esMD Pilots Workgroup

1. esMD Pilots Workgroup January 9, 2014

2. Meeting Etiquette • Please announce your name each time prior to making comments or suggestions during the call • Remember: If you are not speaking keep your phone on mute • Do not put your phone on hold – if you need to take a call, hang up and dial in again when finished with your other call • Hold = Elevator Music = very frustrated speakers and participants • This meeting, like all of our meetings, is being recorded • Another reason to keep your phone on mute when not speaking! • Feel free to use the “Chat” or “Q&A” feature for questions or comments From S&I Framework to Participants: Hi everyone: remember to keep your phone on mute  NOTE: This meeting is being recorded and will be posted on the esMD Wiki page after the meeting

3. Agenda

4. Announcements • We need the Pilot Project Profiles from each pilot participant for esMD ASAP – these are pastdue! • Pages on the Wiki are being developed for each of the pilot organizations • A demo will be provided next week for how to navigate the space • Next meeting: Digital Signatures and PPA overview

5. Pilot Interest

6. Electronic Determination of Coverage (eDoC) 6

7. eDoC General Workflow Patient LCMP Physician Specialist / Service Provider Templates and Rules Payer 7

8. eDoC Workgroup Structure 8

9. Power Mobility Devices (PMD) 9

10. PMD Definition 10

11. PMD Reviews and Submission Methods PMD Reviews require Suppliers to submit: • Face-to-face evaluation documentation (created by the physician/practitioner) • 7 element order (created by the physician/practitioner) • Detailed product description (created by the supplier) • Any other medical documentation to support the LCD requirements. PMD Documentation submission methods • Mail • Fax • esMD 11

12. Types of Review • Prior Authorization • CA • FL • IL • MI • NC • NY • TX • Prepay Review • Postpay Review 12

13. Decision Letters • Prior Authorization Decision Letters are sent to: • Physician/practitioner • Beneficiary • Supplier • Prepay & Postpay Decision Letters are sent to: • Supplier 13

14. Coverage and Documentation Requirements • Complete coverage and documentation requirements are outlined in the following policies: • National Coverage Determination (NCD) for PMD • LCDs for PMD • Jurisdiction A LCD (including NY) • Jurisdiction B LCD (including IL, MI) • Jurisdiction C LCD (including FL, NC, TX) • Jurisdiction D LCD (including CA) • CMS MLN Matters Article(SE1112) provides further guidance and clarification about documentation for physicians and treating practitioners when ordering PMDs 14

15. Structured Information for PMD • Based on clinical template developed by CMS • Available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Computer-Data-and-Systems/ESMD/Downloads/Suggested-PMD-Electronic-Clinical-Template-v98-posted-11-02-12.pdf • Supports • Data collection by providers during face-to-face evaluation • Reporting of clinical information for coverage determination • Clinical decision support and automated determination of coverage 15

16. Components of PMD Clinical Template • Chief Complaint • History of Present Illness • Past Medical History • Review of Systems • Physical Exam • Patient Assessment and Plan • Physician Information and 7 Element Order • Components focused on data to support a PMD order and coverage 16

17. eDoC Timeline July ‘13 Mar ‘13 May ‘ 13 Aug ‘13 Jun ‘13 Feb ‘13 Apr ‘13 Pre-Discovery Workgroup Charter/Scope Kick-Off PMD Phase 1 Pilots (TBD) PMD Phase 1 Implementation Guide Use Case #1: PMD Phase 1 Standards/Data Model/Harmonization PMD Phase 1 Sub Workgroup PMD Structured Data PMD Phase 2 Implementation Guide Use Case #1: PMD Phase 2 Standards/Data Model/Harmonization PMD Phase 2 (TBD) Sub Workgroup PMD Data Capture Template Sub Workgroup PMD Decision Support 17 17

18. PMD eClinical Template Workflow Patient LCMP DME Supplier Physician HIH eClinical Template ECM Content Transport Services Payer Medicare Administrative Contractors 18 CMS Private Network

19. PMD eClinical Template Streams Physician Provider EHR Stream 1 – Native eClinical Template eClinical Template CDA/PDF Stream 2 – SDC eClinical Template SDC eClinical Template eClinical Template PDF CDA/PDF Stream 3 – Portal eClinical Template P1: PDF P1: PDF P1: PDF Copy and Paste HIH HIH HIH eClinical Template Portal P2: CDA P2: CDA P2: CDA CDA/PDF EHR Database EHR Database EHR Database P3: Signed CDA P3: Signed CDA P3: Signed CDA ECM PDF Content Transport Services Payer Medicare Administrative Contractors 19

20. Next Steps • Complete Pilot Proposal documentation and submit to Sweta • Schedule 1:1 meetings to work on Pilot Project Proposal • Engage the esMD Community