Medicare
An Overview of the Medicare
Carrier Advisory Committee (CAC)
Michael R. Jennings, MD, FACC
The
Ohio-ACC has been the official representative of cardiology to the Carrier
Advisory Committee (CAC of the Ohio Medicare Carrier (previously
Nationwide Insurance and currently Palmetto GBA) for as long as we have
had a state chapter. The Medicare CAC has practitioner representatives
from all medical disciplines to advise the carrier regarding Local Medical
Review Policies (LMRPs) and individual medical coverage decisions. LMRPs
need to be discussed at a CAC prior to implementation. The members of the
CAC do not have veto power over these decisions however they may influence
the medical director's eventual decisions. Our ability to influence these
decisions by the medical director is based on the openness of the
individual medical director and the relationship of the CAC members with
this individual.
Traditionally
the Ohio-ACC president had been the representative, but this arrangement
necessitated considerable travel for presidents who lived outside
Columbus. Therefore, the Ohio-ACC Board decided to appoint a liaison to
the Medicare Carrier Advisory Committee. For the past five years, I have
served as the representative from the Ohio ACC to the Ohio CAC. I am
available by beeper in Columbus whenever either of the Medicare carrier
medical directors has a question or needs advice regarding a matter of
medical practice. I have called upon a number of Ohio-ACC cardiologists to
help address these questions. Many LMRPs regarding cardiology procedures
have been rewritten with the input of subspecialists in their respective
areas.
The
Ohio-ACC Board of Trustees has chosen to retain and formalize the position
of the Ohio-ACC CAC representative for maximal input to the Medicare
medical directors whereby has been created. This individual needs to live
and practice in central Ohio and be available to attend three or four
Saturday morning CAC meetings throughout the year as well as be available
to be on call by beeper to the two medical directors. This individual will
report to the Ohio-ACC president and the Board of Trustees. The Chairman
of the Third Party Committee (Dr. Charles Botti, Jr.) will continue as the
alternate. The new Ohio-ACC CAC representative is Dr. Timothy Obarski of
Heart Specialists of Ohio. He may appoint additional alternates as needed
for special projects.
During
the past year there have not been any important cardiology LMRPs
discussed. We have rewritten many however over the past five years. There
is a tension at the level of national Medicare regarding the place of
local control versus national standardization of policy. Local control by
way of CAC's has historically had precedence with few national coverage
decisions (which take precedence over local if a national policy exists).
CMS is under pressure to make coverage uniform throughout the country. The
ACC has supported local medical directors for statewide carriers and LMRPs
because the physicians are able to have much more influence at the local
level as compared to the national level. The ACC now has a meeting of the
CAC representatives from the states twice a year and active e-mail
contact, which I have participated in and benefited from when we have
contentious issues in Ohio. This is very beneficial to prevent major
coverage problems for our patients.
The Ohio-ACC is currently very active in the Medicare CAC in Ohio, and
this has resulted in favorable coverage decisions for many cardiology
procedures in Ohio over the past few years. Our influence requires that we
be available to help the medical directors when they ask. Dr. Obarski will
be available to do this-- however, he needs your help and support to
accomplish the task. I will encourage him to involve members of the Ohio
ACC who are experts in their area of interest to help solve problems as
they develop. He may ask you to present your opinions to the Medicare
Medical Directors and I would encourage you to help if asked.
We
can either sit back and complain or we can get involved and fix the
problems. We are indeed fortunate to have two excellent medical directors
Dr. Robert Kamps, an internal medicine physician, and Dr. Robert Ludwig, a
gastroeneterologist. They are very committed to the Medicare beneficiaries
in Ohio and their doctors. We look forward to continuing our strong
working relationship with them.
Medicare
Part B
There has been a transition of the Medicare Part B
contract from Nationwide to Palmetto GBA and AdvanceMed.
Visit the Palmetto GBA site at www.PalmettoGBA.com
Click here for the most recent Medicare Bulletins.
You can obtain a copy of the
Medicare Physician Fee Schedule at no charge by downloading it from www.PalmettoGBA.com.
Copies are also available on paper or compact disk (CD) for a charge of $5.00
each. Please forward your request, along with your payment, to the address
below. Make checks payable to Palmetto GBA.
Dale Bates
Medicare Disclosure/FOIA
Palmetto GBA
P.O. Box 182947
Columbus, OH 43218-2947
Medicare Concerns?
Timothy Obarski, DO,
FACC, Ohio-ACC Liaison to Medicare