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Coverage Determinations Project Team

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. Project Team Charges. I Advocacy II Guidelines

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Coverage Determinations Project Team

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  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 Advocacy • II Guidelines • III Education

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

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

  5. MAC Response to Model LCD • Two MACs currently considering adoption • MAC J10—AL, GA, TN • Communicated with AAOS staff that they would introduce • AAOS coordinated with CAC representatives • Drafted comment letter • MAC J1—CA, HI, NV • In preliminary stages • Identical to model LCD • AAOS will support

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

  7. AAOS

  8. AAOS

  9. AAOS

  10. Member Publications

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

  12. “If we don’t all hang together we will certainly all hang.” Benjamin Franklin

  13. 0 500 Miles 0 500 KM WA ME MT ND VT OR MN NH ID MA NY SD WI CT RI MI WY PA IA NJ NE NV OH DC DE IN MD IL UT CO WV CA VA KS MO KY NC TN OK AZ NM AR SC GA AL MS TX LA FL CIGNA Cahaba NGS Palmetto Noridian Novitas FCSO NHIC WPS AK Medicare Administrative Contractors by Contractor HI AK & HI not to scale

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