Meeting Minutes
Medicare Jurisdiction D DAC Combined Conference Call
5 February 2008, 12 Noon Central
Attendees Listed at Bottom
General Business:
Introductions: Barb Stockert, DAC Chair, introduced the executive committee. Also in attendance was Dr. Pilley of IntegriGuard, Karolyn Osborn of IntegriGuard, and Janet Kirsch of Noridian Administrative Services. Janet introduced her staff which included Jody Whitten, Tracy Schutt and sheryl Mandigo.
Barb Stockert asked that attendees place their phones on mute, refrain from using cell phones to call in on if possible and noted that only Executive committee members and A-team leaders should normally address CMS, NAS or IG.
Approval of Minutes from October 2, 2007: A motion to approve minutes of October 2, 2007 in Orlando was made by Sharon Nichelson and seconded by Leslie Rigg. Motion was upheld.
Medical Review Update- Dr. Pilley with IntegriGuard:
Barb Stockert thanked both Dr. Pilley and Karolyn Osborn for their efforts with the DAC and expressed that we developed a good relationship and anticipate they will continue this relationship with us in the future. Barb then welcomed Dr. Szczys. Dr. Szczys did clarify the spelling of his name.
Dr. Pilley provided an update on knee orthosis policy. He noted he has completed a number of Medicare tasks but really enjoyed working with the DAC. He thanked the DAC for offering good questions and felt he has worked hard to give good answers and while he is not CMS he has worked diligently to solve our issues from a medical review standpoint. He noted that IntegriGuard is going to await the medical review transition before publishing the final draft of the knee orthosis policy and that there were a number of revisions since the last draft (2004) with input from AOPA. The tables have been revised with input from Mitch Dobson, Joe Miller and Dave Davis of the VA. He further commented there have been codes added back in and the names of the tables have been changed with 4 types of additional codes; those that are not necessary, additional types, not separately payable and then all the other codes that are incompatible or maybe made for other types of devices. This will be clearly outlined in the policy.
The definition of a qualified provider is another issue yet undecided since there is conflict between BIPA and MMA as to what defines a qualified provider and Congress has mandated negotiated rule making. There are number of codes definitions added and further defined what were appropriate for flexion and extension. Dr. Pilley and his team greatly expanded this list and listened to the comments. The HCPCS will be added and the LCDs will be added. It has been a very interesting and time consuming issue. We have the LCD code by coverage.
Karolyn Osborn, IntegriGuard: The transition group meets weekly for some groups, some every two weeks. Cut over date is the last date of February. Cut over date for questions are the very last week of February. If anyone is on prepay edit for medical review you will get an ADR notice with a Noridian address starting next week. ADMC will process and complete up until the last week of Feb and then they will transfer over to NAS. Dr. Szyzcs has been on the teleconferences and has been involved in process. IntegriGuard will process claims up to the 28
th
. Claims under review will be handled by IntegriGuard when they transition on the 28
th
and then NAS will absorb these and begin to handle these claims.
Noridian Update: Janet Kirsch –
All current email subscribers to SafeGuard Services, who have not subscribed to NAS DME emails, must subscribe to the NAS DME email in order to continue receiving medical review updates.
NAS will provide updates to changes that will occur, including mailing addresses and fax numbers, in the near future. Do not make any changes until notice and instructions are provided.
CEDI Transition-May 1, 2008
National Government Services, Inc. has been awarded the DME Common Electronic Data Interchange (CEDI) front-end contract by CMS. With this contract, CEDI will provide a single front-end solution for the submission and retrieval of electronic transactions.
With this change, DME MAC Trading Partners (Electronic Submitters) will send all electronic claims and Claim Status Inquiry transactions to CEDI. CEDI will return all electronic front-end reports directly to the submitter.
CEDI will also receive the ERA and Claims Status Response transactions from the DME MACs and deliver them to the Trading Partner’s (Electronic Submitters) CEDI mailbox.
CEDI will be working with DME suppliers, clearinghouses, billing services and vendors to minimize any disruption to the current EDI processes. Some key dates are:
February 1, 2008
The CEDI system went into production allowing testing to begin. Electronic submitters can move fully into production with CEDI before their final cutover date.
March 31, 2008
Jurisdiction A and Jurisdiction D will no longer process new requests for submitter IDs or changes to an existing ID. All new setups and changes will be done by the CEDI Enrollment Team.
April 30, 2008
Jurisdiction B and Jurisdiction C will no longer process new requests for submitter IDs or changes to an existing ID. All new setups and changes will be done by the CEDI Enrollment Team.
April 30, 2008
Last day for Jurisdiction A and Jurisdiction D to process EDI transactions.
May 1, 2008
All Jurisdiction A and Jurisdiction D EDI transactions will be processed by CEDI.
May 31, 2008
Last day for Jurisdiction B and Jurisdiction C to process EDI transactions.
June 1, 2008
All Jurisdiction B and Jurisdiction C EDI transactions will be processed by CEDI.
There is a Web site dedicated to CEDI as a resource for all CEDI documentation and communication. This website is www.NGSCEDI.com. In addition to the CEDI Web site, CEDI outreach materials will be distributed through each of the DME MACs.
The CEDI Help Desk will provide support for Trading Partners (Electronic Submitters), vendors, clearinghouses and billing services to resolve issues and answer questions about connectivity, receipt of files and electronic formats. The CEDI Help Desk number is 866-311-9184. Hours are 9:00 AM - 9:00 PM (ET). Email support is also available by sending an email to ngs.CEDIhelpdesk@wellpoint.com.
Trading partners, vendors, software companies, billing services and clearinghouses will want to join the CEDI list serve to receive important EDI information after transition. NAS will continue to send EDI related email list notices during the transition.
Accreditation Deadlines
Existing suppliers enrolled in Medicare prior to January 1, 2008, must be accredited by September 30, 2009.
DMEPOS suppliers submitting an enrollment application to the NSC on or after March 1, 2008 must be accredited prior to submitting the application. The NSC shall reject the enrollment application unless the DMEPOS supplier provides supporting documentation that demonstrates that the supplier has an approved accreditation.
DMEPOS suppliers who are enrolled for the first time with the NSC between January 1, 2008 and February 29, 2008 must obtain and submit an approved accreditation to the NSC by January 1, 2009.
For more information see the CMS fact sheet posted on the NAS DME website, in the Enrollment/Accreditation section.
New Proposed Enrollment Requirements
A proposed rule was published in the Federal Register on 1/25/08, with comments due by 3/25/08 on changes in the enrollment requirements for DMEPOS to establish and maintain billing privileges.
Changes to existing standards that are proposed involve:
DMEPOS suppliers must be licensed to provide services and cannot contract these services out
Define appropriate site for the physical facility
Further define business hours and a business telephone number
Change in liability insurance requirements
Delivery and equipment instruction clarification
Proposed new standards involve:
Obtaining oxygen from a state-licensed oxygen supplier
Keeping documentation for 7 years after the claim is paid
Prohibition from sharing practice location with another Medicare supplier
Business hours for at least 30 hours per week
Tax delinquency would be reason for non-enrollment in Medicare
Overpayments can begin from date of adverse legal action or felony conviction
Favorable Redetermination Decisions
As a cost saving measure, DME MACs are no longer required to provide written notices on fully favorable redetermination decisions. The remittance advice sent to the supplier and the MSN sent the beneficiary will serve as notice of the decision and reversal of the original decision.
Email for Redetermination and Reopening Questions
Effective January 1, 2008, suppliers may email questions and concerns regarding reopenings and redeterminations to dmeredeterminations@noridian.com.
Questions and concerns may include but are not limited to:
Timely filing inquiries
Appeal regulations and rights
Coverage questions
Documentation requirements for redeterminations
Redetermination/reopening request forms
Redetermination letter wording
Social Security laws
Interpretation of denial messages
Confidential information, such as PHI, cannot be e-mailed. Responses will be sent within two business days.
Contact Center Closures
When the call center is closed for training days or federal holidays, we are only closed in the mornings. Afternoons are our busy time for calls so we strive to limit our closure time to half a day in the mornings. Experience has shown us that call volumes are very high the day after the holidays so we wanted to spread the word that we are only down half a day. Our call center closure schedule is posted on our website on the right hand side and is also included in our email list notices.
Questions:
Q - Zena Jacobi - Regarding CEDI, when will information be available?
A- Janet Kirsch, NAS: NAS has published a notice on this transition and there is information on the website . They have other education materials available on the website and they hope to distribute with their future transmittals.
Q - Deanne Birch Can you elaborate on the contracting services and the changes in the supplier standards?
A – Janet Kirsch, NAS: She did not review all the details of that portion in great depth but suggested everyone review the proposed rules as it sounds like (all employees) have to be a W2 employee.
Q - Marshall Polluck: How does that conflict with the competitive bidding where contracting is allowed in parts of counties where we want to bid?
A – Janet Kirsch, NAS: This is good question to add or send in during the comment period.
No other questions.
CMS Update, Larry Young:
Larry thanked the team and noted that he would attempt to join us in Long Beach for MedTrade if his travel budget allowed.
Medical review is moving to DME MAC on March 1.
The front end EDI transition will occur on May 1
st
. Suppliers can submit claims prior but May 1
st
is the cutoff date. These are the two big functional changes that CMS has been working on with the carriers.
CMS has asked the carriers to have 1099 notices mailed out to suppliers by Jan 31. "We didn’t feel in the past that this was a requirement, but IRS had a different view this year and consequently they had to be sent to suppliers by carriers."
Changes are in the works to approve the data center request allowing more same and similar information available via the IVR . This will allow the suppler to check the system for patients having same and similar equipment denials within the system. Larry believes this will save NAS and suppliers money. While Larry does not have all the details, likely this will be by HCPCS code. CMS just needs to have some of the contractual issues cleaned up with the carrier.
Q - Sharon Nichelson: Will we have to have the customer with us?
A - Janet Kirsch of NAS: No, having the customer on the line will not be a requirement.
Q - Sharon Nichelson: Project Date?
A - Janet Kirsch of NAS: The implementation date is not firm at this time, but we hope by March, but likely by MedTrade.
DAC D White Paper Update:
Barb Stockert asked if Larry Young could update on this project. He wanted to finish same and similar first. Larry deferred to the same and similar project noting that this has much to do with checking up front if the beneficiary is under the care of a home health agency and may be solved in another venue. He did not have much to share on this project.
Q - Marshall Polluck: Can CMS clarify, on the re-enrollment project. Are there any stopgaps in the project? Is it being done with everyone?
A - Larry Young, CMS: It is being done with everybody. It is not targeted; there are some people who are very crafty about their credentials. Barb Suggested that this be presented to the NSC team and they could provide the question to the NSCAC or to the NSC directly. Dr. Pilley noted that this is a phased in process where the NSC is looking at areas where high fraud and abuse occurs. It is being done with the intent of ferreting out fraud and abuse and is driven by NSC. Dr. Pilley and Larry Young both elaborated on the craftiness and entrepreneurial spirit that is alive with some people to work at organized crime, not only within our industry but all of Medicare.
Marshall and our team reported that this is a small percentage and this was noted by all.
A-teams- (see attached notes on Q&A)
Next meeting DAC only May 5
th
in the evening, and May 6 with NAS and CMS .
Barb Stockert called for a motion to adjourn, Troy Paz Motioned, Leslie Rigg Seconded. The call closed.
Respectfully submitted.
Robert J. McKnight
Administrative Manager
Attendees:
Robert Szczys, MD – NAS
Janet Kirsch – NAS
Jody Whitten – NAS
Tracy Schutt – NAS
Sheryl Mandigo – NAS
Geri Lehr-NAS
Mark Pilley, MD – IG
Karolyn Osborn – IG
Barb Stockert –EC
Sharon Nichelson – EC
Troy Paz – EC
Carlos Reyes – EC
John Kenney – EC
Joe McKnight – EC
Kimberlie Rogers-Bowers – Alaska
Teri Jamison – Arizona
Rosalee Weber – California
Laura Steelquist – Hawaii
Troy Paz –Idaho
Lelia Wilkerson – Iowa
Wade Hendrickson – Kansas
Mike Calcaterra – Montana
Dave Hosman – Missouri
Mary Rogers – Nebraska
Rich Pozesky – Nevada
Greg Lord – N. Dakota
Sha Eppley – Oregon
Kay Johnson – S. Dakota
Deanna Birch – Utah
Val Taylor – Washington
Char Barkley – Wyoming
Zena Jacobi – EDI/EMC team
Cindy Coy – Education Team
Marshall Pollock – HME Team
Sha Eppley – HME Team
Deanna Birch – IV/PEN Team
Rosalee Webber – IV Pen Team
Sharon Nichelson – Medical Supplies Team
Karl Lindborg – O&P team
Leslie Rigg – Rehab Team
Gemma English – Respiratory Team
Colleen Shaw – Respiratory Team
Wade Hendrickson – NSC team
Wade Hendrickson – SADMERC team
Others,
Julie Piriano
Rose Schafhauser
Paul Komashock
DAC Meeting with NAS/ CMS
6 May 2008
Attendees listed at bottom
Introductions, Barb Stockert: Barb asked each member of the panel and the general membership to introduce themselves and their role related to Jurisdiction D. DAC.
Minutes from meeting with Noridian and IntegriGuard, 5 February 2008: Barb reviewed minutes asking if there were any modifications or changes. None were offered. Troy Paz motioned for approval of the minutes; J.R. Brandt seconded the motion, which carried.
Protocol: Barb reiterated the protocol for our discussions today with the carrier and asked all in the audience to turn off their cell phones.
Roll call of States and A-teams: Joe McKnight read the roll call of State membership and A-team leaders. Members from the various States and A-teams were accounted for.
Medical Director Update: Dr. Szczys spoke about his background noting he is a board certified surgeon of 22 years. He spent 7 years in a small town and later moved to a larger practice. He has been with NAS for the last 8 years. For the past 4 years he has worked in part B Medicare and focused the last 2 in the DME arena. Regarding the transition from IntegriGguard, he commented they have spent a lot of time trying to make this transition smooth and he feels they have accomplished this. He encouraged suppliers to let the staff at NAS know if any has issues with the transition so he can address them.
Dr. Szczys noted the DME Medical Directors meet 3 times per week to discuss issues related to the DMACs. Currently, they are looking at the CPAP LCDs. The NCDs have an effective date that is effective but the Medical Directors don’t have the NCR (Cchange Rrequest) which is holding up the process. The effective date for the NDCDs is still the same but it cannot be implemented until the Medical Directors approve the LCD. Dr. Szczys cautioned to be careful with your practice and make sure suppliers do not make changes until the LCDs are published and implemented.
Regarding the Knee Orthosis policy, he noted they are on their second draftupdate. The Medical Directors anticipate the final draft will be implemented out the 1
st
of July. No further comments have been received, and the current draft policy is on under the futures LCD web page for suppliers to reviewsite, please review it.
NAS has published some new FAQs, particularly on Urological Supplies. There was some confusion in the previous translations on the policy. The FAQs have provided some clarification, particularly about "grandfathering". These imply the new beneficiary will not have to re-qualify and they will not have to reuse supplies. The other FAQ publication is on PMDs. This outlinesd what constitutesed the face- to- face review and the questions surrounding this. Please review these FAQ’s.
Spring 2008 Jurisdiction D DAC POE Update-MedTrade
Introduction of Education Staff
·
Amy Hallett-10 years with Medicare, has DME claims processing experience and mostly recently worked as a business analyst in our systems area
·
Peggy Sorge-20+ years billing experience, worked at several ND DME suppliers before joining NAS
·
Jody Whitten-Boise office-POE Advisory Group coordinator
·
Tracy Schutt-Fargo office-website and bulletin coordinator, Online Learning Center lead (not present at MedTrade)
Educational Events Attended
March: National Home Infusion Association, NAMPS, CAMPS, UTMED
April: PAMES, MAMES
Upcoming Educational Events
June 9-12: VGM Heartland Conference-Waterloo, June 12 10:45 am-12:15 pm DME MAC Update session-Janet and Peggy attending, along with Jurisdiction A and B DME MACs, NSC and CBIC invited
September 10-13: AOPA-Chicago: September 12, one hour panel session with other DME MACs tentatively planned for afternoon-Peggy and Amy attending
September 10-12: Big Sky Ames-Montana
Workshops Held
CPAP
Glucose Monitor and Testing Supplies
Oxygen
Documentation Prior to Claim Submission
CMS-1500 Workshop-focused on NPI and common claim errors
Upcoming Workshops (to be scheduled)
Respiratory Assist Devices
Hospital Beds-CERT Focus
Manual Wheelchairs-CERT Focus
CMS-1500 Workshop
Ask the Contractor Teleconferences
Held quarterly for large suppliers and small suppliers in 2008-schedule for entire year on website in training section
Next small supplier ACT is May 14 at 3 pm CT
June 11 is next quarterly ACT-also at 3 pm CT
Will be scheduling an ACT on competitive bidding by end of June-timing depends on availability of materials and direction from CMS
POE Advisory Group
Latest meeting held on March 13, focused on Online Learning Center
Next meeting is June 12
Working on obtaining more active members
Supplier Manual
Rewrite project is still in process-should start seeing PDF versions soon
Online Learning Center
This was launched on February 2.
Five lessons currently available under Medicare and DME Fundamentals course: Appeals Process, ABN, Benefit and Payment Categories, CMN/DIF, Overpayments
Lessons under development: CERT (in final testing), Claim Submission, DME Fundamentals (soon), Documentation for DMEPOS, Fraud and Abuse, EDI (includes ERA, EFT, MREP)
DME Coverage and Specialties course is also under construction.
OLC lessons are reviewed by applicable NAS staff, including some call center staff. POE AG members and DAC Education A-team members are also involved in the review process.
Website Updates
Claim submission timelines chart added to Claim page
Appeals tab created-more changes coming to split out levels of appeals into separate sections on this web page
Coverage/Medical Review tab created as a result of MR transition-includes LCD search box and listing of all LCDs by title, number, HCPCS and description-will direct to CMS website for LCD link-can access policy article at bottom of LCD
Coverage/MR web page also includes: Links to IOM Coverage sections, ADMC information, including the request form, information on CERT, the Physician Letter, Documentation Checklists and Policy Decision Trees
Schedule of Events-calendar for all educational activities, including links for more information or to register
We encourage you to take the web site survey to provide feedback as each comment is reviewed and we want to know if you like the changes.
NPI-May 23
As of May 23, 2008, only the NPI will be allowed for all HIPAA standard transactions.
This means:
·
For all primary and secondary provider fields only the NPI will be accepted and sent on all HIPAA electronic transactions, paper claims and standard paper remittance.
·
Any claim with Medicare legacy (NSC/UPIN) identifiers in any primary or secondary provider field will result in rejection of the claim.
Articles will be posted soon on EDI front-end edits that will hit when identifiers other than NPI are reported. Paper claims will also be rejected via the claims processing system, rather than being returned. All denials will be un-processable denials. An article will also be posted soon addressing paper claims.
TestEST NPI-only Submission NOW
CMS has instructed providers to begin submitting a small number of claims as NPI-only (i.e., no legacy number/ NSC/UPIN.) After submitting, providers must ensure claims process through the Medicare payment system. If claims process as expected, continue increasing the volume of claims sent with the NPI-only until all claims are sent with NPI-only. Don’t Wait! This testing process must begin now.
NAS has worked with many DME suppliers that are sole proprietors to ensure that their crosswalk is established before the May 23, 2008 deadline. We will be having twice a week calls and then daily calls with CMS to monitor progress as deadlines approaches and for several weeks thereafter.
CMS, in collaboration with the Healthcare Information and Management Systems Society, has requested clearinghouses that submit Medicare claims to participate in a one day NPI preparation exercise called "Legacy Free" day. On Wednesday, May 7, 2008, participating clearinghouses should submit Medicare claims with NPI-only in all provider identifier fields. This "exercise" will result in feedback on your readiness as it pertains to your National Provider Identifiers.
PTAN Required
The Provider Transaction Access Number (PTAN) shall be a required authentication element for telephone and written inquiries beginning May 23, 2008. Initially, the PTAN shall be the legacy number or NSC # for currently enrolled providers. Newly enrolled and re-enrolled providers will be assigned a PTAN and this will be communicated in the enrollment letter.
CSR Telephone Inquiries -On or after May 23, 2008, CSRs shall authenticate providers using the National Provider Identifier (NPI) and provider name.
IVR Telephone Inquiries -On or after May 23, 2008, contractors’ IVRs shall authenticate providers with two data elements: NPI and PTAN
Written Inquiries-For written inquiries dated May 23, 2008, or after, contractors shall authenticate providers using provider name and either the NPI or PTAN. Letterhead containing name and address is enough for authentication, as is fax cover sheet with name and address.
Medical Review
Medical review functions are going well. We are current on ADMC requests and have been analyzing data to determine which HCPCS and providers may warrant a medical review. Our CERT coordinator has written several articles on CERT and calls suppliers who have not returned documentation to the CERT contractor timely.
CEDI Transition
This occurred on May 1, 2008 for Jurisdictions A and D. National Government Services, Inc. is the Common Electronic Data Interchange (CEDI) front-end contractor providing a single front-end solution for the submission and retrieval of electronic transactions. Jurisdictions B and C are scheduled to transition on June 1, 2008.
The CEDI web site is www.NGSCEDI.com. The CEDI Help Desk number is 866-311-9184. Hours are 9:00 AM - 9:00 PM (ET). Their email address is ngs.CEDIhelpdesk@wellpoint.com.
Trading partners, vendors, software companies, billing services and clearinghouses will want to join the CEDI list serve to receive important EDI information after transition. NAS will continue to send EDI related email list notices for the short term.
Look for the latest article on how to best reach CEDI as they currently are experiencing busy phone lines. The latest article will also have information on some other planned enhancements to help better serve electronic trading partners.
Accreditation Deadlines
Reminder: Existing suppliers enrolled in Medicare prior to January 1, 2008, must be accredited by September 30, 2009. NAS feels that there are some suppliers who do not realize that this impacts them or think that this applies only to suppliers who want to be part of the Competitive Bidding program so we will continue to educate on this. CMS also clarified that if a pharmacy only provides drugs and not the equipment or products needed to administer the drugs, they are exempt from accreditation. This was published in the NSC May 2008 news.
Revised ABN Form
Effective 3/3/08, the revised ABN form may be used. CMS is allowing a 6-month transition period so the revised ABN must be used no later than 9/1/08. Major changes are:
New title is "Advance Beneficiary Notice of Non-coverage (ABN)" and may be used for voluntary notifications, in place of the Notice of Exclusion from Medicare Benefits (NEMB) form.
There is a mandatory field for cost estimates of the items/services at issue
New beneficiary option, under which an individual may choose to receive an item/service, and pay for it out-of-pocket, rather than have a claim submitted to Medicare.
Revised CMS 855S Enrollment Form
Medicare contractors will continue to accept the 2006 version of the Medicare enrollment application through June 30, 2008 but suppliers are encouraged to use the new Medicare enrollment application (02/08 version) immediately. The only change to the form is that Supplier Standards 22 – 25 were added. These address accreditation.
IVR Same and Similar Update
NAS staff is currently testing this functionality and things are going well. The projected launch to suppliers is the week of May 12. Promotional materials on new features are in the process of being created.
CMS Calls
May 13-DMEPOS Competitive Bidding, 12:30-2 pm ET
CBIC and CMS staff will provide a general overview of this program, along with exceptions and situations suppliers may encounter. A PPT will be available before the call. Review MLN Matters articles SE0805, SE0806 and SE0807 before the call. Registration is required.
May 14-NPI Roundtable, 2 -3:30 pm ET-Registration is required.
MedTrade
Our booth # is 1357 and CBIC and NSC staff is also at the booth. NSC has a new ombudsman, Erika Williams, so stop by and meet her. We also believe that CEDI staff are at the show and may be in the booth. CEDI will be holding an EDI session on Thursday, May 8, 2008 from 8:30 – 10 am in Seaside Meeting Room-Ballroom B. This is for vendors and suppliers. Registration was requested but we don’t feel that you will be turned away unless the room is at capacity or advance registration was required.
NAS will also be participating in a DME MAC Update Session on Wednesday from 8:30-9:30 in the Promenade Meeting Room 203B, with the other DME MACs. You will hear the same information from NAS as you heard today but you may want to hear from the other DME MACs if you bill to those jurisdictions.
Questions for Janet Kirsch:
Q - Does the IVR check the claim history for all regions or just region D?
A –The IVR has initial CMN and revisions and you can check claim history (only NAS claim history), not nationally. If a DME item requires a CMN, we check the national CMN file in the Common Working File. This is the existing same and similar information provided by the IVR, and not related to CMNs.
Q – Does the IVR check the Common Wworking Ffile?
A – No, CWF is housed in 10 different places along with many other pieces of Medicare information and is actually the final step in the payment process to check claims before processing but the IVR enhancements will not check against does not actually check the CWF claim history, but we do access the CMN information at CWF for items requiring a CMN.. DIF information is not kept at a national level, only in each jurisdiction’s claim processing system.
Q - Will the enhancement bump up against product categories, check older codes against new ones or look for entire categories of products such as with wheelchairs?
A - Based on the code you enter, it will check for same and similar items to that code. If you enter the old code, it will check against the old code. The IVR does not know how to check for older codes, if a new code is entered or vice versa. You must enter all applicable codes. You will not check old codes against new codes or visa-versa.
Q - A member expressed concern regarding having beneficiaries on the line to discuss eligibility, particularly during this transition to CEDI. Specifically they noted that one carrier does not allow the beneficiary to be on the line where another requires this. There is also poor information coming back from the CWF regarding part A and B coverage and if the beneficiary is still listed under a part C plan.
A - Larry Young, CMS representative, pointed out that the CWF is updated nightly, but there is no easy fix for the part A and part B updates and HMO updates.
Q - Are there plans to provide the same and similar information under the 270 271 information?. A - Larry Young indicated likely not.
Q - How do we promote that?
A – Larry Young, we can take that back as a question. Now it is a new update that we can use so we could likely use this functionality. Larry will check;, he is willing to export it. We are sensitive about how our system can be gained. NAS is the only DME MAC that has a large the volume that of has the same and similiar calls.
Q - Do you have competitive bidding staff?
A – Janet Kirsch, no, we were not given staff. We were not given the lead on this project as CMS contracted with Palmetto for many competitive bid functions to be the Competitive Bidding Implementation Contractor. We are trying to attend the same conference calls, and can answer the general questions, but and we are not the experts.
Q - You will however need to process the claims?
A – Janet Kirsch - Yes, we will have to handle that. Just to elaborate a little bit. (Larry Young) - There will be an expectation that DME MACsyou will provide the education on every part of this. The CBIC will handle the procurement, while, the NAS will handle the claims processing.
CMS Update- Larry Young:. Larry spoke on about the IVR changes. "As Janet explained, we have worked this out." He hopes this will be updated and functional next week. Larry also spoke on the SADMERC or the Pricing Data Analysis and Coding (PDAC) contract. He anticipated a transition in the summer or late fall of this year. A question was raised about how many more changes the industry would have to endure from CMS and he responded: "It has been two years to finally get the environment where we think it should look like. It is just now getting to where we are where we think it should be. I don’t think we can do much more other than re-bidding the contractors every five years."
DAC D CMS / NAS Work Project Updates:
Home Health White Paper – Barb Stockert asked Larry Young to update the DAC on this piece.
Same and Similiar Via IVR: This project is now almost complete. As indicated above, Larry Young and Janet Kirsch expect this to be completed in the next couple of weeks.
Repair policy concerns: Members stated a number of concerns regarding how this will be handled. At present, we are not getting our expenses covered. There is no consistency. A question was posed to Dr. Szczys regarding some guidance on how he would like this to be addressed. Dr. Szczys: NAS would like to see the specific se concerns documented in a more formal letter, along with examples provided to show inconsistency or to support the concerns. and questions to address this with examples.
New Business: Barb Stockert noted the concerns of the DAC regarding the CEDI and the need for better communication. Janet Kirsch has agreed to assist us with provision of a contact person from the CEDI contractor. Janet will facilitate the introduction. Janet stated they have been in close communication with the CEDI contractor. They meet with some teams weekly and others monthly during the transition and post transition. With this partnership Noridian has been partnering on and posting things to the website. Concern was expressed regarding wait times and poor responses from the CEDI contractor. Phone waits are currently, 2.5 hours and more on Friday, e-mail now has a 2 day response time. Larry Young will follow up on these concerns with the CEDI contractor. Some members noted their provider numbers were being rejected and when they checked with the CEDI the response was that they should re-enroll or they can refresh the submitter IDs. Janet Kirsch was surprised by this. She agreed to check further into the problem if examples are provided.
A-TEAMS and Q&A (question set under separate cover)
Next DAC meeting 31 July 2008.
Barb Stockert called for a motion to adjourn., Troy Paz motioned., JR Brandt seconded the motion.
Respectfully submitted,
Robert J. McKnight
DAC D Administrator.
|
|
F Name |
Affiliation |
Confirmation |
|
Young |
Larry |
CMS |
Yes |
|
Szczys |
Robert |
NAS |
Yes |
|
Jodyi |
Whitten |
NAS |
Yes |
|
Kirsch |
Janet |
NAS |
Yes |
|
Hallett |
Amy |
NAS |
Yes |
|
Sorge |
Peggy |
NAS |
Yes |
|
Stockert |
Barb |
EC |
Yes |
|
Nichelsen |
Sharon |
EC |
Yes |
|
Paz |
Troy |
EC |
Yes |
|
Reyes |
Carlos |
EC |
Yes |
|
Kenny |
John |
EC |
Yes |
|
McKnight |
Joe |
EC |
Yes |
|
Rogers-Bowers |
Kimberly |
Alaska |
Yes |
|
Chapman |
Kelly |
Arizona |
Yes |
|
Schafhauser |
Rose |
California |
Yes |
|
Gammie |
Nancy |
Hawaii |
Yes |
|
Paz |
Troy |
Idaho |
Yes |
|
Wilkerson |
Lelia |
Iowa |
Yes |
|
Showalter-Roberson |
Sheila |
Kansas |
Yes |
|
Guinn |
Lisa |
Montana |
Yes |
|
Lind-Fraher |
Connie |
Missouri |
Yes |
|
Nichelson |
Sharon |
Nebraska |
Yes |
|
McKnight |
Joe |
Nevada |
Yes |
|
Stockert |
Barb |
North Dakota |
Yes |
|
Eppley |
Sha |
Oregon |
Yes |
|
English |
Gemma |
South Dakota |
Yes |
|
Birch |
Deanna |
Utah |
Yes |
|
Piriano |
Julie |
Washington |
Yes |
|
Jackson |
Mary |
Wyoming |
Yes |
|
Jacobi |
Zena |
EDI/EMC |
Yes |
|
Lind-Fraher |
Connie |
Education |
Yes |
|
Coy |
Cindy |
Education |
Yes |
|
Chapman |
Kelly |
HME |
Yes |
|
Eppley |
Sha |
HME |
Yes |
|
Birch |
Deanna |
IV Pen |
Yes |
|
Clock |
Robert |
Medical Supplies |
Yes |
|
Malinowski |
Janet |
O&P |
Yes |
|
Brandt |
JR |
O&P |
Yes |
|
Piriano |
Julie |
Rehab |
Yes |
|
Call |
Evan |
Rehab |
Yes |
|
English |
Gemma |
Respiratory |
Yes |
|
Showalter-Roberson |
Sheila |
NSC |
Yes |
|
Shafhauser |
Rose |
SadmercSADMERC |
Yes |