Combined Meeting Minutes for Region D DAC Meeting with CMS/NAS/CEDI Wednesday May 12th 9:00 AM PST Sands Convention Center Las Vegas, NV Casanova Room # 607

Sheila Roberson, Chair opened the meeting and welcomed everyone.

Introductions of the Executive Committee, Administration, Noridian, and CEDI were held. (An attachment that shows all members that signed attendance sheet is included at the back of the minutes).

Sheila reviewed the meeting protocols.

Barb Stockert, Administration completed the Roll Call for State, Leaders, and A Teams.

The minutes from our February 9th, 2010 teleconference were approved. Troy Paz made a motion to approve and Chuck Gunther seconded it. All were in favor.

CEDI Update:

The CEDI Update was provided by Stacy McDonald:

The CEDI Help Desk will be closed in observance of Memorial Day but the Gateway will be open. Claims received by CEDI on May 31, 2010 will have June 1, 2010 assigned as the date of receipt.

Stacy encouraged members to sign up for the List Serv if they have not done so.

May 28th Providers will be able to check their CEDI enrollment through the IVR. A List Serv will be coming out explaining this.

PECOS: The percent of errors on claims is continually decreasing. Currently we are down to about 28.5 percent. Stacy encouraged suppliers to use the report on CMS’s website as a resource.

Stacy also clarified that PECOS files are updated Monday – Saturday and some Holidays. They are not updated quarterly.

Internal testing for the 5010 standard will begin on 1/1/11. Vendors and suppliers will have to test with CEDI. The CEDI gen response report will go away with 5010 and D.0 and be replaced by the 277CA for 837 claims and the NCPDP transaction response report. Vendors will have to translate the 277CA and NCPDP transaction response report so it is readable by CEDI suppliers. There will be more education released on this but suppliers can access information on the CMS website by searching for 5010.

CMS Update:

Ed Lain from CMS was not present at the meeting so there was no CMS update.

Medical Director Update:

The following Medical Director Update was provided by Dr. Whitten:

DME Medical Directors are focusing on Urological Supplies and the adjudication of claims involving the policy. They are reviewing the NCD and are looking at writing an article to clarify it. The medical directors took strong stance on PECOS. There should not be something that causes this many problems. They are asking for a delay that could be until July. There needs to be more clarification on it.

The lack of a CMS administrator has posed some problems. They are hoping to have an interim appointed soon. There needs to be someone to take the lead. Consideration also needs to be made for people that are knowledgeable in the industry.

The least costly alternative mandate relating to drugs in decisions has been found to be somewhat inconsistent. Many times an upgrade to a particular drug is deemed to be medically necessary. This can also apply to other policies. The Medical Directors and Contractors are reviewing how many edits are affected in making the decision. Many times the final decision is to allow the upgrade, and we have to go back and make a decision on how to handle.

There are situations when the medically necessary upgrade is not necessary and we need to have clarification on how to handle these claims. CMS and the contractors should look at just saying it is not medically necessary. Then an upgrade by the supplier could be allowed.

Dr Whitten has been involved in a number of ALJ issues and the appeal process. Many claims are initially denied and then paid thru the appeals process. Compression Devices and Surgical Dressings are two of the policies where this is most commonly seen. It does not make sense that the claim initially denies, and then is finally paid thru appeals. We have to remember that we are bound by the NCD’s. It appears that a number of the NCD's are somewhat confusing for suppliers and may have to be clarified in the LCD. It does not make sense that someone has to go thru hoops to get something paid. I have recommended a number of these to be paid at the ALJ level. There are a number of major issues and they need to be dealt with. We will have a result in time The work that the DAC does and the communication the DAC provides along with your feed back is helpful. If you feel something is inconsistent you need to tell us and we will work to get it clarified.

The POE Update:

The Provider Outreach and Education (POE) Update was presented by Jody Whitten:

Jody introduced Noridian staff in attendance: Lori Irwin, Calli Brady, Peggy Sorge.

Jody reminded members to sign up for email list serves.

The Noridian website is currently being redesigned. Jody encouraged us to take the web tour that is offered. Currently tabs are located on the top of the screen. With the update they will be moving towards left hand navigation.

Web Ex’s will be held on the new design, May 17th and 20th at 2:00 PM.

Jody explained the Endeavor portal and its capabilities. Suppliers are able to check eligibility, claim status, and Remittance Advice Notices. It is available Mon. – Fri. 24 hours a day 7 days a week for eligibility. For claim status and Remittance Advices it is available Mon. – Fri. 6am to 6pm and Sat. and Sun. 7 am to 3 pm. Future capabilities with this portal will include Appeal requests and the ability to request reopening and down the road there is the potential for suppliers to correct errors on line. To enroll in this program click on the claims tab on Noridian’s website, and then Endeavor. If a supplier has multiple NPI numbers it may take about 7 days to get set up. Endeavor is all web interfaced, is available for all states, and updated on a daily basis. Same and Similar Equipment is on the “to do” list for Endeavor and Appeals and Reopenings will take precedence so these things will eventually be able to be done on line.

Jody encouraged member s to stop by the NAS booth and get an IVR guide. Overpayment information is now available on IVR with FCN, and notification whether a physician is in PECOS is also available on IVR.

Two MLN Matters were brought to everyone’s attention:

Two MLN Matters were brought to everyone’s attention: MLN Matters 6911 - Enhancement to Home Health Consolidated Billing Enforcement

When this was initially implemented in 2000, the edit criteria were set so that supply services would reject if the dates overlapped the Home Health episode dates. Beginning on Oct. 1, 2010 CMS has implemented new edits so if supplies were provided before the need for Home Health Care occurred they will be paid. The edit will be changed to only reject services if the From date for the supply occurs within a Home Health episode. . This change is effective 10-1-2010,

MLN Matters MM 6698 - Signature Guidelines for Medical Review Purposes This requirement gives direction to Contractor’s on what is acceptable. For medical review purposes, Medicare requires that all orders and medical records that are used in the determination must be authenticated by the author. If a signature is illegible on an order or medical record suppliers may receive a development letter to verify the requirements are met. Medical Review will send ADR letters to suppliers. They will have 20 days from the date on the letter to respond with an attestation statement or signature log. If this is not done the claim will be denied. Jody reminded everyone that they should be on the lookout for these letters.

The CMS website has recently changed. The HHS has been dropped from the email address. You can access CMS’s website at www.cms.gov/.

The Provider Outreach and Education Team are in the middle of face to face events.. May 17 th they will be in San Diego, and May 19th in Las Vegas. These are all day events. Topics that are discussed are: CERT, Written and telephone re-openings, HCPCS Code/Modifier Issues, Successful tips for claim filing, and web tips for easier navigation on the NAS website.

Noridian will be hosting numerous Web-Ex training sessions. Much of this training is geared to be policy specific. They will be focusing on the policies that have a high CERT error rate. Glucose Monitor Testing and Enteral Nutrition are two that will be held. Documentation Prior to DME Claim Submission, PAP, RAD and Refractive Lenses will also be held in June.

Ask the Contractor Teleconference calls are being held on a quarterly basis. There are general and policy specific ACTs. May 20th will be the next general session call. July 14th an ACT call on Oxygen will be held, and on Oct. 20th an ACT call will be held on Enteral Nutrition. All calls are at 3:00 pm CST.

RAC Update:

Dr Ellen Evans from the RAC was present at the meeting. She gave a summary of the RAC. HDI is the Medicare Contractor for Jurisdiction D. It was rolled out about 1 year ago. HDI begins by looking for trends on claims. They will research these and check for limits.

Once issues are discovered they are brought to the attention of CMS. If CMS agrees these are developed and an audit is put in place. They look for trends and follow limits of the policies. Presently most of these are automated but requests for Medical Records can also be done. Suppliers should check regularly to see if they have received a medical record request.

Dr. Evans stated that they are looking for ways to improve their processes and if we have suggestions we should submit our thoughts to her. Her contact information is: RACCMD@RAC INFO.COM. They are also currently hiring for management and reviewer positions at HDI. If anyone is interested they can check the qualifications on HDI’s website.

Troy Paz told Dr. Evans that there are many rumors about the RAC and would it be possible to clarify what they are doing to try and dispel some of these rumors. Dr. Evan’s reported that what we’re doing now will probably be different than what we do in a year or two. We cannot discuss particulars but as issues are developed HDI works with NAS to be sure they are looking at the same way

Troy asked, how do you come up with queries? Dr. Evan’s responded, we look at the Demo Project, the OIG report, and studies that have been done. It is no mystery that CMS very concerned. Providers should shore up their processes based on these things. They should study the LCD’s and use correct billing for each policy. Providers should be sure their documentation is in line with the LCD. Dr. Evans clarified we do not target providers. We receive daily data dumps which accumulate to 4.5 million claims. We look at series of claims and the way they are billed. If you are doing what you are supposed to there should not be a problem. We do not looking for specifics.

Suppliers should use their manufacturers for support. Get documentation from specialists. If the DAC would like to organize a sub group to focus on this we would be glad to work with you.

Additional Business:

A concern was brought to the attention of Dr. Whitten and Jody of a problem with the information that 1- 800-MEDICARE is giving to beneficiaries. They are stating that when a pt is in a SNF on a Part A stay that it is acceptable to change the POS on the claim to 12 since that is the patient’s home. Jody stated that this is not correct and that POS of 31 or 32 should be used. Dr. Whitten asked that the question be emailed to him so he can pass this information on to CMS. Sheila thanked VGM for our room sponsorship. She encouraged all members to thank them for their generosity and support of the DAC.

Sheila also thanked Troy Paz for his work on the website and Barb Stockert for her work as the DAC Administrator.

Next Meeting:

Out next combined meeting with the Region D DAC/Noridian/CEDI/RAC will be our Teleconference Meeting on July 27th, 2010. The time for this call will be forth coming.

With no further business to conduct the meeting was adjourned.

Respectfully Submitted,

Barb Stockert Region D DAC Administration