting the examples.

c. HME: Barb Stockert, A-Team Leader:
· Q4. We were previously told by Region D that we could have a customer initial and date a statement that indicated they never had same or similar equipment before. This statement could be sent to re-determination and we would receive a PR denial. Is this still in effect?
1. Answer: Yes this would be effective and could result in a favorable denial for the provider. Doug Frazier did state to be aware that in an audit we would have to have additional documentation to back this up. CIGNA also suggested that a conference call between patient, provider and CIGNA could also be done. Mary Rheinecker stated that if we knew the customer had same or similar equipment before that getting an ABN would be required to receive a favorable denial.
· Q6. Can we bill the beneficiary for the months we were denied? Or can we bill for a purchase?
1. Answer: We have to follow the capped rental guidelines so billing Medicare for a purchase would not be allowed. Mary Rheinecker stated we would receive a medical necessity denial on the first months claim. The subsequent months should deny for needing a new CMN/RX. These denials could be sent to re-determination with our documentation. If the customer wanted to purchase the wheelchair outright, we could do so as far as no claim would be submitted to CIGNA. This would be an agreement between the provider and the customer. If the customer wanted to continue to rent the wheelchair, an ABN would be required in order to get a favorable denial for the provider.

d. Infusion Therapy: Deanne Birch, Assistant A-Team Leader.
· Q7. There are still concerns regarding the use of GA modifier and the type of denial received.
1. Answer: The DMERC cannot ignore the fact that coverage for the pump is with the drugs. DME benefit applies for the pump, and as long as there is a pump involved, if the pump is denied, then the drugs will be denied.
a. Question: if we use GA modifier for both the pump and supplies?
b. Answer: IVIG should be covered. In order to get a PR denial, must have an ABN properly filled out.

e. Medical Supplies: No further clarification needed.

f. Orthotics and Prosthetics: Sharon Nichelson A-Team Leader:
· Q8. The DAC would like to verify if they did get pricing from the manufacturers?
1. Answer: Yes, they did.
a. Question: if pricing came from other sources, what is the origin of the 100% markup?
Answer: Will have to take back.
CIGNA has requested examples.
· Q10. How do we avoid a denial when using HCPCS code L2999?
1. Answer: Need to provide information. Check the DMERC Dialogue or Supplier Manual for information required for these claims.
· Q11. Will CMS or the NSC answer?
1. Answer: Lauri Tan responded probably CMS will answer. Not manufacturer sponsored and not regional, but national. Lauri will send query back to CMS.

g. Rehab: Leslie Rigg A-Team Leader:
· Q13. Regarding the liability in the answer provided, the concern is what is the value of getting an ABN?
1. Answer: It gives the authority to get payment from the beneficiary.
a. Statement: There are many issues providers have with being unable to locate the entity that would be responsible.
b. Response: Not part of Medical review, and would fall into the providers debt collection process.
CIGNA Medicare Response: This would be a supplier’s business decision. They could look to the beneficiary’s estate. A supplier could look to CMS for guidance in a specific situation.

h. Respiratory: no further clarification needed.

i. SADMERC: Wade Hendrickson A-Team Leader.
· Q24. Response from DMERC was that HCPCS code A4221 is not an adequate code for the type of supplies being used now. Talked to a number of manufacturers. Now hearing that no one using old product cost for new technology for cost is increasing. Now the allowable does not cover cost. Talking to CMS for an Inherent Reasonableness (IR) now. Based on pricing 72 hour change frequency for catheter infusion sets, therefore the patient can go farther with out changing and therefore still thought the reimbursement is adequate.
· CIGNA wants to continue with having the SADMERC and NSC questions included.

· AdjAdj
10:45 – 11:00am
New Business

8. Adjouurnment: Motion to adjourn the meeting by Sharon Nichelson and seconded by Barb Stockert. Adjourned at 5:45pm.

Region D DAC Participants

Barb Stockert
Chuck Gunther
Cindy White
Connie Lind-Fraher
Deanne Birch
Diana Guth
Doreen Alderete
Duane Ridenour
Fran Henderson
Gary Hill
Gemma English
Gloria Peterson
Heidi Thometz
Herb Langsam
Janet Malinowski
Joe McKnight
Harry Brandt "JR"
Karen Bonn
Kay Francke
KC Cooper
Kevin Quaglia
Kimberlie Rogers-Bowers
Laura McIlvane
Laura Steelquist
Leslie Rigg

CIGNA Government Services/ Region D DMERC: Doug Frazier, Mary Rheinecker, Barbara Douglas and Jessica DeWerff.

Region D DAC Participants: see enclosed listing.

Meeting Opened at 10:00 am.

1. Introductions: Region D DAC Chairperson Rich Pozesky opened the meeting with introductions of the DAC Executive Committee, DMERC and a roll call of DAC participants ensued.

2. General Business:
a. Review of the meeting protocols: Rich Pozesky reminded who is able to address CIGNA staff during the meeting. In addition, discussed the revision to the DAC Articles regarding a protocol of removal from the DAC by not following protocol. Rose Schafhauser to get a copy of the Articles to Doug Frazier.
b. Approval of the meeting minutes from June 28, 2005: A motion to approve the meeting minutes as written was made by Wade Hendrickson and seconded by Robert McKnight. Motion carried.

3. Medical Director Update: Mary Rheinecker.
a. New Medial Director: the new Medical Director is Dr. Mark Pilley. Dr. Donald Norris is still the acting Medical Director until Dr. Pilley is signed on.
b. Working on last of the Local Medical Review Policies (LMRPs) conversion to Local Coverage Determinations (LCDs): Home Dialysis, Hospital Beds, Pneumatic Compressors, TENS, and Group III Support Surface. Should be complete by December 2005.
c. Working on information about the Mobility Assistive Equipment (MAE) National Coverage Determination (NCD) and the interim final rule. There was a joint meeting with Region B on the policy. The meeting went well and there were no surprises on the comments. The MAE will be revised and the DMERC will be putting it out on their website. There are revisions to the current motorized wheelchair policy. This is just a revision and not a new policy. The revision is to incorporate the NCD. This is being released on Friday and will be on the CMS website next week.

4. Medicare Beneficiary Information Provider Access:
a. Same/similar: Rick Graver discussed a current White Paper that the Region D DAC is developing on same and similar. There continues to be issues with the beneficiaries not informing the provider they have had same and similar equipment. Providers are not getting paid and have to go through review. Providers have to use ABN's or conduct a three way conference call with the beneficiary, DMERC and the provider. Discussed having access to the common working file (CWF) or provide other solutions to address this problem. The White Paper will be sent out to the Region D DAC Executive Committee and state representatives. A copy will be sent to CIGNA before sending to CMS.
i. CIGNA agrees with the DAC; however, CMS may hold it up. There was a reminder to the DAC that the previous form used for this issue that was utilized in review, the form is no longer valid. Another form on the release of information gives a small window of opportunity to call without having the beneficiary present. The CIGNA Senior Customer Service representative can let you know how that process works.
1. The key to this issue is the need for a better tool. At this time, it is still recommended to do a 3 way call. CIGNA recommended the DAC to put in the White Paper the statistics on what the number of calls to CIGNA could be if it is recommended this as an option.

5. Provider Outreach and Education (POE) Update: Doug Frazier.
a. Fall Seminars: The seminars are on respiratory policies. CIGNA still has room available in most of the states.
b. Ask-the-Contractor Teleconferences (ACT): All aspects of change request (CR) 3376 went into effect as of October 1, 2005. Go to the Education tab on the CIGNA website, and click on "Ask-the-Contractor Teleconferences." CIGNA is looking to the Provider Communications (PCOM) Advisory Group for input and topics.
c. NetCourses: There are currently 26 NetCourses that are available. There are 3 new ones: Facial Prostheses, Lower Limb Prostheses and Eye Prostheses. MAE course now online – providers will find it very thorough.
d. Documentation Checklists are also available on website. This is a good tool to use.
e. Indian Health Services (IHS): CIGNA has provided basic education and will continue to educate the clinics.
f. Staffing: The department has been fully staffed for 6 months.

6. New Business:
a. Recognitions: The Region D DAC recognized the service of Dr. Robert Hoover and Mary Rheinecker. A special recognition went out to Doug Frazier for his hard work and dedication to the DAC.
b. Rehab Mobility Assistive Equipment (MAE) National Coverage Determination (NCD): Rick Graver discussed some of the MAE issues. The DAC will comment on the interim final rule on the 25th and the LCD on the 31st. There has been a rumor of a delay; however, even if there is a delay, we still need to submit comments.
i. Education: The "Letter to Physician" is extremely helpful. The DAC asked for as much educational materials so that providers can educate themselves, doctors and their referral sources. Response from CIGNA is that there are FAQs directed to physicians. They are expecting to continue to add this type of education to their website. The concern by the DAC is that providers will be put in a position to determine medical necessity. In addition, the Q & A's on the website are a bit confusing. Need clarity about the documentation the provider has to have on file. CIGNA responded that they understand the importance of the role of the provider. That is why they want to make sure providers make comments.
ii. Same and similar: the question was asked if a beneficiary was provided a power operated vehicle (POV) that will not meet their current needs and now need a power wheelchair, will the claim be paid? The response is the claim should not deny as same and similar, but cannot guarantee. The DAC will formulate further questions.
c. Other:
i. O & P A-Team White Paper: John Kenny referenced the HCPCS LSO Fee Schedule Determination White Paper that was forwarded to CIGNA for review prior to forwarding to CMS after this meeting. Mary Rheinecker was able to review the White Paper and indicated that it referenced materials out of the old Medicare Carriers Manual (MCM). The references should be from the Internet On-Line Manual (IOM) that is located on the CMS website. There are considerable changes from the MCM to IOM. Go to CMS website Topics/Manuals/Internet On-Line Manual/Durable Medical Equipment (DMEPOS). There is a crosswalk from the MCM to the IOM at http://www.cms.hhs.gov/manuals/pm_trans/R1823b3.pdf .

7. Questions & Answers:
a. EDI/EMC A-Team Member Duane Ridenour had no further questions.
b. Education/Communication/PCOM: A-Team Leader Cindy Coy:
i. Question number 2: Has CMS written a CR? The response from CIGNA was no.
c. HME A-Team Leader Barb Stockert had no further questions.
d. Infusion Therapy: A-Team member Rosalie Weber:
i. Question number 7: What code is used if the drug is covered but the pump is not? The response from CIGNA is that when the pump is not covered, the drug is not covered. Use J code and bill for a coverage denial. Question was asked if there is a system in place to get a clean denial. CIGNA responded that you should get the same denial no matter what your modifier is. There is not a Medicare Benefit for the drug if the pump is not covered. The GA modifier is required to tell the DMERC that you are billing for denial.
e. Medical Supplies A-Team Leader Pat Spanel had no further questions.
f. O & P A-Team Leader Sharon Nichelson had no further questions and asked CIGNA to watch for revisions to the aforementioned White Paper.
g. Rehab: A-Team Leader Leslie Rigg:
1. Question number 11: Regarding the power elevating leg rests change from each to pair has restricted the allowable. Where can we go to plead our case? CIGNA recommended going to CMS.
2. Question number 12: Is the response for the coated hand rims the same? Yes, CIGNA recommended going to CMS to plead the case.
a. If a supplier feels that they cannot provide coated hand rims, are they required to? Coated hand rims give a better grip for someone so there is medical need. CIGNA suggested going to the alpha numeric workgroup at the SADMERC. There is a form to submit for a new code and provide medical justification.
b. Leslie Rigg asked if there is a prescription for a wheelchair that included coated hand rims, is there an avenue to not provide the coated hand rims but regular hand rims? This will have to go back to CIGNA for response. The DAC needs this clarification for the Medicaid agencies as well.
3. Question number 13: Definitions for K0090 and K0094 - Is there a better avenue for the description of these codes? CIGNA will look at the codes and descriptions and they will get back to DAC central.
4. There was a presentation in Region C to help providers understand the Algorithm process; will this be available in Region D? CIGNA will work with Region C on this.
h. Respiratory A-Team Leader Robert McKnight had no further questions.

Motion to adjourn the meeting at 11:22 am by Yvonne Cordoza and second by Sharon Nichelson.