Representatives from:

Baird, Kurtz, and Dobson, LLP, Ashley County Medical Center, Arkansas Hospital Association, Medicaid/EDS Provider Relations, White County Medical Center, Medical Park Hospital Hope, Arkansas Department of Health, Facilities Services, North Arkansas Regional Medical Center, Arkansas Foundation for Medical Care, St. Bernards Healthcare, St. Vincent North Rehab Hospital, and Chambers Memorial Hospital

Tanya Brooks, Professional Services
Amanda Crosby, Manager, Provider Audit and Reimbursement
Charlotte Garlington, Senior Nurse, Medicare Post Pay Review
Greg Hart, Professional Services
Linda Lewis, Supervisor, Medicare Part A Claims and Customer Service
Barbara McDanel, Director, Medical Integrity Programs
Theresa Milligan, Director, Medicare Administrative Support
Kelley Vaughan, Analyst, EDI
Forrest Wolfe, Manager, Medicare Claims

1. Arkansas Hospital Association

• A representative reviewed the general purpose of the Provider Advisory Group and introductions were made of new members:

• Arkansas Blue Cross and Blue Shield, as the Medicare Part B carrier for Missouri, has elected to close the office in St. Louis, Missouri on May 7, 2003. The Missouri functions have been distributed to the other Arkansas Blue Cross and Blue Shield operational sites as follows:

Arkansas - Provider Relations and Correspondence
Louisiana - Customer Service Calls and Provider Enrollment
Oklahoma - Process of Part B claims

• Provider Advisory Group (PAG) - There have been some changes to report. We are no longer considered the Provider Advisory Group (PAG). The name has changed to Provider Communication Advisory Group (PCOMAG). On our web-site, we now have a link to the PCOMAG, which contains a description of the group and the minutes. The minutes must be finalized and out in 7 days. The issue of whether to provide the names of the representatives in the minutes or use generic identifiers was discussed. For this meeting we will use the generic identifiers. We will develop an authorization form for the members to sign, which grants us the use of their names in future minutes.
• Another key component of the PCOMAG is to gather input from the members on the best ways to get information out to other providers, etc. Some venues could be teleconferencing, video conferencing, etc.

• The physicians fee schedule is now a 1.6% increase instead of a 4.4% decrease. The enrollment period was extended until April 14, 2003. This was the last day to change their participation status. There could be periods of participation and non-participation during the first of the year. January and February DOS claims processed after March 1with the 2003 fee schedule will be adjusted in July, as these should be paid at the 2002 fee schedule.

• Outpatient PPS Issues:

1. Transitional Outpatient Payments (TOPs) - When we first went on Outpatient PPS we were given a cost to charge ratio for each provider to use to calculate the cost. Now we have new instructions to use more current year's data. This has resulted in overpayment calculations for some providers. There is a cost report settlement for TOPs that we use. There will be retrospective settlements of the TOPs payments, which may result in us taking money back. There are a few which will receive more money. A representative from North Arkansas Regional Medical Center asked, "What cost to charge ratio did you use versus what you are using now?" The cost to charge in the beginning was '96 now it is the most recent filed cost report we have in house regardless of its status. These could change again as we get additional information to settle the cost reports. A representative from Arkansas Hospital Association asked, "How are we notifying the providers?" As we have calculated the new ratios, we have notified the providers of their new ratios and are providing letters as we settle the reports. The representative then asked that Amanda send him a copy of the letter being sent to advise providers of their new ratio.

2. CMS’s use of the term pass-thru in talking about the payment for certain new drugs in biologicals and technology has been very confusing because a lot of the providers still expect that they will still get a bi-weekly lump sum pass-thru payment for those things. This is not true. The payment is now included in the claim payment - not separately. This is very confusing for the providers. A representative from Ashley County Medical Center asked about the elimination of the pass-thru in January. They are still receiving less than they would have gotten when the pass-thru was being paid separately. Amanda noted that each year when the new calculations are developed; some items are reclassified as "not new", thus not subject to extra pass-thru payment. If a provider has specific questions on claims, they can contact Amanda's staff to help them calculate. It was noted that Blue Cross (Regular Business) is still paying for these items.

• Provider Enrollment:

• Provider-Based Status:

• A representative from Arkansas Hospital Association asked, "Is the Medicare inpatient reimbursement now being paid under the new provision of the Omnibus Budget Act of 2003 that lowers the labor portion of the base rate and equalizes the base rate for all hospitals?" Amanda wasn't sure on exactly what was being paid but would check into it.

4. Arkansas Department of Health Facilities Management

• Nothing to report

• A review was presented for the top 25 reasons for provider calls and top 25 denial reasons. Most of the errors relate to the patient name on the claim not matching the name on our files. The top reason for phone calls is asking for claim status. Claims status is always the top reason for calls - all this information is available on the remote. When a call is placed, we will only give claim status on 4 claims at a time, and then, the providers must hang-up and call back. With the remote system, you can stay on as long as you want and obtain all of your claim status. You can have as many remote units as you want, just let us know how many. Forrest will go back and look at the statistics to see how much more the providers are using the remote system. A representative from Ashley County Medical Center had an issue with a staff member not being able to gain access to the remote. The staff member is coming in at 5 - 6 a.m. in the morning to do their work because they are having a difficult time getting onto the remote. It was noted that the system generally is accessible Monday - Friday from 5:00 a.m. - 6:30 p.m., and also on Saturdays. There was a request for provider specific information as to their level of inquiries - Forrest will provide. There was a question about the large increase in inquiries about names from the fourth quarter of 2002 to the first quarter of 2003. Forrest will verify the numbers since they do appear to be monthly numbers instead of quarterly. There was a question about whether you can check the name on the remote? This was confirmed.
• There was a question about the possibility for remote for Part B. This would be a real help to providers that have in-house clinics. A representative from Arkansas Hospital Association noted that during a meeting on April 8, 2003 a new committee was initiated just for Blue Cross private business. He stated that Sharon Allen, President of Arkansas Blue Cross and Blue Shield, continues to push the use of the Advanced Health Information Network (AHIN). AHIN is web-based and can be used for submission of claims, correction of claims, and to check claim status. A question was asked in regards to the access to 270/271 after October 15, 2003, we want to use one source. One of the problems with AHIN is that it only checks certain insurance. The ones that are mostly needed you can't check. IGI is the consultant being used by a consortium of providers who wants to add Blue Cross and Medicare information.

6. Linda Lewis - Medicare Part A Claims and Customer Service

• We are getting calls on claims that we have just received. They are asking that they be worked special. We prefer that the claims be at least 20-25 days old before calls are made. We are trying to work our locations in order.
• SM5052 Questions - This is a HIC name match issue, which requires contact with another CWF host. Providers asking for them to be released. Providers have to wait 5 days before they can be released. Also, we get calls on codes stating that these are covered codes why aren't you paying for them. Linda noted that because a code is listed in some of the books, which are available on the market, it doesn’t mean Medicare covers them.
• SM5044 Location - We are holding claims and are working to get them released in the near future. These are claims, which contain some National Coverage Determination lab codes that were incorrectly kicked out by the system. The codes were published in the AHA Notebook publication. The system has now been fixed. But, we have quite a few claims pending which must be adjusted. Over 10,000 claims approximately impacted. The issue is how to work them based on whether they are included, excluded or payable based on the code and the coverage. We are using SuperOps to attempt to set up an automated method of processing these claims. If the providers submitted the claims without the codes to get the claims paid, they will have to submit the claims with the codes for adjustment. Charlotte Garlington noted that the April newsletter contained a large number of changes to the codes, which will impact the processing of claims. The newsletter changes will be effective back to January. NCD went into effect November 25, 2002 but the actual NCD updates did not go in until January 1, 2003 and this is when everything was turned off. You will need to go back to January 1, 2003 on all claims.
• Linda also stated that there are a few other reason codes APR03, OCE3, and 37150, which have problems and they will hopefully have the system fixed this week. There will be a mass release on these once the fix is made. There was a question about the release of MSP claims by the end of April. This will have to be checked and information will be provided. The issue about the OCE15 and A9515, 92597 and G0200 and others will be addressed in a short note and provided to a representative from Arkansas Hospital Association for inclusion in the AHA Notebook and on the Medicare web-site.
• Greg noted that one of the handouts is a printout off of the CMS web-site. It addresses the changes to the various Medicare manuals and Program Memorandums. There was one about the current OPPS and OCE changes. This is CMS's attempt to get information out more timely.

7. Barbara McDanel - Medical Review and Program Integrity

• Barbara noted that our Fraud and Abuse activity has been awarded to AdvancedMed out of Nashville, TN and the transition was completed as of March 15, 2003. In the future, a representative from AdvancedMed may be attending the PCOMAG.

8. Charlotte Garlington - Medicare Medical Review, Part A

• The LMRP and April newsletters are out. We are about to implement some edits on various policies which will contain the diagnoses and codes in the policies that will result in auto denial of claims not meeting the criteria. We are working to clear out the claims that have been held for various reasons. An issue came up with a provider with a Skilled Nursing Facility (SNF) who did not know about remote and that they are able to obtain claim status information through the remote. Charlotte stressed that the personnel who deal with the remote should be providing the personnel working the claims filings with the reasons why the claims are being denied. Also, please be sure that all the various levels of personnel in the facilities are aware of the web-site, the newsletters, the policies, and the remote with the reason codes.
• Last quarter it was noted that there were a lot of providers who were not responding to the Additional Development Requests (ADR) and it was asked if this had improved. Charlotte stated that she would need to review the data and get a report to the PCOMAG at the next meeting. She noted that the re-reviews have increased greatly. We are looking at the reasons for this increase.

• Charlotte noted that a therapist in a meeting yesterday had never seen an UB92. They did not know what is required to be filed in order to get a reimbursement on a claim. Also, they did not know what documentation is necessary for the billers to have available in order to code the claim.
• A representative from Chambers Memorial Hospital asked for information concerning the billing of the E&M 99211 code for wound care. Charlotte will get the information together and get back with the representative since they have a therapist on contract that wants to do this. Another provider noted that they have the same issue. For therapists who are trained to do wound care, how do the facilities get reimbursed for the debridement by a therapist? A question was asked to find out what code 99211is really for? Charlotte noted that there is talk about setting up special E&M codes just for use by the hospitals.
• There was a request for a workshop on wound care, which would include, what can be done, how to bill, and etc. for outpatient services. Greg noted that there will be a Part B workshop for physical therapy. Greg also noted that since we have gotten a lot of questions about wound care and there are new policies, we will work on a special article in the next newsletter. There was also a question about autologous wound care.
• Charlotte made a brief statement on the Additional Development Requests (ADR) letters issue. There was an issue with the date on the letter and the mail date; thus providers are losing time. The reason is that we use the larger envelopes with our return address. The Post Office has a new scanner, which was seeing the return address as the mail address and they were being returned to us. We are now not using the larger envelopes until the scanning issue is resolved by the Post Office.

9. Medicaid/EDS

• Medicaid started registering all providers for HIPAA in March. If you bill through a vendor, they will register for you based on their submitter ID (include everyone they bill for). If you have your own submitter ID, you need to register. You can call 501-374-6609 or use the web-site for the registration. This is an on-going process. The deadline has been scheduled for October 16, 2003. We will be sending out another RA message reminding the providers. We started HIPAA testing for vendors this week. It is going pretty good. The testing is optional. They can call 1-866-695-6508 or 501-375-1025 to test the various transactions. In early June we will begin training for the new Provider Electronic Solutions software which is provided by us free of charge. The workshops on the software will be conducted prior to the testing. Some providers use a clearinghouse for their billing and their own software for eligibility. The providers can test their software if they wish. AT&T is making some changes, which will require Medicaid to change their phone numbers by the end of June. There will be a RA message with the number and the AHA will publish it in the AHA Notebook.
• Greg noted that the volume of problems with crossover claims between Medicare and Medicaid has gone down. However, we have noted that some providers are making changes to their enrollment with Medicare but not with Medicaid - thus, there are issues with crossover claims.

• The 7th scope of work included the removal of Payment Error Prevention Program (PEPP) and change to Hospital Performance Monitoring Program. Arkansas is still the number one contractor in payment errors in the country. This is after a major drop in the volume of errors. On Medicaid, we are in the process of renegotiating contracts with DHS.

• Medicare Part A Testing - We don't see a big impact as of now. At this time their clearinghouses, vendors, and in-house are testing. SSI and WebMD clearinghouses have passed their tests and we are waiting to receive their Trading Partner Agreements (TPAs) to put them in production. SSI's software has also been tested. Providers using this software will receive a TPA once SSI provides us with the information as to the providers who use their software. Approved vendors and clearinghouses will be posted to the web-site once all the paperwork is completed. We have 4 - 5 vendors, which cover the vast majority of the Part A providers in Arkansas. On the UB92 side there are 13 submitters currently testing, however, take in account that SSI has 10 hospitals and they are counted as one submitter. On the Part B side, there is definitely an issue with the number of submitters who are testing. Medicare is required to test unlike Medicaid where it is optional.
• Effective October 16, 2003, all submitters must use the HIPAA compliant version of their software. A question was asked that if a submitter passes the test for Blue Cross does this mean they also pass for Medicare. The answer is no because this is two separate issues. We are doing end to end testing, where someone is looking at the in-bound data and then running it through the actual processing system to be sure that the claim will process. This is confusing for the providers as to where they have to test and how. There was a question about whether a Trading Partner Agreement (TPA) will be required with Medicaid.
• Please stress to staff that HIPAA is applicable to every insurer, not just Medicare and Medicaid. There will be more information on the Office of Civil Rights (OCR) web-site about the penalties and how they will be enforced concerning Privacy & Security Training. The deadline for personnel was April 14, 2003.

12. Greg Hart - Provider Education

• Noted that we have scheduled a Critical Access Hospital Workshop for July 17, 2003 and a Medicare Hospital Workshop for July 24, 20003 with the Arkansas Hospital Association (AHA). Also, AHA has scheduled an OPPS Coding workshop in June. The exact date will be announced at a later time. Check out web-site www.arkmedicare.com or visit www.arkhospitals.org.
• If you have agenda items for the meeting, please provide them advance so that we can have the appropriate staff available and research done prior to the meeting.
• Physical Therapy and Occupational Therapy payment limits go back into effect July 1, 2003. Speech and Physical Therapy are one limitation at $1590 and it’s a beneficiary limit for whoever bills those codes. Occupational Therapy is another $1590 limitation. It does not apply for hospital outpatient, but it does apply in other settings. Physical Therapy and Speech Therapy does not apply to the 13X-outpatient bill type.
• Medicare ambulance services are covered when they are medically necessary to the nearest facility. If taken to a farther facility, the mileage difference is not covered.
• The meeting adjourned at 12:40 p.m. The next meeting will be July 16, 2003.