JANE & Terra Notes

Question 1

Steps to qualifying New Patients for the allograft.

Answer 1

1. Referral from Dr
2. Gather all information.
   (copies of ID, Insurance cards etc.
3. Initial Evaluation
4. IVR
5. Place order for Graft if IVR complete.
6. Schedule appointment.

*Ahsan will check insurance before the IVR (so that we don’t waste time & money doing an IE…if the insurance doesn’t pass the IVR)

Question 2

New Hope currently accepting the following insurances…

Answer 2

Medicare B
Aetna
Cigna
Tricare

Question 3

FNP process

Answer 3

1. Initial Evaluation
2. LOMN (Letter Of Medical Necessity)
   which includes primary diagnosis,
   CPT Codes.
3. Order Form signed by FNP

Question 4

On JANE the following is very important when registering new patients…

Answer 4

Patient release of information? Yes
Signature on File? Yes
Accept Assignment? Yes

Question 5

The LOMN should include a sentence something to the effect that….

Answer 5

I plan to use a 4x4 graph on this patient weekly times 10 weeks for a total of 160cm (4x4 =16, 16x10weeks = 160sqcm)

Question 6

If a patient is impaired and doesn’t make their own medical decisions…

Answer 6

POA = Power of Attorney from family member is needed.

Question 7

Frequency Guidelines for allograft…

Answer 7

10 weeks maximum.

Question 8

Estoy al borde de un desarollo rapido de todo lo Q PBLTyC … los deseos de mi corazon…

Answer 8

I’m on the brink of a rapid unfolding of the desires of my heart for abundance and prosperity and excellent health y proteccion divina.

Question 9

Guarantor…

Answer 9

person who carries the insurance. (self/spouse/parent)

Question 10

Portal/ Website where Medicare processes claims …

MAC Medicare Administrative Contractor

Answer 10

Noridian = CA
Novitace = CO

Question 11

Noridian has …

Answer 11

safeguards in place to prevent fradulent claims. All steps must be followed exactly by the rules and regulations established by Noridian.

Question 12

When a new graft product is realeased and it goes up in the HCPiCS (hickpicks)

Answer 12

*higher MRR
*LCD - Local Coverage Determination guidelines have to be reviewed to see if it applies to Noridian claims.

Question 13

On 10/2/2023 Terra and I did a
Pre-Claim Review on … aka Pre-D

https://med.noridianmedicare.com/web/jadme/cert-reviews/mr/pre-claim

Answer 13

ADMC - Advanced Determination Medicare Coverage (done before IVR)

*Terra emailed me a list of things that we need to submit.

*but then later we (Terra & I) called Noridian and it was determined that the ADMC is not necessary even for SNF patients.

Question 14

Q4281 CPT

Answer 14

Barrera

Question 15

Q4205 CPT

Answer 15

Membrane Wrap from Alerce

Question 16

Vashe

Answer 16

*a saline-based solution used to clean wounds
*inhibits bacterial growth
*creates moist environment and loosens materials in wound bed.

Question 16

Moleculight Inc

Answer 16

Wound Imaging Device
*visualize bacteria load
*portable
*non-invasive
*real-time

Question 16

Grafts from Alerce

Answer 16

We’re stopping at 10 grafts.
Based on phone conversation with Rick, Ahsan, and Alerce CEO.

Question 17

HCPCS (hickpicks)

Answer 17

*Line on ADMC
*Q Codes corresponding to c.m. of graft utilized for a patient.

Question 17

PECOS is registered through CMS and corresponding MAC (Medicare Admin Contractor) in CA it’s Noridian.

Answer 17

*Medicare Enrollment Mgmnt System.
*Allows individuals/ groups to enroll as
providers.
*To access PECOS go to the NPPES registry login w/ UN&PW.

Question 18

MSRP

Answer 18

Manufacturer Suggested Retail Price

Question 19

ASP (related to graft)

Answer 19

Average Sales Price

Question 20

IVR

Answer 20

Ins. Verification Request

Question 21

LCD

Answer 21

Local Coverage Determination

Question 22

ADS

Answer 22

Automated Development System (Noridian Portal)

Question 23

JE in Noridian

Answer 23

Serves Part A & Part B

Question 24

HIPAA

Answer 24

Fed agency protects patient privacy.