All About CMS' Carrier Advisory Committees
March 19, 2009
By Saty Satya-Murti, MD, FAAN
What is a Carrier Advisory Committee?
- A Carrier Advisory Committee (CAC) enables neurologists to provide input on policies and patient care that comes under Medicare.
- Although Medicare is a federal program, policy setting, payment processing, and utilization review are frequently within the purview of regional non-governmental carriers (a.k.a. contractors).
- Carriers are regional administrative domains. They are often divisions of large health care insurance companies such as Anthem or Blue Cross/Blue Shield Association members. Each carrier has a medical director and an administrative staff.
What is the composition of a CAC?
- CACs consist of the medical director and representatives of specialties, state medical associations, and other health care providers, such as podiatrists and chiropractors.
- Typically, physician representatives are selected by the state specialty societies. Length of service may or may not be specified by the society.
How does a CAC operate?
CACs usually meet on a quarterly basis. Meeting times are announced well ahead of time. Medical policies (called Local Coverage Determinations or LCDs) under consideration, are disseminated in advance of the meeting. Often there are neurological topics of interest slated for discussion.
What does a standard LCD look like?
Policies are written in standard formats that include federal statutes governing Medicare, a brief scientific review behind the issue, then the policy itself, followed by a list of applicable procedure and diagnostic codes (ICD-9-CM). Policies are usually less than 10 pages long and explicitly detail coverage conditions (affirmative or negative). Once familiarized with the formats, one can usually scan a policy in 10 to 20 minutes.
What are some of the duties of a CAC representative?
- Provide substantive feedback on coverage and policies of local and national scope
- Communicate between practitioners and administrators/policy setters, with the CAC member as the communicating medium
- At times the contractor staff or Medical Director may seek help in education or review of data and claims from other health care providers—this is an optional service that might be compensable
The actual mechanics of these processes are flexible and context-dependent. For details, please contact Katie Shepard, Senior Manager, Medical Economics, at firstname.lastname@example.org or (651) 695-2783.
You can also browse Centers for Medicare & Medicaid Services (CMS) web resources, such as the Medicare Program Integrity Manual, Chapter 13: Local Coverage Determinations, or Zone Program Integrity Contractors (ZPIC): B. Secondary Sources of Data.
Why should I become a CAC representative?
- As a CAC representative in your state you gain a voice. The neurology community and you have the opportunity to shape the environment in which neurologists practice.
- Being a CAC representative is a service to fellow neurologists and colleagues.
What are the opportunities associated with being a CAC representative?
- You will have input on Medicare policy decisions. You will be able to voice balanced opinions on medical policies that directly impact neurology as a profession. The forum is collegial and conducive to learning.
- In the arena of health care this is an interactive effort at education, shared awareness of contemporary issues, and an underutilized opportunity for silent learning.
Can you give me examples of how CACs and the CAC process will be of benefit?
- In the fall of 2008, the AAN Professional Association realized that intraoperative neurophysiologic monitoring (IOM) practice was less than optimal in certain regions. We developed a model coverage policy for this technology. CAC representatives brought this policy to a Carrier Medical Director for Highmark. Highmark altered its existing medical policy on IOM to fit the standards outlined in the Academy document.
- NeuroCAC members and Contractor Medical Directors have worked collaboratively in the past to obtain early coverage of new technologies (e.g., deep brain stimulation, vagal nerve stimulation).
- Issues that are not otherwise prominent within the working routines of contractor staff may gain helpful attention. For example, questions may be addressed about appropriate use of nerve conduction studies, reimbursement for same date-of-service procedures, and E/M consults.
- CAC members can serve as a conduit for bringing concerns and decisions of the Academy to the attention of the contractors.
What if I can't make it to every CAC meeting?
- CAC representatives may be able to participate via phone or designate an alternate member to attend.
If you are not a representative, do you know who the representative is for your region?
The Academy keeps a listing of all Neurology CAC representatives for the 50 states (NeuroCAC). The NeuroCAC is a resource for representatives to share issues across states; and staff also sends NeuroCAC representatives regular updates and Medicare news. Contact Katie Shepard at email@example.com, or (651) 695-2783, if you need your representative's name and/or contact information.
How will the new Medicare Administrative Contractors (MACs) change current CAC structure?
This is an area of uncertainty as CMS continues to roll out plans for the MACs in the future. These new groupings may provide greater opportunities for influence in the Medicare policy world. Stay updated on the CMS MAC process: monitor the Academy's website for the latest information on this important subject.
About the Author
Dr. Satya-Murti was an early NeuroCAC member (1993–1995), and later a Medicare contractor medical director for three Midwestern states (1995–2005). Currently he consults for nonprofit organizations and industry. He is a panelist for Medicare's MEDCAC (Medicare Evidence Development & Coverage Advisory Committee).
Within the past 24 months, Dr. Satya-Murti received personal compensation for serving in an advisory role for Genentech, GlaxoSmithKline, Amgen, Avalere Health LLC, Covance, Argenta Reimbursement Advisors, NeurogesX, AMAG Pharmaceuticals, and Allergan.