Jurisdiction C Council

Pre-Meeting

April 16, 2013

Jim Stephenson, Kim Brummett, Claudia Amortegui, Tom Heinrich, Don Hardin, Michael Hamilton, Joe McTernan, Donna Leslie, Debbie Hughes, Meghan Greene, Sylvia King, Preston Schoen, Susan Guthrie, Deanna Rollyns, Eric Parkhill, Laura Williard, David Chandler, Amie Barone, Jim Knight, Pam Kaehler, Todd Tyson, Stephanie Hess, Andrea Stark, Laura Hafford, Gerry Francisco, Paul Komishock

  • Q&A Dates have been added for October 2013.
  • A motion was passed to continue the Management Contract with Rose Schaafhause. This was passed by council vote.
  • Review of the CGS Agenda was completed.
  • Discussion of non-qualifying cmns was completed. There is currently no way to get them to deny oxygen if the supporting documentation does not meet requirements. The council discussed potentially adding a KX modifier.
  • There was discussion regarding past meetings where it was stated that only KH modifier capped rental claims will be audited for prepay. We have had some providers getting audits on multiple month claims. We will research past meeting minutes to find if this was documented.
  • There was discussion regarding audits for ongoing supplies. We will discuss this with CGS to determine if this can be excluded for patients that are audited once and pass for services such as aerosol meds, enteral, ongoing supplies.
  • RAC has had limited representation at our recent meetings. Andrea gave update on Group 3 support surfaces that have been audited by CGS.
  • CEDI update-ICD10 will be implemented October 2014. This will be a fast and hard cut off. We will not have the ability to test this for a period prior to implementation.
  • 855S form has been revamped. The paper application was changed earlier this year.
  • 2% Sequestration cuts were implemented on 4/1/13. This is only on Medicare payments. This does not apply to copayments or deductibles. This cannot be passed on to patients or to secondary plans. There is some opinion that the 2% reduction being applied to the CB rates should not be allowed. There are some medicare advantage plans that are taking this reduction as well.
  • There was discussion on the delay in redeterminations being processed greater than 60 days. This will be discussed at the CGS meeting.
  • We will also discuss the issue with patient audits not being received by CGS. There was an issue on 2/26 and 2/27 with their fax server. We have several instances of this issue.
  • The council discussed PECOS issues. There are still a lot of physicians not enrolled. AAHomecare is not asking for a delay in PECOS because they will be asking for delay on Face 2 Face. It has been said that claims will deny as PR16 and ABN is not required. We will ask for clarification at the CGS Meeting. If it is statutorily non-covered do providers have to file claims?
  • Strategic Health Solutions is a Supplemental Medical Review Contractor and will be used to audit claims and perform extrapolation.
  • Review of Q&A was completed.
  • Discussion of Scooter store was held and it was decided that this should be taken up at a regulatory and national level on what the patients should do for repairs of their current rental equipment.
  • A Team Chair responsibility is to gather questions from the industry and recruit people from the industry to be on the A Teams.