Coverage Determinations Project Team

 Members

David Templeman, MD, ChairDaniel Berry, MDCraig Butler, MD

Wilford Gibson, MDDavid Halsey, MD

Wellington Hsu, MDPeter Mandell, MD

Ashlen Strong, Lead StaffMatt Twetten, Staff

Project Team Charges

• I AdvocacyI Advocacy

• II GuidelinesII Guidelines

• III EducationIII Education

CDPT/AAOS Actions

• Member EducationMember Education

• Member PublicationsMember Publications

• Audit Reporting ToolAudit Reporting Tool

• Orthopaedic CAC NetworkOrthopaedic CAC Network

• Model LCD for TJA ProceduresModel LCD for TJA Procedures

• Congressional LetterCongressional Letter

• Meetings with CMSMeetings with CMS

• MLN Matters ArticleMLN Matters Article

• Meetings with MACsMeetings with MACs

• Regulatory Comment LettersRegulatory Comment Letters

Model LCD

• Modeled after First Coast Service Options LCD Modeled after First Coast Service Options LCD in Floridain Florida

• Reviewed by AAHKSReviewed by AAHKS• Improved by CDPT and PLImproved by CDPT and PL• Sent via postal mail and e-mail to ALL Sent via postal mail and e-mail to ALL

Contractor Medical DirectorsContractor Medical Directors• Available at www.aaos.org/Medicare101Available at www.aaos.org/Medicare101

MAC Response to Model LCD

• Two MACs currently considering adoptionTwo MACs currently considering adoption• MAC J10—AL, GA, TNMAC J10—AL, GA, TN

• Communicated with AAOS staff that they would Communicated with AAOS staff that they would introduceintroduce

• AAOS coordinated with CAC representativesAAOS coordinated with CAC representatives• Drafted comment letterDrafted comment letter

• MAC J1—CA, HI, NVMAC J1—CA, HI, NV• In preliminary stagesIn preliminary stages• Identical to model LCDIdentical to model LCD• AAOS will supportAAOS will support

Audit Reporting Tool

• AAOS Fellows can report audit activity AAOS Fellows can report audit activity to the AAOSto the AAOS

• Distributed via Distributed via Advocacy NowAdvocacy Now, state , state orthopaedic societies, the BOC list-serv, orthopaedic societies, the BOC list-serv, and AAOEand AAOE

• Find it at www.aaos.org/Medicare101Find it at www.aaos.org/Medicare101

AAOS

AAOS

AAOS

Member Publications

For the Latest Information

• Visit the Medicare Audits 101 webpage:Visit the Medicare Audits 101 webpage:

• www.aaos.org/Medicare101

Benjamin Franklin

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

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