Region D DAC Meeting with CMS/NAS/CEDI
TuesdayNov. 16thth9:00 AM EST
GeorgiaWorldCongressCenter
Atlanta, GA
Room # B213
DAC Chairperson Sheila Roberson welcomed everyone to the DAC meeting, and introduced the Executive Committee for the DAC.
Chair:Sheila Roberson
Secretary:Leslie Rigg
Treasurer:Teri Jamison
Past Chair:Sharon Nichelson
Nordian Administrative Services and CEDI were introduced and the following in attendance:
Medical DirectorDr. Richard Whitten
POEJody Whitten
POEAmy Hallett
NASCheryl Mandigo
CEDIStacy McDonald
CEDISally Hopkins
Barb Stockert, Administration completed roll call of the State Representatives,
A Team Leaders, members, and guests. **Attendance List Attached to Minutes.
Sheila Roberson reviewed the meeting protocol.
The meeting minutes from August 17th were approved. Kimberly Rogers Bower made the motion to approve and Rick Graver seconded it.
CMS Update
There was no CMS update as Ed Lain was not in attendance.
CEDI Update:
Stacy McDonald provided and released the following update from CEDI.
60 Day Password Expiration
CEDI will be implementing a change to the timeframe for passwords on the CEDI Gateway to expire. Currently, passwords expire every 90 days. This change will go in on 12/30/10 and any passwords that have not been changed in the last 60 will have to be changed..
As a reminder, after 90 days where a Trading Partner does not login to the CEDI Gateway, their password will be suspended and they will have to contact the CEDI Help Desk to have it unsuspended.
After 13 months of non-use, a CEDI Trading Partner will be marked inactive and their login ID will be removed. The Trading Partner would need to complete the CEDI forms in order to be re-activated.
Network Service Vendor Requirement
CEDI is in the process of requiring all connectivity to the CEDI Gateway be done through a Network Service Vendor. This move is to improve the security of the connections coming into National Government Services.
There are three key dates for this initiative:
Effective November 1st, any new Trading Partner signing up with CEDI is required to use a Network Service Vendor and report that vendor on the CEDI Submitter Action Request form.
April 30, 2011 will be the last day dial up services will be provided on the CEDI Gateway.
On May 1, 2011 all connectivity to the CEDI Gateway must be done via a Network Service Vendor.
We have an FAQ on our CEDI website with information on this initiative. Listservs have gone out and the reminder listservs will continue to be sent through the end of April 2011.
There is a list of those Network Service Vendors who have connectivity to CEDI on the CEDI website. You can visit their websites for information, but we encourage you to call them directly to get details on services and pricing they offer. Most if not all of them have rates that are not on their website to fit the needs of the suppliers who only send a few claims.
HIPAA 2 Transition – Versions 5010 and D.0
Medicare will be implementing the new versions of the X12 and NCPDP formats in order to be compliant with HIPAA.
The X12 transactions are the 837 claims, 835 electronic remittance, 276 claim status request and 277 claim status response and will move to the 5010A1 versions.
For NCPDP, claims transactions will move to the version D.0 Telecommunications Standard.
Transactions Affected by the Errata Version / Base Version / Errata Version837 Health Care Claim: Professional / 005010X222 / 005010X222A1
835 Health Care Claim Payment/Advice / 005010X221 / 005010X221A1
276/277 Status Inquiry and Response / 005010X212 / N/A
999 Implementation Acknowledgment For Health Care Insurance / 005010X231 / 005010X231A1
277CA Claim Acknowledgement / 005010X214 / N/A
National Council for Prescription Drug Programs (NCPDP) Version D.0 of the Telecom Standard / D.0 / D.0 April 2009
CEDI has created a page on our website dedicated to the upcoming transition to the 5010 and D.0 formats. There is an FAQ as well as links to the CMS 5010 and D.0 web page and to the X12 and NCPDP websites to purchase the guides.
We are working with CMS to create the Companion Documents for the 5010 and D.0 transactions and will release those as soon as they are completed.
The timeline for implementing 5010 and D.0 is:
- January 2011 – Vendors and those who do their own programming (also referred to as in-house programmers) may begin testing the base versions of the X12 transactions and NCPDP D.0.
- April 2011 – Vendors and in-house programmers may begin testing the 5010 Errata or A1 versions of the X12 transactions.
- Once vendors have passed testing of the X12 5010A1 versions and/or the NCPDP D.0, they may begin moving their customers into production.
- Trading Partners will only be able to move into production for the A1 version of 5010 but will be able to test the base version prior to April 2011.
- Once in-house programmers have passed testing of the X12 A1 versions and/or the NCPDP D.0, they may move into production.
- As of January 1, 2012 ONLY 5010A1 and D.0 transactions will be allowed.
Vendors and in-house programmers are only required to test the claims transactions.
The 277CA will be replacing the CEDI GenResponse report and is an X12 formatted transaction. It will be necessary for software vendors to support the 277CA for their customers and we are expecting vendors will create a tool to translate the 277CA into a readable format. CEDI will not provide support to Trading Partners in how to read a 277CA.
The current CEDI NCPDP error report will be replaced by the NCPDP Transmission Response Report, and like the 277CA, will need to be translated into a readable format by vendors for their customers.
Medical Director Update:
Dr. Whitten provided the Medical Director Update.
Don Berwick met with all 4 Medical Directors. He is very interesting and has an extremelygood background. He wants to push CMSto obtain better data and to clearly identify things that worked well. Public Health, Long Term Care are very important to him and he believesthey need to be looked at.
He wants to identify coverage for items that are new and then evaluate what each out come will be. He wants to lower cost over time evaluating what worked well and then identify the outcomes themselves. There is a need to reduce boundaries and one way to do this is by prevention. We need to focus on such things as smoking, obesity, stroke, heart attach and eliminate them
There is definitely a need for more communication and the need to obtain better data and identify best practices. We need to focus on improving patient care, making safety improvements, and to coordinate what is in the physician record. It could be helpful to track individual patients and their outcomes. We may need to look at changing the structure of our documentation. Some areas that are not understood need to be looked at, and there is a need to make the requirements of the policies clearer.
The physician letters that were developed have definitely helped to lower the number of errors and appeals. Dr Whitten said he is still spending a lot of time on ALJ issues but since the Dear Physician Letters have been developed there has been a dramatic decrease in the number of appeals. Dr. Whitten mentioned that the Region D Rehab team was extremely helpful in developing the Physician Letter on Powered Mobility.
Dr. Whitten discussed the least costly alternative requirement and the fact that 54 LCD’s have this listed in them. If least costly alternative is not used the only alternative is to deny the claim outright. This has to be looked at and a decision made on the best practice way to handle it.
Dr. Whitten suggested holding meetings with groups as the DAC to enhance education for all suppliers and physicians. We need to look at what we can do creatively on some policies such as wheelchair cushions that have the least costly alternative requirement in them. Dr. Whitten suggested holding a meeting with some members of the DAC regarding this. Sheila Roberson, Rick Graver, and Tom Hood volunteered.
Some of the policies that are being revised are: LCDfor glucose monitoring. There has been lots of feedback on this mostly for insulin using patients. There have been lots of CERT errors with patients not on insulin. It may be decided to stick close to what the draft policy requires.
Pneumatic Compressions Devices—expect some changes in this policy. There has been lots of frustration on the E0562.
Some of the dressings in the Surgical Dressing Policy need to be looked at because their need is so specific. Other policies have to be updated/fixed with newer language.
Dr Whitten said he is very appreciative of the help the DAC has given. He is also hopeful that with real CMS support that we can improve policy.
Noridian Update:
Jody Whitten provided the Noridian/POE Update. The update will be sent separately. (I spoke with Jody 11.22.10 and she was having some computer problems. Once it is fixed she will send the transcript of the POE update. This will probably be early next week…Barb).
Old Business
Dyna Splint Update:
Sheila spoke on this issue. She stated that the Regions are not in sync and that Regions A and C responded differently on this. Dr. Whitten questioned why we not getting the same response. We should not be changing the POS. Sheila stated that 1 800 Medicare tells callers that the place of service can be changed and it was verified by attendees that they have been told this by Noridian Customer Service on different occasions as well. Dr. Whitten said we needto find out where this is coming from and how this all relates to the Dynasplint issue. Dr. Whitten will investigate this and report back.
POD Update
Deanne Birch spoke on this topic. Dr. Whitten stated that there has been no update yet and that Noridian has requested clarification from CMS on this. **Letter to Dr. Hoover Attached)
Status of Electronic RX’s
Sha Eppley states she asks this question every quarter but has not yet gotten a response to it. Dr. Whitten said he would follow-up on this and report back. He will talk with Ed Lain to see if there has been an update.
New Business
MaryJackson stated she is receiving audits for some dates of service and is not being given the opportunity to find documentation for subsequent dates of service. Should this be happening? Dr. Whitten did not think this was happening on CERT Audits as they will usually allow dates before and after. Sha stated this usually happens on prepay audits and there is some information about this on Region B Website. NAS will review.
The next Region D DAC/Noridian/CMS/CEDI Teleconference Meeting will be in February, 2011. The calendar for 2011 will be developed and released within the next couple of weeks.
There being no further business the meeting was adjourned.
Respectfully Submitted,
Barb Stockert