Medicare Audits Update

Orthopaedic CAC Network

David Templeman, MD | October 20, 2012

What is a CAC?

• Contractor Advisory Committee

• A group of clinicians that advises Medicare contractors about coverage determinations

Why Should We Care?

• Other specialties and non-physicians will speak for us if we do not speak for ourselves

• Some coverage determinations have dramatic consequences (TJA)

AK & HI not to scale

0

0

500 Miles

500 KM

AK

TX

UT

MT

CA

AZ

ID

NV

OR

IA

COKS

WY

NM

MO

MN

NE

OK

SD

WA

AR

ND

LA

HI

ILOH

FL

GAAL

WI

VA

IN

MI

MS

KY

TN

PA

NC

SC

WV

NJ

ME

NY

VT

MDDC

NH

CT

DE

MA

RI

1

23

56

815

131412

1110

9H

Medicare Administrative Contractor Jurisdictions

About CACs

• Each CAC advises its MAC by reporting to its contractor medical director (CMD)

• A MAC that covers 5 states will have 5 different CACs

• Each of those 5 orthopaedic surgeons should have a consistent message regarding orthopaedic procedures for the CMD

What Does a CAC Rep Do?

• Meet 3-4 times per year• Review proposed LCDs• About ALL types of medical

services, not just orthopaedic• Report back to state orthopaedic

society and the AAOS

Orthopaedic CAC Network

The Network will share information in order to:

• Ensure a consistent message from orthopaedic surgeons

• Learn what may be coming to a MAC near you

Orthopaedic CAC Network

The Network will:• Meet at the AAOS Annual Meeting• Hold 4 teleconferences annually• Produce/receive 6 newsletters

annually

Orthopaedic CAC Network

• Policy recommendations will be made by the Board of Directors and its Coverage Determinations Project Team

• Network led by BOC executives

Orthopaedic CAC Network

• AAOS has identified CAC representatives in 27 states and DC

• Vacancies for orthopaedic surgeons in 19 states

• No information for AR, HI, MD

Where Are the Vacancies?

• Alaska• Colorado• Idaho• Illinois• Indiana• Kansas• Kentucky

• Massachusetts• Missouri• Montana• Nebraska• New

Hampshire• New York

• North Carolina

• Ohio• Utah• Washington• West Virginia• Wyoming

How Do We Fill a Vacancy?• Nominate someone through your state

orthopaedic society

• Contact your CMD and tell him/her of the nomination

• If you need your CMD’s contact information, contact Ashlen at strong@aaos.org

Who is My State’s CAC?

• Look at the display outside the door

• Contact Ashlen for more information at Strong@aaos.org