MINUTES FROM POP ADVISORY BOARD MEETING
August 17, 2011
Meeting was called to order at 1:05 P.M. at the State of Alabama Medicaid Agency – 8th Floor, 8D Conference Room
ATTENDEES PRESENT:
1. Felicha Fisher, State of Alabama Medicaid Agency
2. Marilyn Chappelle, State of Alabama Medicaid Agency
3. Ida Gray, State of Alabama Medicaid Agency
4. Linda Stephens, State of Alabama Medicaid Agency
5. Will Whatley, State of Alabama Medicaid Agency
6. Cathy Sherman, Alabama P & O Association (Alabama Artificial Limb and Orthopedic)
7. Glenn Crumpton, Alabama P & O Association (Alabama Artificial Limb and Orthopedic)
8. Fred Crawford, Alabama P & O Association
9. Stephen Blackwell, Shoals Orthotics and Prosthetics, Inc.
10. Ronald Ezell, Alabama State Board of Prosthetists and Orthotists
REPORTS:
The following reports were submitted to the board:
§ Total Claims Paid for FY 2011 (1st, 2nd, & 3rd Quarter): Total – $858,761.16
§ Paid Claims FY 2011 (1st Quarter): Total – $294,204.56
§ Paid Claims FY 2011 (2nd Quarter): Total – $267,125.23
§ Paid Claims FY 2011 (3rd Quarter): Total – $297,431.37
BUSINESS:
§ Condolences were given to Ronnie Ezell regarding the passing of his father.
§ Thoughts and prayers were given to APOA for Dan Oglesby regarding his mother being ill.
§ Introduction of all attendees.
§ Attendees reviewed FY 2011 Reports. Currently, POP is on track to remain under budget. Felicha stated if our budget remains between $300,000 – $350,000 per quarter, we will not exceed our allotted amount.
Page 2
Minutes From POP Board Meeting
August 17, 2011
§ Felicha stated that she did a comparison regarding expenditures for FY 2010 & FY 2011. Glenn inquired what the totals were for each quarter for FY 2010.
o Total Claims Paid for FY 2010 (1st, 2nd, 3rd & 4th Quarter): Total – $920,041.26
o Paid Claims FY 2010 (1st Quarter): Total – $165,005.81
o Paid Claims FY 2010 (2nd Quarter): Total – $146,361.47
o Paid Claims FY 2010 (3rd Quarter): Total – $213,327.92
o Paid Claims FY 2010 (4th Quarter): Total – $395,346.06
§ Retrospective Review letters were mailed to ten randomly selected Accredited Facilities on May 19, 2011. Felicha stated out of the ten facilities, all records were acceptable and were received by the Agency in a timely manner (within 30 days). Majority of the records were received within a week from the date of the request.
§ Stephen Blackwell inquired about what procedures Medicaid has in place to monitor fraud/abuse. Felicha stated that is the purpose of the Retrospective Reviews. A query is run, grouping paid claims by accredited facility and then by recipient ID. Medicaid cannot view every claim for abuse, but we monitor the claims as best as we can, especially the “big ticketed” devices. No sign of fraud or abuse has been detected at this time.
§ Felicha inquired if there is an updated version of the APOA Products Illustrated Guide. The 2009 version is the latest guide Medicaid has. APOA will forward a copy of the 2011 version to Felicha.
§ APOA will do a review of all current codes to see if any codes are not being utilized. This procedure will determine if any codes should be eliminated or if any codes will be recommended as additional codes.
§ Glenn Crumpton stated that there are some codes he does not use because the “complimenting” code is not currently covered by Medicaid (ex. L5972). Glenn wants to add L5972 to the POP Program in order to utilize Code L5986. Code L5986 is currently covered by POP. Stephen stated that he has to improvise, using the codes that are currently covered by Medicaid in order to make the device work. Felicha asked Glenn to research the codes and send documentation regarding which codes he recommends Medicaid should add. Cathy will be responsible for submitting documentation to Felicha. Once information is received from Cathy, Felicha will forward to Marilyn and Dr. Moon for consideration.
Page 3
Minutes From POP Board Meeting
August 17, 2011
§ Fred Crawford read an email to the board that he received on August 15, 2011 from Stephen with Baker Medical. Stephen asked Fred if Alabama Medicaid reimburses for LSO/TLSO spinal braces for adults. The last time Stephen looked at the most recently revised Fee Schedule, it looks like Medicaid might reimburse for adults on some items including some L Codes for LSO/TLSO spinal braces, but he is not exactly sure. According to POP newly covered codes, the two L Codes in question (L0472 & L0486) are covered by Medicaid. Fred gave a copy of the email to Felicha for Medicaid’s response. Felicha will respond to Stephen via email.
§ Fred Crawford stated mastectomy fitters are licensed now, but the fitters can only be supplied by an accredited facility. The funds for mastectomy fitters are a different allocation from POP. Fred hopes the mastectomy filters will not require a PA. Fred stated that he will communicate with Ida regarding the mastectomy fitters.
§ Cathy stated she is concerned about bilateral patients. At the present time, there is not a modifier within the system to notate “left” or “right”. Ida is in the process of updating the system to identify “left” and “right”.
§ The Legislative Session will begin a little later the coming year. Session will begin February 2012.
ACTION ITEMS:
§ APOA will review current Procedure Codes for possible additions and/or deletions.
§ Felicha will respond to Stephen with Baker Medical regarding Codes L0472 & L0486.
§ APOA will provide Felicha with the 2011 version of the AOPA Products Illustrated Guide.
§ Cathy will submit documentation to Felicha regarding adding code L5972 in order to utilize code L5986.
TENTATIVE DATE FOR FUTURE MEETING:
§ Thursday, January 19, 2012
Meeting adjourned at 2:15 P.M.
Meeting was called to order at 1:05 P.M. at the State of Alabama Medicaid Agency – 8th Floor, 8D Conference Room
ATTENDEES PRESENT:
1. Felicha Fisher, State of Alabama Medicaid Agency
2. Marilyn Chappelle, State of Alabama Medicaid Agency
3. Ida Gray, State of Alabama Medicaid Agency
4. Linda Stephens, State of Alabama Medicaid Agency
5. Will Whatley, State of Alabama Medicaid Agency
6. Cathy Sherman, Alabama P & O Association (Alabama Artificial Limb and Orthopedic)
7. Glenn Crumpton, Alabama P & O Association (Alabama Artificial Limb and Orthopedic)
8. Fred Crawford, Alabama P & O Association
9. Stephen Blackwell, Shoals Orthotics and Prosthetics, Inc.
10. Ronald Ezell, Alabama State Board of Prosthetists and Orthotists
REPORTS:
The following reports were submitted to the board:
§ Total Claims Paid for FY 2011 (1st, 2nd, & 3rd Quarter): Total – $858,761.16
§ Paid Claims FY 2011 (1st Quarter): Total – $294,204.56
§ Paid Claims FY 2011 (2nd Quarter): Total – $267,125.23
§ Paid Claims FY 2011 (3rd Quarter): Total – $297,431.37
BUSINESS:
§ Condolences were given to Ronnie Ezell regarding the passing of his father.
§ Thoughts and prayers were given to APOA for Dan Oglesby regarding his mother being ill.
§ Introduction of all attendees.
§ Attendees reviewed FY 2011 Reports. Currently, POP is on track to remain under budget. Felicha stated if our budget remains between $300,000 – $350,000 per quarter, we will not exceed our allotted amount.
Page 2
Minutes From POP Board Meeting
August 17, 2011
§ Felicha stated that she did a comparison regarding expenditures for FY 2010 & FY 2011. Glenn inquired what the totals were for each quarter for FY 2010.
o Total Claims Paid for FY 2010 (1st, 2nd, 3rd & 4th Quarter): Total – $920,041.26
o Paid Claims FY 2010 (1st Quarter): Total – $165,005.81
o Paid Claims FY 2010 (2nd Quarter): Total – $146,361.47
o Paid Claims FY 2010 (3rd Quarter): Total – $213,327.92
o Paid Claims FY 2010 (4th Quarter): Total – $395,346.06
§ Retrospective Review letters were mailed to ten randomly selected Accredited Facilities on May 19, 2011. Felicha stated out of the ten facilities, all records were acceptable and were received by the Agency in a timely manner (within 30 days). Majority of the records were received within a week from the date of the request.
§ Stephen Blackwell inquired about what procedures Medicaid has in place to monitor fraud/abuse. Felicha stated that is the purpose of the Retrospective Reviews. A query is run, grouping paid claims by accredited facility and then by recipient ID. Medicaid cannot view every claim for abuse, but we monitor the claims as best as we can, especially the “big ticketed” devices. No sign of fraud or abuse has been detected at this time.
§ Felicha inquired if there is an updated version of the APOA Products Illustrated Guide. The 2009 version is the latest guide Medicaid has. APOA will forward a copy of the 2011 version to Felicha.
§ APOA will do a review of all current codes to see if any codes are not being utilized. This procedure will determine if any codes should be eliminated or if any codes will be recommended as additional codes.
§ Glenn Crumpton stated that there are some codes he does not use because the “complimenting” code is not currently covered by Medicaid (ex. L5972). Glenn wants to add L5972 to the POP Program in order to utilize Code L5986. Code L5986 is currently covered by POP. Stephen stated that he has to improvise, using the codes that are currently covered by Medicaid in order to make the device work. Felicha asked Glenn to research the codes and send documentation regarding which codes he recommends Medicaid should add. Cathy will be responsible for submitting documentation to Felicha. Once information is received from Cathy, Felicha will forward to Marilyn and Dr. Moon for consideration.
Page 3
Minutes From POP Board Meeting
August 17, 2011
§ Fred Crawford read an email to the board that he received on August 15, 2011 from Stephen with Baker Medical. Stephen asked Fred if Alabama Medicaid reimburses for LSO/TLSO spinal braces for adults. The last time Stephen looked at the most recently revised Fee Schedule, it looks like Medicaid might reimburse for adults on some items including some L Codes for LSO/TLSO spinal braces, but he is not exactly sure. According to POP newly covered codes, the two L Codes in question (L0472 & L0486) are covered by Medicaid. Fred gave a copy of the email to Felicha for Medicaid’s response. Felicha will respond to Stephen via email.
§ Fred Crawford stated mastectomy fitters are licensed now, but the fitters can only be supplied by an accredited facility. The funds for mastectomy fitters are a different allocation from POP. Fred hopes the mastectomy filters will not require a PA. Fred stated that he will communicate with Ida regarding the mastectomy fitters.
§ Cathy stated she is concerned about bilateral patients. At the present time, there is not a modifier within the system to notate “left” or “right”. Ida is in the process of updating the system to identify “left” and “right”.
§ The Legislative Session will begin a little later the coming year. Session will begin February 2012.
ACTION ITEMS:
§ APOA will review current Procedure Codes for possible additions and/or deletions.
§ Felicha will respond to Stephen with Baker Medical regarding Codes L0472 & L0486.
§ APOA will provide Felicha with the 2011 version of the AOPA Products Illustrated Guide.
§ Cathy will submit documentation to Felicha regarding adding code L5972 in order to utilize code L5986.
TENTATIVE DATE FOR FUTURE MEETING:
§ Thursday, January 19, 2012
Meeting adjourned at 2:15 P.M.
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