Region D DAC Executive Committee Members:
Chair: John Kenney
Vice Chair: Joe McKnight
Secretary: Mike Hayden
Treasurer: Barb Stockert
Past Chair: Val Taylor.
Administration: Maureen Hanna.

DME Medicare Administrative Contractor (MAC) Noridian Administrative Services (NAS):
Education Teamleader: Janet Kirsch
Education Representatives (Fargo): Tracy Schutt and Sheryl Mandigo
Education Representative (Boise): Jody Whitten
Contact Center Team Leader: Laurie Severtson
DME Appeals Office (Grand Forks): Various

Program Safeguard Contractor (PSC) IntegriGuard:
Medical Director: Mark Pilley, MD
Medical Review Manager: Joan Madsen, RN, BSN
Medical Review Supervisor: Karolyn Osborn, RN
LCD/HCPCS Coordinator: Melanie Addison, RN, BSN
CERT Coordinator: Michelle Davis, RN,
Lead Claims Analyst: Amy Barnes
Medical Review Nurses: Mary Park, RN and Patricia Marshall, RN.

Region D DAC Participants: see enclosed listing at end of minutes.

Meeting opened at 9:10 am PST

1. General Business: John Kenney
a. John announced that this call is being recorded for consistency in note taking and also for those that missed the call so they can go back and listen at a later time.
b. Chair, John Kenney opened the meeting with a review of the meeting protocols.
c. Approval of the meeting minutes from September 19, 2006 in Atlanta. A motion to approve the meeting minutes as written by Laura McIlvaine. Second by Barb Stockert. There were no oppositions. Motion carried.

2. Teamleader Update: Janet Kirsch
a. IVR Update: Noridian did have some difficulties when the contract was first taken over and have quickly resolved those issues. Over the last several months they have not heard of any new issues. 70% of calls are now handled by the IVR. If you are having problems please call Customer Service at the time of occurrence so they can troubleshoot.
b. Payment timelines update: A couple of weeks ago, an article was posted on website. Also there is a home page graphic "Important-Click here to find out more about NAS DME Claims". They do have a high inventory and are working on corrective plans of action. As of 1/29/07, 67.3% of the suspended claims are less than 30 days old. Only .35% of all suspended claims are 90 days or older. They have a process via the DAC to work with cash flow issues and are meeting with Joe and Barb on almost a weekly basis. An updated article is expected to be posted in the next week or so to the Noridian website. This was posted on 2/12/07.
c. "Re-opening" status of claims and how to move these thru the system most efficiently: This is an area where there are a lot of re-openings that are pending. Many are due to system issues that they have had. Also, due to provider clerical errors. They have not had the opportunity to do an analysis at this time. But, Janet can look at doing this in the future. Janet suggested that providers look at website regarding the difference of redetermination and reopening. A plan of action has been put into place to reduce reopenings (phone and written). Update to information from conference call: Written reopenings are current being worked in the 60 day timeframe.
d. Matrix - John Kenney reported that the Matrix is also being posted to DAC website, approximately every 2 weeks. Update coming next week from Janet. An updated matrix was provided to the DAC on 2/12/07 and posted to the DAC website on 2/13/07.

3. Medical Directors Update: Dr. Mark Pilley
a. Many issues have surfaced re: local coverage determination (e.g. power mobility devices).
b. Joe McKnight from Executive Committee asked what the relationship is between IntegriGuard and DME MAC? Dr. Pilley responded that IntegriGuard (PSC) is a subcontractor under EDS (the prime contractor) and the statement of work includes medical review, post and pre-payment claim review, assistance with developing local coverage determinations, revisions to local coverage determinations, re-consideration requests for local coverage and provide medical support for program integrity (EDS). EDS is the prime data analysis provider (for claim utilization). Contractor error rate testing assessment is owned by DME MAC and PSC. There is a new process in last few months with local coverage determination and that involves a unique relationship will full PSC and DME MAC. The PSC is still charged with development and revision of local coverage determination and articles. But, the DME MAC has accountability of adopting and implementation of local coverage policies. The PSC also reviews appeals and redeterminations (if over turned – they need to review and understand why). There is a good working relationship with Noridian and they have identified no barriers yet with the two working together.
c. Maureen Hanna asked if Dr. Pilley was aware of the expected announcement dates for competitive bidding sites. The PSC has not been informed either. CMS Central and Regional Office are very actively engaged in this process. These are all new processes and these are not without controversy and complexity. CMS would want to implement with as much forethought as possible so as to reduce any kinds of problems and errors.
d. John Kenney asked what the Medical Directors priorities are for the near future?
i. Nebulizer policy being considered now and is in review and consideration by DME MACs. A notice is expected in the not so distant future.
ii. In process now of reviewing and revising the knee orthosis policy. Comment period ended 10/15/04. Working with AOPA and others on it.
iii. Capped rental on oxygen – currently working on policy articles.
iv. Committed to getting back on quarterly publication schedule. Next one due around March 1st.
v. Education article regarding the use of GK and GL modifiers for PMD (with and without ABN) and additional automation for submitting these claims. Goal is to allow suppliers to provide a beneficiary with higher grade model chair when they meet requirements for lower model and then have the claim automatically adjudicated.
vi. They see a need for providing documentation guidance for glucose testing.
e. John Kenney asked if LCD for nebulizer, knee orthosis and oxygen capped rental will be published as a policy or a draft for review?
i. Per Dr. Pilley responded:
1. Capped rental – will be a published article.
2. Nebulizer – will be final policy.
3. Knee orthosis – may have to be released as draft because of time period since initial published draft (2004) and new codes that may be added.

4. DAC-D CMS Work Projects: John Kenney
a. Same/similar eligibility information: no update.
b. HH PPS White Paper: no update.

John asked for Dr. Pilley’s assistance on this as our previous CMS DAC contact is no longer over DME.
i. Dr. Pilley will attempt to identify this and get back to John.
1. Jim Underhill, CMS RO X, was contacted with regard to this issue. He related that the DAC has received a reply from CMS with regard to this request. It is my understanding that CMS has responded as follows:
a. Due to HIPAA and Confidentiality law suppliers can not have access to the claims processing system. This is in statute and to provide access would be a violation of Federal Law
b. CMS has provided a process whereby suppliers can obtain information regarding same and similar devices and this process has been communicated by CMS to suppliers in response to the White Paper.
ii. Janet has also expressed a need to CMS Central management and has copied them on meeting notices and the agenda for this call. She also invited them to be on the call today but there was a schedule conflict. Larry Young is their Contract Officer.

5. Provider Outreach and Education (POE) Update: Janet Kirsch
a. Provider Outreach – Their last meeting was in December. A list of members and minutes are under the Training section of their website.
b. All remaining Ask the Contractor teleconferences for this year are posted on the website, in training section.
c. Something new for small suppliers (less than 10 FTE equivalents) is that they will have their own Ask the Contractor teleconferences. They will be held every other month beginning in February.
d. CMS-1500 Workshops conducted since December because of NPI. They have not scheduled any for February or March. But, if there is enough interest they will consider doing.
e. Webtours – Have been very popular and well attended.
f. Bulletins (first one was in December) and Listserve messages. Second bulletin coming soon . Update: Second bulletin was posted to website on 2/6.
g. They have assigned an Education Staff person for both the National and State Associations involved in the DAC. They just started making calls to them and the calls have been very well received. The purpose is to strengthen the relationships. A calling tree will be established to address concerns. Janet will forward the contact list to DAC Executive Committee in the next week or so.

6. A-Team Leaders review of answers provided by NAS and IntegriGuard:
a. EDI/EMC
i. Not applicable – no questions were submitted.
b. Education/Communication/POE (Cindy Coy)
i. Question 1 – Suppliers are tasked with current rules/regulations as well as past ones (on post-payment audits). Now that manuals are on-line is there a plan to post past issues? If so, will suppliers have access?
1. Janet reported that Noridian does not have archive copies of the Supplier Manual posted. Starting approximately one month ago, there is a list at the top and it indicates what has changed (e.g. chapter, section, what was added/deleted). Janet does not anticipate a lot of the manual changing unless there is a CMS directive. Chapter 16 does have a lot of changes due to HCPCS codes. They do have some of Cigna’s files (CD-ROMS) and providers can call Customer Service and request copies on a case by case basis.
ii. When audits are done – how do auditors know what the past requirements were?
1. Janet responded that if IntegriGuard or other CMS entities need it, they can approach Noridian and ask for copies of the archive files.
c. HME (Marshall Pollock)
i. Question 4 – re: E0118 the DAC is still gathering additional information that has been requested.
1. Janet was given the HIC# information by Maureen last week and did research before the call. The initial claim was downcoded and paid. Then the claim was appealed and the modifier "GA" was removed.
ii. Is this considered a covered item? Does this require an ABN?
1. Dr. Pilley will do additional research with SADMERC.
2. Janet to send claim specifics over to Dr. Pilley. Completed on 2/10.
a. IntegriGuard, LLC is currently researching additional information regarding this claim .
3. Dr. Pilley stated, if not covered as a device it seems providers could issue ABN for non-covered device and collect money from beneficiary.
a. Further research reveals that E0118 is considered "not valid for Medicare" and would therefore require a valid ABN in order for the supplier to bill the beneficiary.
iii. Leslie Rigg provided more information re: PMIC HCPCS book. The E0118 was in this book and the code was in noted in red (meaning not a valid code). She gave an ABN that stated "may be considered non-covered".
1. IntegriGuard feels that the appeal did not uphold ABN because the ABN was not specific enough.
d. IV/PEN (Deanne Birch)
i. No further questions at this time.
e. Medical Supplies and Wound Care (Mary Turner)
i. No further questions at this time.
f. O&P (Sharon Nichelson)
i. Question 8 – Can dynamic orthotic items be placed in a nursing home as a capped rental if medically necessary? If not, then what HCPCS code should be used? HCPCS codes E1800 – E1840.
1. Per Janet, the language is provided by CMS. The Item must be medically necessary and they would need equipment in the nursing home.
ii. John provided some additional clarification. Historically, dynamic orthosis in the SADMERC description were listed as dynamic orthosis. Approximately 5 – 6 years ago the L codes were changed to E codes and the description changed from orthotics to dynamic devices. The general understanding in the industry was if it had an E code it was considered DME and was therefore not eligible to be placed in an institutional setting such as nursing home, even though it is an orthotic device. We are now seeing that dynamic orthotics are being billed under E codes for dynamic braces and placed in nursing homes on a very frequent basis. Our question, Is this OK (assuming medical necessity is met)?
1. As per discussion with the DME PSC Medical Directors and SADMERC, E1800 and E1840, dynamic Orthosis, are considered DME and therefore non-covered in the SNF setting.
iii. In the past, the L3964 SEWHO was denied in POS 31 and 32. The L3964 SEWHO attaches to a wheelchair, and has thus been considered to be durable medical equipment by Medicare not an orthosis. Does the rationale that the DME exclusion does not apply to orthotics, prothetics, and supplies be applicable to this HCPCS code? If not, please explain.
iv. Question 9: This is in regards to a Medi-Cal claim and the retro of beneficiary claims submitted to prior to 9/2006 that was submitted to Cigna via CMS-1500.
1. Top of claim states "DHS Health Insurance Payment Demand – M991 and their Medi-Cal provider number.
2. Box 9 – states Medicare retro billing
3. Box 30 – amount paid by Medical is noted
4. Box 31 – tax number
5. Box 32 – provider information
6. Box 33 – states to remit payment to DHHS
Claims submitted after September have been denied by Noridian due to (education status 610) due to extraneous information 24a – 24k on CMS-1500. Provider called and was told to re-submit claim.
a. Janet to research if there were directions from previous contractor. She will discuss with claims processing. Update: Received examples on 2/6/07.

g. Rehab (Leslie Rigg)
i. Question 11: In the response you document that "it is anticipated that the physician’s order is received prior to the supplier’s completion of the product description". For many suppliers, this information is readily combined on one order. The physician may receive an initial order that is prior to a face to face evaluation or the supplier may not receive an order because the order has been written for an evaluation and that has gone to the therapist. Again this may be prior to the face to face. The policy does not appear to specifically state that these must be separate documents. More generally policy would appear to indicate that documentation must include all of these elements.
1. Per Dr. Pilley – the physician order itself should be signed after the face-to-face examination has been completed. This can be the same day. There must be an indication for need of PMD in home setting (via assessment) and if home setting is accommodating. There must be documentation in medical records (e.g. progress notes) in addition to supplier or PT evaluation exam. Two documents are not required. An article has been published by all PSCs. Supplier initiated forms are not considered part of the medical record. They are looking for accountability from physician in terms of face-to-face exam documented in progress notes. MDs who perform physicals document this as the purpose of why they were in the office. Often patients are in for a chronic condition and there is no documentation of an independent exam taking place. They are looking for face to face with a functional assessment.
ii. Question 14: We do not feel that this answer addressed the question. Val Taylor provided the following for further clarification: Please refer to the ADMC case # 2304. We understand that the ADMC specifically addresses the medical necessity of the equipment and that it is not a guarantee of coverage. Our question is in regard to the medical necessity of the power positioning needed for a C-5 quad ICD-9 (344.04). The finding that the equipment does not meet medical necessity requirements for the power base or any other power positioning system is the issue. If the process is specifically designed to address medical necessity, it would seem that a power chair is medically necessary in this case. The supplier would need to understand that the payment, if any, would be based on the allowance for the least costly Group 2 or Group 3 PMD. Then the medical necessity for the other power seating needs, power tilt, power recline, specialized back or positioning armrest would be addressed as well .
1. Per Dr Pilley, an ADMC is not a claim. As a result, they do not adjudicate the same as a claim in terms of downcoding. Cigna may have downcoded device in the past. But they do not see this as ADMC the process.

Further information provided by Val: The chair was chosen by the podiatrist due to size (height and weight), father of 4, very active outside the home. This is his 3 ^rd power base and he has a 20 year history in a power chair. They knew the chair would not be covered but wanted the accessories covered.
1. IntegriGuard response (Karolyn) – cannot give affirmative on ADMC for base.

Val asked if base is denied how are accessories addressed?
2. IntegriGuard Response (Dr. Pilley) - There are a set of modifiers that can be used to pay the difference between level 3 and 4 (e.g. line 1 "GA" and line 2 "GL" to on claim). There are new modifiers that are going to be released soon (GK?).

Val stressed that on crossover claims – when denied "not medically necessary" then the secondary follows and does not pay even with a prior authorization.

iii. Question 16: Joe McKnight asked if this means that the safety evaluation must include entry and exit concerns – and the equipment should not be provided if safe entry or exit cannot be assured from the standpoint of safety?
1. Dr. Pilley responded – If you cannot get in/out of residence you may not be able to respond to an emergency. ADA laws require "open access". Two issues: medical necessity and accessibility (not covered by Medicare). In some states the Medicaid programs put out RFPs to companies that can do home modifications to make accessible. Normally the home assessment is done by the supplier and they see ramp and/or door enlargement is done. Beneficiary safety needs to be addressed (which is not currently in policy). It is anticipated the beneficiary or caregiver "safely use in home" (does not address entrance/exit). Dr. Pilley will check with other medical directors. Dr. Pilley feels this is a provider issue and they need to involve social services due to quality of care.
iv. Question 17: Does this mean that the initial Product Description can be amended or is a second document needed with the additional information? Can providers add the omission then have MD initial and date addition?
1. Yes, as long as documented by MD. However, indications need to be supported in the medical record too.

h. Respiratory (Yvonne Cordoza)
i. Question 21c – The dilemma is suppliers cannot bill the beneficiary and we cannot reuse the medications (under state pharmacy law). If there is documentation to support that the provider checked with beneficiary before shipping (e.g. in notes) can we bill and get paid for this?
1. IntegriGuard will need to research further. Currently, if "not deliverable" then it is "not payable". An ABN cannot be given as it must be written and needs a witness.

7. New Business:
a. Next DAC meeting – Medtrade Spring (Las Vegas) April 24-26, 2007.
i. Noridian and IntegriGuard state that the afternoon of 24 ^th works for them.
ii. Maureen will contact AAHomecare and request meeting rooms. Updated information:
1. DAC only meeting has been scheduled for 4/24/07 from 9:00 am – 11:00 am (Vegas time) in room N264.
2. DAC meeting with NAS and IG has been scheduled for 4/24/07 from 1:00 pm – 3:00 pm (Vegas time) in room N264.
iii. John Kenney reviewed the timeframe for the April Q&As.
1. March 23 – The DAC will have the questions to Noridian and IntegriGuard.
2. Noridian and IntegriGuard will have responses back by April 11 ^th so that both the Executive Committee and A-Teams will have sufficient time to conduct their conference calls.

Motion to adjourn at 12:00.

Region D DAC Participants

A-Team Leaders & Assistants
Deanne Birch
Yvonne Cordoza
Cindy Coy
Sha Eppley
Wade Hendrickson
Zena Jacobi
Sharon Nichelson
Marshall Pollock
Duane Ridenour
Leslie Rigg
Cheryl Stokes
Mary Turner

State Representatives
Kimberlie Rogers-Bowers (Alaska)
Teri Jamison (Arizona)
Laura McIlvane (California)
Lelia Wilkerson (Iowa)
Sheila Showalter (Kansas)
Dave Hosman (Missouri)
Mary Rogers (Nebraska)
Rich Pozesky (Nevada)
Sha Eppley (Oregon) – already noted above
Deanne Birch (Utah) – already noted above
Val Taylor (Washington) – already noted above

Jurisdiction D DAC
Combined Meeting with Noridian Administrative Services, IntegriGuard, and the DAC
Meeting Minutes
17 July, 2007, 12 Noon Via Teleconference

IntegriGuard:

Dr. Mark Pilley
Karolyn Osborn

Introductions and Announcements of Changes in the Executive Committee: John Kenney announced the change of Barb Stockert to fill the role vacated by Joe McKnight as Vice Chair when Joe assumed his new role as DAC Executive Manager. John welcomed Sharon Nichelson to her role as treasurer, Karl Lindborg to his role as A-team leader for O&P replacing the role vacated by Sharon. John reviewed the meeting protocols that require listen only, asking that only the A-team leaders speak during the Q &A sections.

Approval of Minutes from April 24 ^th meeting: Noridian and CMS have received the meeting minutes and they have been reviewed . Janet noted her changes were incorporated. Dr. Pilley motioned the minutes be approved; seconded by Barb Stockert. The motion carried.

Medical Directors Update: Dr. Pilley opened the discussion with information that there will be a change in medical review. This function of the PSC will be moved to the DMEMAC with the transition was to be completed by October 31 but has now been delayed. The exact date of transition remains to be determined. The new medical director will be Dr. Robert Szcyzs. Work however is business as usual. No major change in availability or the availability of his staff. There will be continued work on policy articles. Dr. Pilley anticipates that some of the IntegriGuard staff will be at MedTrade. John Kenney offered that if at all possible it would preferable to have him there even via teleconference. Dr. Pilley said he is continuing to work on the Knee Orthosis policy. He has been doing ongoing work on codes with AOPA. They (IntegriGuard) have revised the draft again. His goal is to have it published before end of transition period. IntegriGuard is continuing to publish on website and notes on website.
Q - John Kenney asked: Until there is a notice should we ask all of questions to you? A – Yes, We can always get you in by telephone would that be OK.
Q - Regarding Knee policy, will it a new document? A - No, we are not anticipating that. We got good comments back. The modification of the current policy reflects most of the comments gotten during the comment period. It will be sent out for 45 day period for comment and will follow due process. We hope to have it out before Oct 31.

Noridian Update: - Janet Kirsch
Summer 2007 DAC Update

Workshops Held
 Appeals-5 sessions since April
 Ostomy-3 sessions since June
 Urological Supplies-3 sessions since June
 Web site tour-monthly sessions started again in June

Upcoming Workshops
 Documentation Prior to Claim Submission-2 sessions tomorrow (7/18)
 Surgical Dressings-2 sessions planned for 7/25
 Canes/Crutches/Walkers and Oxygen under development
 Offering CMS-1500, appeals and other specialty workshops on a monthly basis

Ask the Contractor Teleconferences
 Held quarterly call on June 12 and one on June 20 for small suppliers
 Next quarterly ACT is September 11. Next small supplier call is August 22. All scheduled for 3 PM CT. See training section of website for more details.

POE Advisory Group
 Last meeting held on June 14-good attendance and discussion. Minutes posted to website under Training/POE section.
 Next meeting is September 13

Supplier Manual
 Creating PDF version of each chapter and will archive previous versions of each chapter. Will still do real-time updates to the HTML version, with PDF versions to be updated quarterly
 Updates will be done chapter by chapter with goal to have completed by the end of 2007

Website Updates
 Latest addition was rolling ads in upper left hand corner of home page
 Coverage section added for LCDs, NCDs, and related links and other coverage information
 Accreditation section added under topic of Enrollment
 Link for DAC and other state associations added to the Other DME and Medicare Resource Links section under the main topic of Contact
 Survey results improving-satisfaction score has gone up 9 points since March
 Will be promoting web changes

Upcoming Events
August 9 AZMESA Meeting-Phoeniz (Sheryl Mandigo attending)
August 12-14-National Association of Chain Drug Store Conference-Boston-(Janet Kirsch attending) will be holding panel session with other DME MACs and possibly a booth
September 13-14 Big Sky AMES-Butte (Jody Whitten attending)
October 2-4 MedTrade
October 25-MAMES Fall Conference-Bloomington, MN

NPI: CMS is encouraging providers to submit a small volume of their claims with only the NPI number. If payment is received correctly, providers can increase the amount of claims submitted with only an NPI. This is the best way to test the crosswalk of NSC numbers to NPI and correct any errors.

The data dissemination of NPIs via the CMS website was delayed until August 1 to allow providers to update their information. July 16 (yesterday) was the deadline for correcting supplier specific information that will be released to the public.

Suppliers are also reminded that effective July 1, for remittance advices, both paper and electronic, the reporting of supplier identifiers changed. NPIs are now returned as the payee, while the TIN is the additional payee identifier, rather than the previous process of reporting TIN and the legacy number, even though the claim may have included both the legacy number and the NPI. For more information, see MLN Matters 5081 and 5452 and question 1 of this quarter’s DAC questions.

New CMS 1500 Claim Form: This transition went very smoothly due to our education campaign. We educated early and often on the claim form changes, published many reminders on the deadline for submitting the claim form and the changes on the new form, posted an icon on our website as a reminder and also ran email list ads. NAS is receiving very few claims on the "old" version of the form.

We are currently emphasizing correct completion of Item 11 and Item 29 on the CMS-1500. Item 11, used to report insurance information, must be completed, with either the word "None" if Medicare is the primary insurance or a group number when Medicare is secondary. If Medicare is secondary, an EOB must be attached.

Item 29 is for reporting amounts that patients have paid on the claim. Many times this is completed in error to represent coinsurance, deductibles, or primary payer payments. Any amount submitted in this field may result in the beneficiary receiving payment even on an assigned claim.

Appeals Process Changes: Last week, NAS started accepting faxed requests for both written reopening and redetermination requests. We are in the process of communicating this to suppliers and updating the forms with the new fax #. The new fax # is 1-888-408-7405. Suppliers are reminded that DME MACs still have 60 days to complete a reopening and a redetermination. Faxing is just a quicker, easier way to submit these requests.
Effective June 11, 2007, all categories of DMEPOS claim corrections for clerical errors or omissions are allowed as a phone reopening, except for the following:
 Codes requiring review by our medical staff
 Timely denials/late files
 Requests that require documentation
 ABN issues, including adding GA or GY modifiers (changing liability)
 Medicare Secondary Payer (MSP) - MSP issues must be submitted in writing and mailed with an attention line of "MSP."
Effective, July 2, 2007, suppliers were limited to five reopenings per call but we have also increased our phone reopening hours two hours in the morning so current hours are 8 am-4 pm CT. (Hours were stated until 4:30 pm during the conference call in error) Phone hours were expanded as of July 16 (yesterday).

CMS Update: - Larry young could not join us.

A-Team Leaders review of answers provided by NAS and IG

EDI/EMC
Zena Jacobi, Leader
Duane Ridenour, Assistant Leader
Executive Liaison, Val Taylor

1. The Medicare FFS NPI Contingency Plan Roundtable on 5/10/07 indicated that there would be changes to 835s when an NPI is sent on a claim. It wasn’t clear what the changes are or when they’ll be implemented. Please clarify when these changes will occur and which loop and segment will contain the NPI once the change is made. Also, please clarify whether the supplier number will still be included in the 835 as a contingency once these changes are made.
NAS Response: Please reference MLN Matters 5452, posted to the NAS website on 6/4/07.

Submitted NPIs will be crosswalked to the Medicare legacy number(s) for processing. Medicare's internal provider files will continue to be based upon records established in relation to the legacy identifiers. The crosswalk may result in three scenarios:
Scenario I- Single NPI, cross walked to single Medicare legacy number
Scenario II- Multiple NPIs, cross walked to single Medicare legacy number
Scenario III- Single NPI, cross walked to multiple Medicare legacy numbers
 
Scenario I- Single NPI Cross walked to Single Legacy Number
Electronic Remittance Advice (ERA)- Medicare will report the NPI at the Payee level as the Payee primary ID. Medicare will report the TIN (Employer Identification Number (EIN)/Social Security Number (SSN) (EIN/SSN)) in the REF segment as Payee Additional ID. Medicare will report any relevant Rendering Provider NPI at the claim level if different from the Payee NPI. Carriers, Part A/B Medicare Administrative Contractors (A/B MACs), and DME Medicare Administrative Contractors (DME MACs) (as appropriate) will also report relevant Rendering NPI(s) at the service line level if different from the claim level Rendering Provider NPI. There will be one remittance advice and one check or Electronic Funds Transfer (EFT) per NPI.
Standard Paper Remittance (SPR)- Medicare will insert the appropriate Payee NPI at the header level. The ERA reporting requirements apply to the corresponding SPR fields.
PC Print Software- Medicare will show the Payee NPI at the header level and add the relevant Rendering Provider NPI at the claim level if different from the Payee NPI.
MREP Software- Medicare will show the Payee NPI at the header level and add any relevant Rendering Provider NPI at the claim level if different from the Payee NPI. Medicare will also add any relevant Rendering NPI(s) at the service line level if different from the claim level Rendering Provider NPI.
Scenario II- Multiple NPIs Cross Walked to Single Medicare Legacy Number
ERA- Medicare will report the NPI at the Payee level as the Payee primary ID. Medicare will report the TIN (EIN/SSN) in the REF segment as Payee Additional ID. Medicare will add any relevant Rendering Provider NPI at the claim level if different from the Payee NPI. Carriers, A/B MACs, and DME MACs (as appropriate) will add any relevant Rendering NPI(s) at the service line level if different from the claim level Rendering Provider NPI. Adjudication will be based on the unique combination of NPI/legacy number. There would be multiple remittance advices, checks, or EFTs based on that unique combination.
SPR- Medicare will insert the appropriate NPI number at the header level. The ERA reporting requirements apply to the corresponding SPR fields.
PC Print Software- Same as Scenario I.
MREP Software- Same as Scenario I.

Scenario III- Single NPI Cross Walked to Multiple Medicare Legacy Numbers
ERA- Medicare will report the NPI at the Payee level as the Payee primary ID. Medicare will report the TIN (EIN/SSN) in the REF segment as Payee Additional ID. Medicare will add any relevant Rendering Provider NPI at the claim level if different from the Payee NPI. Carriers, A/B MACs, and DME MACs (as appropriate) will add relevant Rendering NPI(s) at the service line level if different from the claim level Rendering Provider NPI. Adjudication will be based on the unique combination of NPI/legacy number. There would be multiple remittance advices, checks, or EFTs based on that unique combination.
SPR- Medicare will insert the appropriate NPI number at the header level. The ERA reporting requirements apply to the corresponding SPR fields.
PC Print Software- Same as Scenario I.
MREP Software- Same as Scenario I.
Follow up – we are trying to understand where the unknown NPIs are coming from? We were referred from EDI to NPPES. NAS Responded. EDI sent you back to NPPES to verify the information and because taxonomy is related to claim information. Party with the question stated they had received two different NPIs at the request of Medicaid.
Education/ Communication – No Questions

HME – No Questions

IV / PEN – No Questions

Medical Supplies and Wound Care – No Questions

O&P

Karl Lindborg thanked everyone for their responses and asked if there was any further follow up along with John Kenny to both the questions asked in this round of Q&A and the follow up from the previous round.

Rehab

Question # 6 Leslie Rigg Leslie thanked NAS and IG for their response but reiterated the cumbersome nature of the redundant paperwork necessary for PMDs and asked if there was any further interpretation.

2. Frequently patients with ALS and other chronic respiratory diseases will use a Respiratory Assist Device with a back-up rate and are fully dependent on the equipment to breathe. Equipment failure can result in immediate life threatening consequences for the patient. Now that E0471 has been removed from the Frequent and Substantial Servicing payment category, and the patient owns the unit after 13 months, what options are available to the beneficiary for backup equipment? Under the CMS Backup Equipment rule, backup is at the supplier’s discretion when the device is under FSS, not when it is rent-to-purchase.

NAS Response: For some background information that might be helpful on this change, see the Federal Register, dated January 27, 2006 and August 22, 2003. These concerns were raised in the past but were adequately addressed by CMS because maintenance and servicing was allowed on this equipment and the beneficiary also had the choice to not own the equipment, which meant the supplier was responsible for continued servicing of the equipment. As you stated above, this has now changed and the beneficiary is responsible for the equipment and maintenance and servicing are no longer covered.

New Business: Next meeting in Orlando: October 2-4. DACD will provide the room assignments very soon to all involved for meeting information.

Meeting was adjourned at 1 PM.

List of additional attendees: (captured – stated)

Rose Schafhauser
Shelia Showalter
Dave Hosman
Zena Jacobi
Leslie Rigg
Cindy Coy
Connie Lind Frayer
Gloria Peterson
Shay Epley
Gemma English
Karl Lindborg
Rich Pozesky
Mary Turner
Marty Libovitch
Kay Johnson

Region D DAC Executive Committee Members:
Chair: John Kenney
Vice Chair: Joe McKnight
Secretary: Mike Hayden
Treasurer: Barb Stockert
Past Chair: Val Taylor.
Administration: Maureen Hanna.

DME Medicare Administrative Contractor (MAC) Noridian Administrative Services (NAS):
Education Teamleader: Janet Kirsch
Education Representatives (Fargo): Tracy Schutt and Sheryl Mandigo
Education Representative (Boise): Jody Whitten

Program Safeguard Contractor (PSC) IntegriGuard: Dr. Pilley was unable to attend due to a family medical emergency.

Region D DAC Participants: see enclosed listing at end of minutes.

Meeting opened at 1:06 pm

a. Claim Inventories
NAS is pleased to report that our suspended claim inventory has dramatically decreased over the past several months and we are currently exceeding CMS' standards for claim processing timeliness. The CMS standard for claims processing timeliness (CPT) is to process 95% of clean claims, both paper and electronic, within 30 days and 98% of all claims within 90 days. As of April 19, the current CPT for all clean claims is 97.4% and CPT for all claims within 90 days is sitting at 99.90%. We have recently added CPT information to our website so check this section for the current statistics.

Another item of interest is that only 9.06 % of claims pending are over 31 days old.

b. Reopenings/Redeterminations
The reopenings and redeterminations form was recently split into two separate forms. Please ensure that you are using the correct form to speed up processing of these requests. These new forms are located in the Forms section of our DME website.
NAS also started offering telephone reopenings on April 9. Telephone reopenings can be reached by dialing (888) 826-5708 between the hours of 10:00 am to 4:00 pm CT Monday through Friday. There is a limit of 10 reopenings per phone call.
The types of inquires that can be handled as a phone reopening are:
§ Mathematical or computational mistakes
§ Transposed procedure or diagnosis codes
§ Diagnosis changes/additions
§ Modifier changes/additions (KX, RR, NU, UE, KH, KI, KJ, etc.)
§ Date of service changes
§ Procedure code changes
§ Inaccurate date entry
§ Misapplication of a fee schedule
§ Computer errors
If the above changes will result in reduction of payment, these changes cannot be initiated by the phone reopening area and should be sent in writing to the Recoupment team.
Because some issues are more complicated than others and may require more research time or consultation with medical staff, the DME MAC reserves the right to decline the telephone reopening and may request that the supplier submit a written reopening or redetermination request.
If the request involves a CMN/DIF, this may be able to be sent in as a written reopening. If the request involves documentation needed to support the service, this will be referred to the redetermination team.
The following cannot be done as reopenings - they must be sent in writing to redeterminations:
§ Negative Pressure Wounds
§ Surgical Dressings/Wound Covers/Compression Stockings
§ Parenteral and Enteral
§ Wheelchairs/power mobility devices
§ Recoupment issues
§ Medicare Secondary Payer (MSP)
§ Timely denials
§ Late files
§ Requests that require documentation
§ ABN issues
§ GA modifiers
If written redetermation is missing information, will be considered an incomplete request and dismissed.
NAS will be offering reopenings/appeals process Web based workshops so look for these training opportunities.

c. Revised CMS 1500 Claim Form/NPI News
Please review the information posted to our website regarding the common errors NAS is seeing on the revised CMS-1500 paper claim form. When using the new CMS-1500 Form (08/05), suppliers must change the printing specifications so that the correct claim information is printed within the confines of the appropriate boxes. The boxes that have changed are:
 
Box 17a which has been split horizontally into 17a and 17b.  17a, the top shaded box is for the 1G qualifier for the UPIN.  The unshaded bottom box is for the NPII.

Boxes 24A through 24K: Service lines-not allowed for billing of 12 claim lines. The shaded area in 24A through 24H is not used by Medicare.

It is important to note that box 24E on the new form was shifted slightly to the right.  This will cause the diagnosis pointers to fall into the modifier boxes of 24D if providers do not change their printing specifications.

Boxes 32a and 32b. Box 32 was changed to accommodate the submission of both the legacy identifier/PIN number and NPI of the service facility. Box 32a is for the NPI. Box 32b is for the legacy identifier/NSC number.  For box 32b, the ID qualifier 1C must be separated by one blank space from the legacy identifier/NSC number. 
 
Boxes 33a and 33b
Box 33 was changed to accommodate the submission of both the legacy identifier/NSC number and the NPI.  Box 33a is for the NPI.  Box 33b is for the legacy identifier/NSC number. For box 33b, the ID qualifier 1C must be separated by one blank space from the legacy identifier/NSC number.

NAS is returning claims that do not meet the printing specifications with an educational letter stating how to correct the claims and informing suppliers that claims must be resubmitted.

d. NPI
The Centers for Medicare & Medicaid Services (CMS) also recently announced that it is implementing a contingency plan for covered entities who will not meet the May 23, 2007, deadline for compliance with the NPI regulations. Change Request 5595 was released on 4/20. No Medlearn Matters is available yet but should be coming soon.

For some period after May 23, 2007, Medicare will allow continued use of legacy numbers; it will also accept transactions with only NPIs, and transactions with both NPI and legacy identifiers.

After May 23, 2008, the legacy number will NOT be permitted on any inbound or outbound transaction.

Medicare has been assessing health care provider submission of NPIs on claims submitted. As soon as the number of claims submitted with an NPI for primary providers is sufficient to do so, Medicare will begin rejecting claims without an NPI for primary providers following appropriate notice. In May 2007, Medicare will evaluate the number of submitted claims containing a NPI. If the analysis shows a sufficient number of submitted claims contain a NPI, Medicare will begin to reject claims on July 1, 2007, that do not contain NPIs. If a sufficient number of claims do not contain NPIs in the May analysis, Medicare will assess compliance in June 2007 and determine whether to begin rejecting claims in August 2007. Medicare will provide advanced notification of the date they are to begin rejecting claims when a decision has been made to do so.

CMS recognizes that the National Council for Prescription Drug Program (NCPDP) format permits reporting of only one identifier, and will accept either the NPI or legacy number on the NCPDP format until May 23, 2008.

In regard to the remittance advice and the 837 coordination of benefits (COB) transactions, the following will occur until May 23, 2008:

- if a claim is submitted with an NPI, the NPI will be sent on the associated 835 remittance advice, otherwise the legacy number will be provided;
- if a claim is submitted with an NPI, the 837 coordination of benefits (COB) transaction will contain both the NPI and the legacy number, otherwise the legacy number will be provided.

By May 23, 2008, the X12 270/271 eligibility inquiry/response supported by CMS via Extranet and Internet must contain the NPI.

Once a decision is made to begin requiring NPIs on claims, primary providers i.e., billing, pay-to and rendering providers must be identified by their NPIs or the claims will be rejected. Medicare contractors must then use the NPI crosswalk to locate the NPI and associated legacy identifier submitted on the claim for primary providers.

All other providers are considered secondary providers and include referring, ordering, supervising, facility, care plan oversight, purchase service, attending, operating and "other" providers. Legacy numbers are acceptable for secondary providers until May 23, 2008. If the NPI is present for secondary providers, the NPI must only be edited to determine that it has10 digits; begins with 1, 2, 3, or 4 and that the 10 ^th position of the number is a correct check digit.

e. CMN/DIF Changes
CMS recently clarified that the transition period for the use of the new CMN/DIFs will be extended through June 30, 2007. Watch for MLN Matters 5571 for more information as the requirement for when to use a CMN/DIF is also changing to process date rather than service date.
Post Meeting Note (05/09/07): MLN Matters 5571 states that the requirement for submission of CMNs/DIFs is based on service date. NAS has been told by CMS that this to be process date. We have asked for clarification but as of this date have not received a reply.
f. Competitive Bidding/Accreditation Date
Suppliers must be accredited by August 31, 2007 to accept a contract based on the submission of a bid. A flyer on these topics with a quick overview and resources is available at the Medtrade booth. NAS will be not be the lead on educating on this topic, other than providing information on our website and email lists. The Competitive Bidding Implementation Contractor (CBIC) will provide this education. They can be reached at (877) 577-5331 from 9:00AM to 9:00PM (ET) Monday through Friday with questions on this topic.
g. Supplier Outreach and Education
Ask the contractors, both general and for small suppliers have been well attended. See minutes on the Training section of our website.
Teleconferences for 2007 will be held at 3:00 pm CT on:
June 12, 2007, September 11, 2007 and December 11, 2007
Additional teleconferences for small suppliers will be held at 3:00 pm CT on:
June 20, 2007, August 22, 2007, October 24, 2007 and December 19, 2007
CMS 1500 Web based workshops were held monthly; also well attended. Questions from these workshops also posted on website.
Education staff attended NHIA Conference, MAMES, NAMPS and CAMPS association meetings in past months
POE Advisory Group meeting held on March 15. Good discussion was had and attendance increased. Next POE will be in June.
NAS is focusing on improving the DME website based on the Foresee survey results. We encourage suppliers to share all feedback using this survey tool as we need to know which features you like along with suggestions for improvements. Remember that the website is the main way NAS communicates with suppliers other than via email list. Some recent website improvements are easier access to the LCDs, with additional work coming in this area. We are also looking at the format of the supplier manual.

Additional Web based workshops will be offered this summer-focusing on the CERT error rates. Monthly web tours will be offered if you have new staff or would find this beneficial. A web tour video was recently added to our website for quick overview of navigation of our site.

NAS staff, along with the other DME MAC staff are available for questions in Booth 648.

A DME MAC Medicare Update again with three other DME carriers and Dr. Pilley will be held at 11 am in Room N253 on Thursday.

4. CMS Update: John Kenney
a. DAC CMS contact – Larry Young was introduced again.
b. White Papers – Have been forwarded to the organization. CMS is planning on providing written responses back before July meeting.
i. PHI is a concern so CMS and DAC we may have to agree to disagree on same/similar. Not sure if it is technically feasible through IVR and eligibility system. Does not feel it will change any time soon. John stressed the cost to the system and time for processing same/similar denials.
ii. PPS HHA and CWF limitations.
iii. Competitive Bidding – CBIC (Palmetto) contractor. Don’t want DME MAC will not be main educator but will coordinate activities with CBIC.to be point of education but will coordinate.
iv. NPI contingency plans to be releasesd. They are sensitive to problems and issues concerning sharing of NPIs. Mary Turner stated no checks and balances in the system. CMS is hoping that the matches are forthcoming.
v. Larry is the Project Officer for Jurisdiction C and D MACs. His responsibilities include evaluation of MACs operations, activities performed are within the scope of work, DAC participation. Located in Dallas regional office. Other Project Officers are located in Denver and Baltimore. All PSCs report to another Project Officer.
5. Old Business
a. SNF issue – Chuck Gunther reported on issue with Enteral Therapy and the no-pay bill 10/2006. Huge amount of recoupments due to CWF and FI and DME MACs did not match. CMS refers to this as "SNF unsolicited responses". They are just now getting instructions out to DME MACs on how to handle. A resolution should be coming soon.
Post Meeting Note: Reference MLN Matters 5587 for information on this subject.
6. New Business
a. Follow-up questions that need to be addressed by IG should be sent to DAC Central for follow-up with
b. A-Team Leaders review of answers provided by IG and NAS.
i. EDI – Zena Jacobi
1. Question 1 – Concerned about the lack of a dissemination policy, especially with reference to calling physicians. Questioned if enough time would be given.
2. Question 4 – DAC concerned about the lack of check and balances on NPI.
ii. Education/Communication – Cindy Coy
1. Question 5 – Will fax numbers be posted. Janet stated the numbers are included on the letters going to providers.
2. Question 6 – Tthank you for correcting.
3. Question 7 – Requesting sample letter. I don’t recall exactly the discussion on this. If Noridian was to do follow-up on this item, I would appreciate a reminder of what this was about from the Education A-team.
Post Meeting Note: The NSC has posted a model form for suppliers to use as a guide to developing their own form regarding beneficiary rent/purchase options. This model form may be viewed by visiting the NSC Web site: www.PalmettoGBA.com/NSC and by following this path: Supplier Enrollment/Standards & Compliance/Additional Information/ModelForms...

4. Question 10 – Other DME MAC’s provide this information. DAC once again is asking that these be provided. Janet stated they are looking at the best way to do this. Providers should notify DME MAC of this on their pop-up surveys. Substantial changes are on top of page and on email distribution list.
iii. HME – Marshall Pollock – no updates
iv. IV/PEN – Deanne Birch
Question 14 – since information is required in HA0O DAC requesting that this be put back into the DIF. Janet states this follow-up should be sent to IG. The policy states written documentation is required (but not with the claim). Thus in the file should be OK. Janet to determine if DIF can be modified by provider (e.g. add additional questions, but not change existing questions). Post-Meeting Note: Section 5.3 of the Medicare Program Integrity Manual, Chapter 5, states that …"However, when the CMN or DIF is submitted electronically and the supplier chooses to maintain a hard copy CMN or DIF, the font may be modified as follows:

o Pitch may vary from 10 characters per inch (cpi) to 17.7 cpi;

o Line spacing must be 6 lines per inch

o Each form must have a minimum 1/4 inch margin on all four sides.

Without exception, these modified hard copy forms must contain identical questions/wording to the CMS forms, in the same sequence, with the same pagination, and identical instructions/definitions printed on the back; and CMN question sets may not be combined."
v. Medical Supplies – no updates
vi. O & P – Sharon Nichelson
Question 15 – The additional documentation that you require (manufacturer’s name, product name, and part number) is never applicable to ocular prosthesis’s. They are just like your fingerprints that no 2 are alike due to it being made with raw materials. Is there a possibility that you could delete these requirements? The only one that is applicable is condition or reason.
Question 16(a): Thank you for the clarification on 16(a), responding that all dynamic orthotics that are E codes products are non-covered in a SNF.
Are there nursing home place of services that the supplier can provide E code dynamic orthotics? If so, how does the supplier know which nursing home beneficiaries qualify and which do not?
Can E coded dynamic orthotics be billed by a supplier to the Fiscal Intermediaries that would be reimbursable?

1. Question 16c: The provision of dynamic orthotics being provided to nursing home residents during a beneficiary non-skilled stay is very wide spread. Suppliers who have been telling nursing home rehab providers that Medicare Part B beneficiaries are not eligible for dynamic orthotics are being asked for documentation from Medicare because they are hearing the opposite from other providers. Nursing home patients have been being fit with dynamic orthotics across the country for well over a year now, so nursing homes have accepted that these can be provided to their residents without a problem. Can we have an idea of when there might be a notice or update that comes from Medicare that suppliers can use to educate their customers?

Question 16d Thank you for your clarification. We understand this to mean that the L3964 SEWHO can be provided to SNF patients who are eligible for Medicare Part B benefits if it is medically necessary. Is this the correct interpretation? Follow-up question should be sent to Dr. Pilley.
vii. Rehab – Leslie Rigg
1. Question 17 (previous question # 11) seems to indicate that a separate order is required plus a separate product description is required. DAC is inquiring why two separate items are required. DAC feels the current DO and DWO requirement may be a better fit. Thus, if they receive a DWO up front that should be OK.

Follow Up: We are still concerned that the present interpretation of the PMD documentation policy is requiring two orders for the same equipment. We initially get an order from the physician. This typically does not have all 7 required items to be considered an order according to the Policy. At this time interpretation indicates that we need to resubmit the initial order and get an order with all 7 items. We then need to submit a second order (Detailed product Description) prior to the delivery of the equipment. We feel that a single detailed order that contains the 7 elements and the detailed product description should be adequate. This would be similar to the way we utilized the CMN previously. It does not appear that policy stated that two separate orders are needed.

2. Question 18 (previous question 14) if we send in a request for a group 4 chair – get language examples from Leslie on this.
Follow up to IG on this: We continue to have difficulty with obtaining denials that allow for payment from other insurance. This is particularly important in the provision of gr 4 PMD's that may be considered medically necessary by other private insurances or Medicaids. We need a denial that indicates that "Item meets medical necessity by will be paid at the least costly alternative" under the Medicare Program. Val was to provide info on the ADMC issue for the Gr 4 wheelchair that received a denial rather than a downcode.

viii. Respiratory – Joe McKnight no further questions.
c. Next DAC meeting: July 17, 2007
i. Review of timelines for July 17 ^th teleconference. Maureen to send out revised calendar next week.

Motion to adjourn at 2:41 pm .

Jurisdiction D DAC Participants

Sha Eppley Teresa Brammer
Don Hardin Duane Ridenour
Teri Jamison Evan Call
Connie Lind-Fraher Dave Crawford
Rich Pozesky KC Cooper
Randy Turpin Robert Clock
Kaye Martin Jack Pivac
Chuck Gunther Rosalie Weber
Herb Langsam Wally Tschopp
Cheryl Stokes Carlos Reyes
Rick Garver Sharon Nichelson
Marshall Pollock Zena Jacobi
Kimberlie Rogers-Bowers Julie Piriano
Laura Steelquist Mary Turner
Cindy Coy Sheila Showalter
Tami Joplin Diana Guth
Mary Jackson Phil Danz
Bud Turntine Janet Malenowski
Deanne Birch Laura Mcilvaine
Paul Komishick Rose Schafhauser
Miriam Lieber Linda Aiverson

DME-MAC meeting with Noridian Administrative Services, IntegriGuard and CMS
Meeting Notes – October 2 ^nd , 2007

John Kenney opened the meeting with roll call for the states represented and introductions. A list of attendees is attached at the bottom of these notes.

John reiterated the meeting protocols that only state leaders, A-team leaders and Executive committee members were to address the panel from IntegriGuard, CMS or NAS.

Minutes from previous meeting held via conference call, July 17 2007. John Kenney asked if there were any additions, retractions or changes on behalf of NAS, CMS or IG. There were none. Laura McIlvane motioned to approve the minutes and Carlos Reyes seconded the motion. Motion was unanimously carried.

Medical Director Update: Dr. Mark Pilley
a. Knee Orthosis Policy Update: Dr. Pilley commented that he has worked with Mitch Dobson to clean up codes. While finalized, they cannot put a date on publishing, but will respond to comments rec’d. AOPA has been helpful. Feels they have done a good job in clearing things up.
b. Medical Review transition to NAS (update): Dr. Pilley stated that things are still tentative. Dr. Pilley was able to have Larry Young of CMS join the group on the phone. Regarding the Medical review transition,Larry explained that CMS started with the hope to complete the transition this fall; however all of the regions cannot fund it so they are shooting for timeline in Dec with a cutover by March 1 ^st of next year. John Kenney reiterated the conversation for the group. Terms of transition: Medical review with PSC transfer back to the MAC scheduled originally Oct 31 has been set back indefinitely, but hopes are for Dec timeline, and look to complete by March 1 ^st but may be completed by May 1 ^st . What else is going on at CMS? Implementation of a common EDI contractor called CEDI. Is there a timeline?Answer: "We don’t have one at this time - perhaps in the spring". Larry explained: "There are a lot of changes that need to occur so they can continue without disruption." This will mean suppliers can enroll with EDI with one contractor, rather than 4. CMS is aware of the fact that suppliers will need adequate time to enroll and get set up.
 A question was asked: Has there been a determination of who the contractor is? Larry answered: "No, not at this time.
 Is there an internet solution woven into this? No, not at this point. At the carrier level yes, they are working on it; they are doing web based testing. Based on that testing, CMS may move forward.
 Any new word on the Home Health PPS white paper? No update for you at this time. There have been conversations between CMS and Noridian and Noridian was encouraged to have conversations with the other carriers regarding this on how to make this feasible and what information is available. Janet Kirsch added that they are working on IVR functionality to implement a solution. It is the #1 reason for calls. Noridian is very interested in getting this solved.
 Larry asked if there were any more Noridian issues. The general consensus was that suppliers offered no further concerns to him at this time regarding Noridian.
 Troy Paz asked about the benefit or challenges in this change of Medical Directors to Dr. Pilley and Janet. Janet responded that everything will be under one roof so things will be perhaps easier and that the transition will be done in 90 days just as was with the previous contractor; Dr. Pilley feels that things will be similar to what we saw prior to the MMA and the PSC will continue to do investigations through SGS (Safeguard Services), the fraud and abuse contractor). Bob Szczys (pronounced Stich will be the Medical Director. The system will work pretty much the same from a policy stand point.

Noridian Update: Janet Kirsch –Fall 2007 DAC Update

Workshops Held (since July DAC meeting)
 Glucose Monitor and Testing Suppliers-three sessions -205 attendees
 Documentation Prior to DME Claim Submission-5 sessions-350 attendees
 Appeals-one session-55 attendees
 CMS-1500 Claim Form-one session-49 attendees
 Surgical Dressings-two sessions-195 attendees
 Website tour-one session-32 attendees
 Canes/Crutches/Walkers-two sessions-132 attendees-new topic

Upcoming Workshops
 Oxygen
 Power Mobility Devices: Three part series on PMDs, seating and accessories
 Repeats of popular topics, such as Documentation Prior to Claim Submission, glucose monitors, appeals on a monthly basis

Ask the Contractor Teleconferences
 Held quarterly for large suppliers, bi-monthly for small suppliers-minutes posted on website in training section
 Next quarterly ACT is December 11. Next small supplier call is October 24. All scheduled for 3 PM CT.

POE Advisory Group
 Latest meeting held on September 13. Good attendance and discussion. Minutes posted to website under Training/POE section.
 Next meeting is December 13

Supplier Manual
 Creating PDF version of each chapter and will archive previous versions of each chapter. Will do real-time updates to the HTML version, with PDF versions to be updated quarterly
 Updates will be done chapter by chapter with goal to have completed by the end of 2007-will start seeing some PDF chapters soon

Online Learning Center
 Goal is to have several courses available by year-end

Website Updates
· Dedicated NPI web page
 Top 10 Most Visited Links-updated monthly
 Survey results improving-satisfaction score was 61 in July, 59 in August (was 45 in March)

Events Attended

August
AZMESA Meeting-25 suppliers-presented on What’s New and Reminders
National Association of Chain Drug Stores Conference- booth and panel session with other DME MACs

September
Big Sky AMES-Butte, MT-30 suppliers, presented on What’s New and Reminders

Upcoming Events

October MAMES Fall Conference-MN
November NAMPS Fall Meeting

Recap of Year One of Jurisdiction D DME MAC
 39 Web-based workshops on 9 different topics
 Educated suppliers via phone on over 450 inquiries
 Posted approximately 400 web postings and wrote over 200 bulletin articles
 Added over 2,600 subscribers to our DME email list
 Published 6 issues of Happenings, our bulletin
 Met with suppliers face-to-face, attending state and regional events in 9 of our 17 states
 Attended two Medtrade events and NHIA and NACDS Conferences
 10 Ask the Contractor Teleconferences
 Met quarterly with the Provider Outreach and Education Advisory Group for input on our education activities

NPI
Since October 2, 2006, suppliers have been encouraged to submit both the NPI and Medicare legacy identifier (NSC number) on their claims. During this timeframe, suppliers were not penalized for invalid NPI/legacy ID combinations.
Effective October 29, 2007, all DME MACs will begin editing the NPI/legacy ID combinations for validity against the NPI crosswalk file. Where a match cannot be located on the crosswalk, claims will be rejected or returned to the provider.
When the claim is returned, a provider should first verify that the correct NPI was submitted. If correct, you will need to verify that your legacy identifier (PIN or NSC) number corresponds with the information on file with the National Plan and Provider Enumeration System (NPPES). NPPES data may be checked on line at https://nppes.cms.hhs.gov .
If your NPPES information is correct and you have included and matched ALL Medicare legacy identifiers with a corresponding NPI in NPPES, but you are experiencing provider identifier problems with your claims that contain an NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855). Please contact your contractor if you need more information.
To fully understand if a supplier's information is valid on both the crosswalk and the contractor's provider file, suppliers are encouraged to submit a small number of claims using the NPI only. If no claims are rejected, the number of claims submitted can gradually increase. If any claim is rejected due to provider identifier issues, the supplier should follow the steps above to correct the information. Once data is corrected, the supplier should wait a few days for the system to update and test again by submitting a small number of claims with the NPI only.
Data Center Transition
Effective October 9, 2007 all data center operations will be performed at the new Enterprise Data Center (EDC). Due to this transition, the Jurisdiction D DME MAC Contact Center will be closing early at 4:45 pm CT on Friday, October 5, 2007. The Interactive Voice Response unit will also be unavailable at this time. In addition, the supplier contact center and IVR will be unavailable on Monday, October 8, which is also Columbus Day. It is anticipated that the IVR and contact center lines will be in full operation on Tuesday, October 9.
These system "dark days" will be the only impact most suppliers will experience. Users who utilize the Claims Status Inquiry system have already been contacted regarding new User IDs and paperwork required due to this change in data centers.
Medigap Numbers Changing
Suppliers should note that new Medigap numbers should be reported on claims as of October 1, 2007. The OCNA numbers will no longer be used. For more information, see MLN Matters SE0743.
New MSP Inquiry/Refund Form
NAS recently introduced a new, interactive form dedicated to DME MSP inquiries and refunds . This new streamlined form will allow MSP inquiries and refunds to be processed more timely by our MSP department. Suppliers can type their information in the form, print and mail to NAS.
The interactive form also has features that allow you to highlight the fields so you can easily see where to enter the information and to highlight the required fields so that the form is complete and no key data is missing. The current Refunds to Medicare form has also been revised to allow for submission of only non-MSP refund requests. We encourage suppliers to utilize these new forms and to share this change with all affected staff in your office.
Joe asked about relationships between NPIs and NSC# where there have been one NPI number tied to multiple NSC# (one for one). There are 50 Medicaid’s’ and only 20 places to put your number on the NPPES registry.
Post-meeting update: Per CMS NPI staff, it is possible that the NPPES system will allow 50 other identifiers as early as March or April. This update is planned for a system release at that time.

John Kenney volunteered on behalf of the DAC to contact Larry Young regarding the NPPES tied to the NPI and the loss of surrogate UPINs. All docs must have an NPI Question from Miriam Liber: How will the IG help address the problem that if Doctors don’t get an NPI, or an NPI for their company, the beneficiary won’t get paid: Answer: Dr. Pilley feels that this is an issue he will bring up to the other medical directors because it is a beneficiary integrity issue. Question: Could an ABN be used if you don’t have a valid NPI?
Answer: We will need to research further. There have been several publications from CMS stating that all healthcare providers need an NPI, because of the "ordering" requirement and because this is needed for filing claims to any health plan. .

Troy Paz asked if Dr. Pilley would be willing to write a letter as Medical Director that we suppliers to provide to physicians encouraging them to get an NPI. Dr. Pilley agreed to write a letter as the medical director asking physicians to get their NPIs and explaining the importance of such. This letter can then be provided to physicians by suppliers who are challenged by physicians who do not wish to get their NPI or don’t understand the need for a separate NPI for their company.

2. CMS Update: Larry Young – See above.

3. DAC D CMS Work Projects: John Kenney
a. HH PPS White Paper. – Per Conversation with Larry Young.

4. A-Team Leaders review of answers provided by Noridian and IntegriGuard.
a. EDI/EMC – No Further Questions.
b. Education/Communication/POE – No Further Questions.
c. HME – No Further Questions.
d. IV/PEN – No Further Questions.
e. Medical Supplies and Wound Care – No Further Questions.
f. O&P – (Regarding provision of orthotics in an SNF – Questions 16 from Fall of 06) John Kenney asked Dr. Pilley for a published article regarding this new finalized position. Dr. Pilley stated he will speak with the medical directors and consider publishing an article on the website.

John Kenney further requested that due to the convoluted nature of the discussion regarding this (now going back two years) and lack of concrete answers, suppliers should not be penalized by the carrier taking back monies from supplies who were told they were billing correctly and paid. Dr. Pilley offered that the new contractor – (recovery audit contractor), is charged to look at this issue. The carrier may not be able to do that however he will consider that with CMS, but under statute they cannot guarantee dependent on the number of dollars so he will investigate. It wasn’t the intention of the carrier to pay something incorrectly. He will investigate and do the "due-diligence". John Kenney contended however, there was not clarity from the previous or current contractors as to the coverage; consequently, neither the carrier paid the claims nor the supplier billed the claims in error. Dr. Pilley will forward this on for discussion with CMS and get back with the team.

g. Rehab – No Further Questions.

h. Respiratory question #5 Follow up - Carlos Reyes stated that our concern is that patients will not have any access to service. What will the beneficiary do if they cannot obtain services? First and foremost we are patient advocates. Dr. Pilley feels that this is a payment issue and that this should be forwarded to CMS.

The second comment was that the patient has had support from the supplier and without it this will generate additional expense to the system. Dr. Pilley discussed this with CMS and this is a payment issue. This is a capped rental item. You can bill Medicare for repair and replacement, correct? Carlos responded. The access is really the availability of the supplier. Dr. Pilley will take this issue back to CMS. Laura McIlvane asked Dr. Pilley, how CMS views this working. Dr. Pilley responded: "I think the answer is that CMS feels suppliers will provide access". Dr. Pilley commented that he understands that there are varying issues to access in rural versus urban areas. Joe McKnight reiterated the concern that particularly where equipment is life supporting (not sustaining) or is very necessary for ongoing function (such as the BiPAP ST or oxygen once the title is transferred to the patient), this could jeopardize a patient’s health since the supplier will not provide backup equipment during the repair period. Dr. Pilley agreed to take this issue back to CMS and discuss this with them. He agreed that these are payment issues that have a clinical ethical impact. We try to follow this as closely as possible he said. I’ll take it back again.

5. New Business
a. Next DAC meeting – (Timeline and Schedule TBD).
6. Adjournment


Alaska – Donna Bunyard
Arizona – Rose Schafhauser
Hawaii – (Nancy ? )
Idaho – Troy Paz
Iowa – Lelia Wilkerson
Kansas – Connie Lind-Fraher
Missouri – Ron Hardin
Montana – Carlos Reyes
Nebraska – Sharon Nichelson
Nevada – Rich Pozesky
North Dakota – Barb Stockert
Oregon – Sha Eppley
South Dakota – Barb Stockert
Washington – Val Taylor
Wyoming – Joe McKnight
Utah – Evan Call

A-Teams:

EDI – Duane Ridenour / Herb Langsam
Education – Connie Lind-Fraher
HME – Sha Eppley
IV-PEN – Rosalie Webber
O&P – Sharon Nichelson
Rehab – Leslie Rigg
Respiratory – Carlos Reyes
NSC – Laura McIlvane
SADMERC – Val Taylor

Janet Kirsch
Dr. Mark Pilley, MD
Via Telephone, Larry Young