Provider Advisory Groups

Attendees:
Joyce Carpenter, St. Vincent’s Infirmary Medical Center
Paul Cunningham, Senior Vice President, Arkansas Hospital Association
Paul Drummond, St. Bernard Medical Center
Tom Stickel, Piggot Community Hospital
Michelle Wilkerson, Controller, Chambers Memorial Hospital

ABCBS Staff:
Cheryl Allison, Provider Education & Training Representative
Pat Clements, Provider Education & Training Representative
Lakeisha Langston, Provider Specialist
Linda Lewis, Medicare Part A Claims and Customer Service
Linda Myers, Provider Specialist
Kelly Vaughan, EDI
Shelly Wickliffe, Medicare Claims

• Paul Cunningham gave opening remarks and welcomed everyone. After introductions, Paul also gave a brief overview of the purpose of this group. This group was established to help get information out from CMS to various organizations. This Group is tasked to develop and direct the best means to communicate CMS changes.
• Greg Hart who chairs the meeting is in Rhode Island paying dues for ABCBS. Pat Clements will take the lead and agenda.
• Information from Hospital Association view, CMS implemented Hospital - How your hospital compares to state and national norms and the care of hospital. These will be updated quarterly.
• Twelve months the metropolitan National Fraud – funding, the house came out with the budget and CMS proposal– Senate did not include us. The house has provision for Medicaid to cut 20 billion over five years. Another 18 billion in Medicare cuts. A budget will go back to the house; this may go on through the summer. This will be posted in a newsletter.
• The legislature passed (state) – (1) Medicaid fairness act help the hospital in terms ability to appeal the Medicaid financial decision go against on denied claims, etc. Acute hospital appeal to decision are made by AMC, Psychiatric go to APS – Read about this. Add a degree on fairness to the hospitals and the law. You can read this off the website.
• (2) Potential Fund source for additional hospital Medicaid payment for additional hospital payment don’t know how much. – Find about 6 1/2 million for each of the two year with the bicentennial with the education question with the things going on into the legislature.
• We were able to get a bill said any money go into a trust fund go any money go into a state insurance (insurance trust fund) taxes on insurance premiums (not sure). Department of Finance & Admin forecast on how much go into this fund doing the course of the year any thing that go in beyond the forecast will be set aside in the Medicaid trust fund, to help pay for additional hospitals. Medicaid right now is capped out to 75 a day, most states in the state are not there and you cannot increase year to year. If we can get more money into this trust fund to increase our hospitals up to 850 a day that will not happen in the next two years. We will go back to the 2007 session and see what we can go to what additional of what we what we already got. Those are some house keeping things, with that Pat Clements will turn over to you and tell us what Arkansas Medicare guide has to say.

• I would like to do some introduction before we get started, we have three new staff members, within Professional Services Lakesia Langston, her duties are reporting-downloading information of providers duplicates claims, High utilization of claims and will be getting those numbers for us. Linda Myers, is doing Tanya Brooks job, workshops, money handling and will be a valuable tools to us, and Greg's right hand. Cheryl and Pat will be going out to education the providers on the utilization. A new Medicare Representative Cheryl Allison which I am thrilled to announce, her background is Health Advantage, so she have a learning curve on the Medicare side. Very delighted to have her with us. She is traveling with me across the state, site visit for IDTF's, workshops. With that said, let us go around the room and introduce ourselves, Pat Clements, Cheryl Allison, Paul Cunningham, Kelly Vaughan, Linda Lewis, Sherele Withlow, Julie Carpenter, administrator & Patient Assess for St Vincent, Bryan Drummond, St Bernard, Jonesboro, Michael Piggott Hospital, Michelle Wilkerson, Chambers Hospital Lekesiha Langston, and Linda Myers.
• I want to give you the purpose of the Provider Communication Advisory Group. Just a refresher as CMS to handle, the focus of this group to provide input from the provider side, your side. How we can educate and improve that process, and how we can get that information out to you the provider. The discussion of the specific hospital provider issues they can always help to illustrate areas that you want to focus on. But the resolution of the specific claims issues of course can not be housed in this meeting. Linda is very good when you bring to her attention, and she is very good at doing that. The membership of this group should be represent providers whose bill under part A, such as Medicaid, billing agent and consultants we welcome them as well. CMS want us to reemphasis the purpose of these groups and to insure that we meet these requirements that they set forth. With that said lets talk about the minutes, any changes or deletion for January 12. This is the record tool that we strive to get this minutes out on the website in seven days from the meeting. We do try to email these minutes to keep you up to date, and always ask to review those if we missed quoted something we added or deleted, make sure you let us know, and Linda know and we will make those corrections. Paul Cunningham added that we download the minutes and put on our website as well. I will suggest to Greg, in my opinion make the minutes as a handout. No changes or deletion leave as is.
• Old Business but is New Business – Denise has asked for information regarding the Medicare prescription drug coverage that is part C & D, I gave you a handout from the Kaiser Family Foundation it steps you through A, B, C, D a brief explanation between the C&D and basically with part C is a title two of the Medicare Moralization Act and a modifier and strictly rename the existence Medicare choice program to a newly called Medicare Advantage, that was a part of the part C. The Medicare beneficiary is going to choose to enroll in a private management plan such as HMO and this is going to provider part A and B coverage benefits to the enrollee. This is going to take place of the traditional Medicare, if you remember years ago, HA offered several years ago which was like your Medipak HMO, this is similar to that. This gives you an idea what part C is.
• Part D is this refer to the new outpatient prescription drug benefit that goes into effect 2006, basically to let you know that it is finance through the beneficiary premiums and rough idea and cause $35 dollars and this will vary from state to state. We encourage you to go out to the CMS website for the official notification. We found this to be rather concentrated, one document, to give you a description between the four, Part A, B, C, D, does this help you?
• Question asked, Are these, Medicare Part C & D are their something that will effect the hospital to a point that is worth doing a workshop on? The New Jersey Hospital association is putting a program with conjunction to CMS and might be something for us to think about.
• Joyce Carpenter, I think it will be very beneficial we have many company that want to contract with us, but we have not signed one yet. But it was close, the first one they were trying to sneak in all these things that could have been detrimental. By the second we had educated ourselves to a better level and we realized what they were trying to sneak in as far as requirement that was totally unnecessary. Not according with the CMS requirement for the programs. So as it becomes more and more vital in Arkansas I think it will help us all to be a lot more educated.
• Michelle Wilkerson - That is like, they told me that humane choice care network was a full replacement for Medicare. Would you have to do the contracts with those companies?
• Per Pat Clements this would be a replacement for Part A&B. This comes under the part C toward the managed care programs an d could be like Health Advantage if they think about doing this, what you have in your hand that will be part C where it totally replaces part A & B. You would have to do those contracts with those insurance companies the way I understand it.
• Questions: Are you saying that this will replace Medicare part A&B sometime in the future? The hospitals is not in the part C& D, do you have to do the contracts?
• Pat Clements – Do you remember Medipak? HMO It gave the patient a choice , they can keep there traditional Medicare Part A & B or they can choose the Medipak HMO or in this case the part C program who ever that is through. You would have to do those contracts with those insurance companies. The patient can choose what they want, either the Managed Care program or Traditional Medicare. Are there any static’s that can be shown in my region that shows how many? This does not start until January 2006. This why they want the hospitals to do these contracts so they can be on their list when they trying to get the beneficiary s to enroll. That is a selling point to the insurance company to have you on their list. Look at the doctors, hospitals, or physicians who have signed up for this, is a selling point. This is a choice. Fee schedule is right with Medicare.
• Joyce Carpenter said it is going to take education, for everybody to realize that when they see that card, it is Medicare you got all the extra steps to follow.
• Beth Ingram has been working with Greg on future workshops etc. Maybe we should consider this.You can download all the information you want to know on the CMS website.
• Will that effect hospital in patient reimbursement drug? This is leaning toward outpatient only. Any other questions?

• On our Medicare website OIG a fraud release, this is geared to part B, but some of your hospital you are billed for physician related services, your staff could get a phone call from an organization stating they are Medicare fraud abuse or employee of Medicare, basically telling our system has gone down and we have lost a lot of physician related information so they are going to ask you for the physician social security number, tax I D number, UPIN, License number, and patient charts, you need to aware that our system , the CMS has not gone down, and we are not calling provider for this information for you might want to advise your staff if they get such a phone call try name and telephone number and let me call you back. Call our clearinghouse for Fraud & Abuse, and bring this to our attention as to who are calling and a phone number if they will get that to you. Be very reluctant to before you give any physician information.
• Is there any specific question that we could ask far as the identification, what is your Medicare identification? Could CMS put something together so they would have that identification? Nothing that I am aware of. If it got to that point, I know we would do something blanket announcement that our system went down, you might receive phone calls or letters requesting information I can’t imagine that happening (repeat). Our system is just fine.
• With the CMS 3376 initiative, we had our very first Ask The Contractor (ACT) teleconference held on March 9, we had 8 providers through out Arkansas who dialed in. Did any of you dialed in? Did not know about it. We need to get that corrected. Let me tell you what ACT is CMS has instructed all the physical interment as well as part B carrier to offer to the providers community an opportunity to discuss to hot topics, topic in general to where you can dial in on a toll free number through teleconference where you can ask the carrier or FI a specific questions. Not specific hospitals questions, if it is a topic that could impact other providers we need to get that out and discuss that we will have agenda, that is posted on the website with a toll free number and give you the time. This is a great opportunity for you all to dial in be a part of that. We give you an update of things that we are seeing that are happening, just an update we will talk about hot topics, when we get those. There are questions we would like to know which is geared to part A hospital. Would you think it will benefit you if we separate and have a second ACT call for the inpatient Psychiatric facility, we had a separate workshop for that. The IPS. Do you think you that we you would be interested in having a separate for strictly hospitals, and another one for the IPS? Would you like for us to strive to?
• With the numbers of hospitals, that has Medicare certified this would not a bad idea. We got the word out, and it is another one coming up June 7, we do have our schedule time and agenda, time and toll free number for you to call in. It will be operated control far as the questions. This way we will know who is calling us, Greg and I will facilitator those calls. It was about 45 minutes long. Open up to questions, we had seven facilities and one Ambulance Company and they were hospital based. April 5, & 12, notebook all information is in there. Check website and newsletters for all the dates.
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• Enhance use of the internet, FYI, Greg has mention this previously, any of our workshop we always spend a certain amount of time to space providers, very good or elementary that you know the information that is available not only with through Arkansas Medicare website, but through CMS, we do spend a certain amount of time walking providers through that, how to asset, what information you can obtain, this is something to share with you. We constantly include in all our workshops, part A or part B
• Training tailored to reduce claims error rate, Linda Lewis will talk to you about the CERT program, the comprehensive error rate testing program, if that is ok with Linda.
• Web Base training – something that is brand new we are very excited about, www.arkmedicare.com. Web Base Training that is free to the provider, available to you 24 hours a day, seven days a week and geared up to have for part A providers some base courses one that we are looking at is Skilled Nursing Facility (SNF) will filing claims, and coverage issues look for in 2005, as time go on, the most of web base training out there is geared to part B training. We do see the need for part training and our first is Skilled Nursing Facility and we are very excited about that.
• Questions, Do you drop off any course if you don't get to it? No, we do not drop off any of these courses. We always have new staff to come in and this is an excellent tool and resource for provider to have. We started in 2003, and no we do not drop off the courses. You can get education credit, and this is through Tulane per Kelly, she was at home doing the modifier. If you don't pass the first time, you can continue to take the test until you pass. It is very user friendly. If you do any part B posting for the 1500, we do have one for the remittance advice, how to read, if you do any part B posting. A good tools. Thanks Kelly.
• Comments on workshop March 24, on the Psychiatric, what you liked and what you did not like about the workshop. Billing, coverage issues as well how asset the calculate from the CMS web site. Practically all the Hospitals were in attendance. Close to 50 in an attendance. Very well attended. Linda did you see the evaluation, went to Medical review, wondering what they had to say about the workshop.
• We are still working with the HFMA to address the provider audit, and reimbursement issues, Greg have mentioned this at the last meeting. He wants the provider audit and reimbursement to part of their meeting. This way we are capturing the right audience. We will let Paul know. We know it will be in September, the date is not finalized. Down the line other meeting held injunction with HFMA meeting, this may before the HFMA meeting. Joyce Carpenter would like to attend this meeting. Thank you Joyce. Since, Paul mention that I will bring up the Fundamental & the general billing update we are working with the Hospital association, and we have a date of September 7, established. The morning session will be covering Fundamental Billing Part A, how to file claims A-Z, the general information basic, very good for your staff who are new billers, and they want some basic education on how to file claims. Afternoon, general billing that will be geared to MSP, medical review, local coverage termination, and more specialized billing on UB92, so right now we are working with other states looking at their materials that they use for fundamentals and the basic billing and the general update and format for Arkansas and Linda Lewis has been looking at some of those format. We are excited about that, we have a date, we know it is going to happen, AHG newsletter, website. Where is he going to be? Beth is working on. This will be heavily attended, first one we set up this way. We are capturing the right audience. Location will follow, check our website and the notebook will there be a charge? Not sure.
• Critical Asset hospital workshop, again we are working with Arkansas Department of Health, Greg is working with them don't have a date set up for that. Will be forth coming. That is all for updates and I will at this point turn it over to Linda Lewis to talk about claims.

4. Claims - Linda Lewis

• First of all, sure you know we have had several system problems going on. Thankfully today, yesterday was holding OPPS claims 27,000 and today we are down to 72 claims. SMU unit, have been working them individually because we, have come down from 20 thousands or more, now to 78. We continue to work with them. We are still working on some issues with that host but as we get claims in now we are able to hold our weekly host. By the end of the week we will have something more current. We are working on some claims that we have to do manually pricing, that is not a big number, only 69 claims for the total of all hospital. Claims that are in SMNP, got that down to two claims. The majority we are looking good on. If you have claims that have reason code 32269 we have permission from CMS, all we need them to give it to us in writing. Those are the big problems.
• We do the adjustment for CERT. Arkansas has a 25% error rate, the majority of that area rate is caused because that we inactivated or return to the providers if they are not perfect in 30 days they fall off the hard system. We have reports that will be tracking, inactivation, send us something with your signature on, get more specific and we have to have reasons. Let us work with you on these that have errors. We are going be rejecting inactivated claims. I am working with our analyze at this time to get more reject codes, because we have a lot easier way of tracking rejected rather than inactivated claims. In the future, If you do call for inactivate, we will do a lot more rejecting than just inactivating. We also have a problems with some providers surpressing claims, we wiped it off one of our books. It wiped off the system where you can't see, but still in our system and when you want something adjusted it is over 30 days before we can do anything. Surpressing is not a good idea. Basically that is the majority what we are having a problem with far as our CERT. Inactivation we asked for in writing now and explanation of why, if we can help you get that claim through it through the system. If is a paid claims we will adjust the paid claim, if it a claim that achieve let us help get through system, if we can't do any of that we will reject. We have a better paper trail when we reject claims. I know some providers have requested a lot of application and it is getting out of hand and I sure its costing on both ends to start over. Adjustments we are getting some that are pages long, nothing is written, nothing highlighted, reason codes, say you want to change charges, they are having to look on you claims to make sure they don't miss anything because we are going to have a very high error rate.
• Everything that comes in needs to have a cover sheet. Will Medicare have the bar codes like ABCBS? I have not heard anything. Not to say that someone is not working on. This would be nice. One of the key issues. That was one of the key issues, things was not getting where they were suppose to. (Piggott Hospital) When I look at the Medicare status report summary P, T, S what constitute the S, that is what is on the suspense, my girls has to correct, and work off, it is a lots of different locations that are going to be in there, if they have problems they have to make up locations. Have you used page 12 but you can not work from there? No. 7% T, 34% P and the rest in S, and that is a lot money it's for the edit to work. They have thirty days to work their claims. They may have to return some of the S. Some of the common things that are worked, duplicate claims, overlaps, value claims, anything on the UB92, certain things that have to filled for outpatient and inpatient, different location, value claims. Is their anything you can do about the S's? Once you work the S claim and corrected then it get kicked over to the P then start the 14 days. When you see the paid it start. It is in either in suspend or paid. When they get the medical record back then go in the 50/40, then possible another error, another edit pops up it could go to a lot so different location, all this works in thirty days, after forty days it fall off the system. Page 12 look at any status location, you can not work or touch the claims but you can look at it. There are some reports that you can look at also, it is the remote.
• We are in the process of hiring some more staff. We have a reluctant new group of CSR and two more CSR and another adjustment clerk, we have different types of adjustment CERT, LJ, regular adjustment, Credit dome and two more service specialist clerks to take phone calls.
• We have moved our beneficiary telephones to the part B. We are consecrating on the provider, one problem, speaking of the beneficiary when they are in the hospital setting they are getting our provider line number, the beneficiary are calling in on the provider line instead of their beneficiary line. We are split out now; we have to count the provider one way and beneficiary the other way. It is important that the beneficiary use the 1-800 -Medicare line a lot do not of them don't like it but they need to use their lines. This is what CMS want us to do.
• Are you asking the beneficiary to call 1-800-medicare, we will make sure we add this to our workshops.
• Updates - Medlearn matters, revision to Medicare appeal process, implantation date is April 25 but is starting after May 1 are re-termination and reconsideration will held differently. Medlearn matters are MM3530 or CR3530, but there are a lot of things that are spelled out. This is very important. How to request re-termination and re-consideration. A couple of years ago they were called re-determination, reviews, the first level is called re-determination and then the second level reconsideration will be done by a qualify independent contractor. (Quick) A lot of different changes. Have your billers look at medlearn on these changes, this real important.
• Any quick for Arkansas - will be two in the nations, they are dividing it up. MM3756 the billers will have a lot different code changes. Medlearn MM3741 expanded PET scan for cervical and other cancers and also new coding and billing requirement. Things that are coming up in May. How many of you get into Medlearn Matters?
• CMS notify FI through a change request called a CR, are you familiar with that? Because of the understanding what the CR is saying it is very difficult at times to understand that verbiage and CMS and came up with Medlearn matters taken the CR in and easier and better understanding. It correspondence with the CR. It is also in the provider news; in between you can go to Medlearn.
• Are you subscription to the website or CMS? It is on the CMS website. We this along with Greg. We don' t have Amanda Crosby or Wanda King. We let Kelly tell us about EDI.

5. Kelly Vaughan

• You will not believe how many duplicate claims we get. Whether you send electronic or paper if a good claims is suspended for whatever reason, you send in another claim before finding out what happen to the first claim. This causes delay of your payment. You need to know what happen to the first claims. Linda Lewis said some providers said if we don't receive any money in 30 days we send another claim back in. The clerks have 30 days to process a claim. We do remote training once a month. Michael wont to look at claims without the staff knowing. Remote is so important, you can take control of your own your claims. Call our provider line for training. The training is free. All you have to have is phone line and outside modem. I am glad I can talk about claims. EDI or HIPPA do not have a lot going on. You can still send paper claims. All electronic submitter is being sent in the HIPPA compliance. The paper claim said they would wait until CMS change. Are there any hospitals sending paper? 835 are a big thing, electronic remit advice. In contingency we will give everyone 90 days. We are in the process of working with another carrier to developing a program that will download and print out in a legal format; all the paper can keep for 10 year if they want. We are on the cap, because our numbers were very low. Please use the 835, this is very important. CMS will set a date sometimes this year. On the arkmedicare.com website, under the EDI we have updates. Everybody needs a X12 user guide that does electronic billing guide, this updated several times a year, the updated manual. Step by step on dialing and how to get that report. Lots of peoples are using the clearinghouse. Stay on top of the clearinghouse. On the EDI website if our system are down if Medicare remote, gateway, messages late, rejection, etc., it will give you this information. This system when into production last year. Will this be part A or Part B? Yes.
• Remit was late in January, February, and March run remits from an old system to a new system and everything is running smoother. We are editing and everything is going well.

6. Pat Clements

• Joyce Carpenters said MSP has done so much better in the last 6 months for us. Wanda King is the manager she came on board two years ago and she has really taken the hem cleaned up and turned it around and I will definitely share that with her.
• The next meeting dates are July 20, 2005 and October 26, 2005.
• Any other questions that we can answers for you all? None.

Adjourn at 12:10

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