NHIC Carrier Advisory Committee Meeting Report
held on April 19, 2006 at the Hilton/LAX

Chaired by Bruce Quinn MD, Medical Director NHIC, part B Medicare carrier
Written by Jeffrey Kaufman MD, FACS

1. Reviewed new LHRH agonist draft policy that expands Least costly alternative policy to include all currently available agents but provides that pricing will be crosswalked only among similar interval drugs, e.g. one month pricing will not be crosswalked to 1/12 of one year pricing (a much better policy than used in many other states). No drug with less than 20% of market share in the previous quarter will be used to set the LCA price for this drug class. Abarelix is specifically excluded from being used in this LCA computation since it is not strictly an alternative medication. Draft is now open to public comment for 45 days before becoming policy. Verbal comments offered by me in the meeting followed up by written comments attached in another email.

2. Reviewed several other new draft LCD policies as posted on the web at www.medicarenhic.com

3. Update on causes for denied claims secondary to duplicated claims and information about 6/1/06 requirement that all physician claims must now be submitted electronically unless office is exempt. Also noted 7/1/06 date when complete transition from paper remittance forms made to electronic remittance advice.

4. Update on CERT process reviews of prior processed claims for errors emphasizing the mandatory responsibility of physician to comply with demands for records or face demand for reimbursement of "overpayment" even if the requested items are from notes made at a SNF or in hospital chart. Instructed to document everything carefully and appeal CERT denials if appropriate.

5. Medicare part A update from Arthur Lurvey MD, United Government Services.

6. Lumetra update, the quality improvement organization for Medicare for California.

7. Next CAC meeting July 19, 2006 in Oakland, CA.