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Coverage Determinations Project Team Members David Templeman, MD, Chair Daniel Berry, MD Craig Butler, MD Wilford Gibson, MD David Halsey, MD Wellington.

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Presentation on theme: "Coverage Determinations Project Team Members David Templeman, MD, Chair Daniel Berry, MD Craig Butler, MD Wilford Gibson, MD David Halsey, MD Wellington."— Presentation transcript:

1 Coverage Determinations Project Team Members David Templeman, MD, Chair Daniel Berry, MD Craig Butler, MD Wilford Gibson, MD David Halsey, MD Wellington Hsu, MD Peter Mandell, MD Ashlen Strong, Lead Staff Matt Twetten, Staff

2 Project Team Charges I AdvocacyI Advocacy II GuidelinesII Guidelines III EducationIII Education

3 CDPT/AAOS Actions Member Education Member Education Member Publications Member Publications Audit Reporting Tool Audit Reporting Tool Orthopaedic CAC Network Orthopaedic CAC Network Model LCD for TJA Procedures Model LCD for TJA Procedures Congressional Letter Congressional Letter Meetings with CMS Meetings with CMS MLN Matters Article MLN Matters Article Meetings with MACs Meetings with MACs Regulatory Comment Letters Regulatory Comment Letters

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7 Model LCD Modeled after First Coast Service Options LCD in Florida Modeled after First Coast Service Options LCD in Florida Reviewed by AAHKS Reviewed by AAHKS Improved by CDPT and PL Improved by CDPT and PL Sent via postal mail and e-mail to ALL Contractor Medical Directors Sent via postal mail and e-mail to ALL Contractor Medical Directors Available at www.aaos.org/Medicare101 Available at www.aaos.org/Medicare101

8 MAC Response to Model LCD Two MACs currently considering adoption Two MACs currently considering adoption MAC J10AL, GA, TN MAC J10AL, GA, TN Communicated with AAOS staff that they would introduce Communicated with AAOS staff that they would introduce AAOS coordinated with CAC representatives AAOS coordinated with CAC representatives Drafted comment letter Drafted comment letter MAC J1CA, HI, NV MAC J1CA, HI, NV In preliminary stages In preliminary stages Identical to model LCD Identical to model LCD AAOS will support AAOS will support

9 Audit Reporting Tool AAOS Fellows can report audit activity to the AAOS AAOS Fellows can report audit activity to the AAOS Distributed via Advocacy Now, state orthopaedic societies, the BOC list-serv, and AAOE Distributed via Advocacy Now, state orthopaedic societies, the BOC list-serv, and AAOE Find it at www.aaos.org/Medicare101 Find it at www.aaos.org/Medicare101

10 AAOS

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14 Member Publications

15 For the Latest Information Visit the Medicare Audits 101 webpage:Visit the Medicare Audits 101 webpage: www.aaos.org/Medicare101www.aaos.org/Medicare101www.aaos.org/Medicare101

16 Benjamin Franklin If we dont all hang together we will certainly all hang.

17 Palmetto Noridian Novitas CIGNA Cahaba NGS FCSO NHIC WPS Medicare Administrative Contractors by Contractor

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