Representatives of BKD, Ashley County Medical Center, Arkansas Hospital Association, Arkansas Department of Health-Facilities Services, North Arkansas Regional Medical Center, AR Foundation for Medical Care, St Bernard’s Healthcare, HealthPark Hospital, Piggot Community Hospital, and Chambers Memorial Hospital

Tanya Brooks, Professional Services
Kristi Buckholz, Network Development Representative
Pat Clements, Network Development Representative
Connie Cogshell, Network Development Representative
Rhonda Cordon, Senior Hearing Officer, Hearings and Appeals
Greg Hart, Professional Services
Nina Jolly, Medicare Provider Audit & Reimbursement
Sara Phillips, Medicare Claim Service
Deborah Reichard, Medicare Medical Review
Sherri Wright, Medicare Audit & Analysis

1. Welcome and Introductions - Greg Hart

Greg Hart and Paul Cunningham gave opening remarks and welcomed everyone.

• Greg reminded everyone of the separation of Medicare Services from the private side. This allows us to concentrate on one area. We are still working through the transition. We no longer have Provider Representatives assigned to certain providers. All Medicare Provider Representatives are assigned to the entire state. We have sent out announcements to this effect. In an effort to assist you in handling your issues in a timely manner we are asking that you direct all issues to customer service first. If for any reason they are unable to assist you they will then send a referral to the Provider Representatives who will then assist you in resolving your issues. We are also asking that everyone utilize the Arkansas Medicare web-site (www.arkmedicare.com) more often.

• A representative of Arkansas Hospital Associated asked if everyone was using the web-site and stated that this site is full of a wealth of information. Greg also mentioned that CMS is pushing us to go more to the web-site as our primary means of communicating an educating our providers.

• Medicare Reform Act (Attachment): The latest law is the Medicare Modernization Act (MMA) of 2003. On the CMS web-site there is a Medicare reform link, www.cms.gov/medicarereform. There is information on various aspects as well as frequent updates on specific topics.

• There is also a new section on the CMS website called MedLearn Matters which gives a summary of the CRs with information specific for providers. We recently sent this information to PCOMAG members along with a survey form entitled Medicare Update Notification Survey. We ask each member to complete this form to let us know how useful this information is as well as how you disseminated it further. Whenever you receive this form we ask that you please complete it and send it back to us.

• Greg went over the composition of the Provider Communication Advisory Group. A representative asked if Medicaid would be returning to the group. Greg replied that Medicaid would be returning but due to the HIPAA compliance events they have not been able to attend. Medicaid will be present at the Hospital workshop in August.

• It was also asked if any hospitals had received their first checks with these new benefits from MMA? They went into effect as of April 1, 2004. A representative stated that he thought that it was the check they received today but it was at a lower amount than expected. Nina Jolly stated that the payments are low this week because the date that the cycle runs has been changed. A couple weeks ago we paid everyone double. The payment was high and now the check is low to catch up. Next week the checks will be at the normal rate. A representative stated that yesterday on the remote there were a huge number of claims that were held in suspense for Intermediary use only. Is this why our checks are so low this week? Nina stated that there were claims that were suppose to be released on April 19, 2004. Sara Phillips stated that to her knowledge they were released. A representative asked if they were being held for review. Sara stated that every quarter we have to update our pricers. We had to hold the claims until the update was complete.

• Greg also mentioned that one of the handouts he has from CMS is the instructions on the process of holding claims. Also, one of the reasons that CMS places holds on the claims is because when updates are implemented they want to make sure that all updates have been implemented and are in effect before they give the go ahead to release the claims.

2. Data Analysis – Sherri Wright

• Sherri distributed the quarterly Dataline report (attached). The purpose of this report is to keep you aware of what kind of questions are being asked by Part A providers and what kind of claims submission errors are being made on Part A claims. They also show what the appeals issues are with the claims.

• On the lab denials we are trying to educate providers through workshops, and also through the newsletters.

• A representative asked, how can we obtain the report by each individual hospital? Sherri stated that on the appeals issues we are unable to pull this information by individual providers. Sherri can run a sample of 10 claims of each one of the reports and then she can go in manually and look up the providers.

• A representative asked if they could get the claim submission report per provider. Sherri stated that we can get this information by individual providers. A representative stated that it would be helpful if they could get a break down on the lab reversals by provider, that way we could take this information back to our facilities and post this information on our web-site. That way this could help us in correcting this information and process it correctly. Greg stated that the appeals portion is fairly new from the data analysis we have been doing. We use this information in a couple of ways. We are looking at how we can get this out to providers and we have been told to make this provider specific in order to make an impact. A lot of the representatives agreed that the report should be provider specific and that way they will know exactly if they are one of the facilities with a high number of denials.

3. ADH Facilities Management

• There are currently 2 hospitals who are applying for critical access status. This will give us 24 facilities.

• The payment cycle has changed. The EFT payments will now go in on Friday instead of Monday. If you’re not on EFT you should consider doing so. If you decide to go on EFT there is some paper work to complete. If you have never completed an 855A and you want to go to EFT then you will need to complete all the sections of the 855A (as though it was an initial application). This does involve quite a bit of paperwork. If you have previously completed an 855A, you only have to complete specific sections. You must submit your request as a change and you only complete the section relating to the EFT. If you have any questions you may contact Natasha Parker or Martha Lane.

• Nina wanted to encourage everyone who may have changes in administrator, address, or some other reason, please complete an 855A notifying us of any of these changes. A representative fron ADH Facilities Management stated that in order for change to become effective, such as bed decreases, administrator changes, increases in bed, or drop in admission of services, we can no longer send them to the regional office and receive your approval until we have the 855A approval for those changes. We will have to hold every change you submit to us in letter form until you complete the 855A. Nina stated that you can go out on the web-site and download these forms. On our web-site there is a section for Enrollment Part A and if you click on that it will take you to the forms. In the future you will be able to file those forms electronically.

• If you have a change of ownership, you will need to complete an 855A. If you keep the same provider number, you need to be aware that if there is an outstanding overpayment that the old provider has not paid or if we subsequently determine there was an overpayment to the old owner the new owner is liable. If you do not want to be liable for any old overpayments that the old owner might have incurred, you need to ask for a new provider number. This will require a little more paper work. It could be worth it, if you for see that the old provider cannot or will not pay their overpayments. The way Medicare looks at it, the provider agreement follows the provider number. If you do not change provider number then you will be responsible for that all old and new overpayments.

• A memo was sent to all CFOs of the hospitals. This memo was talking about some of the changes that had come out relating to overpayments. If a payment is not received by a certain date we must start withholding.

• If you need an extended repayment schedule, the rules have become a little more complicated. We can approve up to 12 months. Anything over 12 months has to be approved by the regional office. To get a 12 month repayment schedule or anything over 30 days you must have a denial from a financial institution. There are specific forms you have to fill out. This information was also in the memo that was mailed out. Every time a letter goes out for overpayment we are sending the instructions for an extended repayment schedule. A representative asked if he would have to be denied by a financial institution if requested a payback over 30 days. Nina stated that if you are requesting over 30 days you will have to be turned by a financial institution.

• Credit Balance Reports: A question was asked at another meeting, "do you have to fill out a separate report for each unit?" You don’t necessarily have to fill out a separate one out for each sub-unit, such as, a swing bed, but what you need to do is on that form where it ask for provider number you need to list the provider number for that unit. If you don’t have that number on the report then Darlene will send a memo to us that says, start withholding their payments. It was asked for the Arkansas Hospital Assosication to place an article concerning if a separate report is needed for each unit in the notebook. Part A needs a separate schedule for each unit however they will accept one certification page (the certification page should identify each subunit).

• Nina had an update on the CR 3052 which states that Critical Access Hospitals can now have 25 beds. They will be reimbursed 101% of cost for both inpatient and outpatient. There has always been an optional billing method for the physician component. Before it had been interpreted that, in order to use the optional billing method all physicians had to agree to it. The interpretation now is that all physicians in a particular department have to agree to it and they do have to complete an assignment of benefits. The critical access hospitals asked to have a special meeting relating to this. It’s on Wednesday, April 28, 2004 at the Freeway Medical Building. Sandy Hayes is the contact person for this and she can be reached at 501-280-4707. If you are going to elect this optional billing method you have to notify us 30 days before the beginning of your cost reporting period. If you have a 6-30 year end and your cost reporting period begins July 1 you will have to notify us by June 1.

• TOPS changes: A change request (CR 3214) was finalized on April 16, 2004. This change stated that they are continuing TOPS for rural hospitals and hospital that are sole community in a rural area, cancer hospitals and children hospitals. Also it states that it is referring to rural hospitals with less than 100 beds. It specifically states, "All rural hospitals having 100 or fewer beds, sole community hospitals which are located in rural areas". The way this is written I would say that the 100 beds do not apply to the sole community. I will get a clarification of this for you.

• We also had a question concerning the Occupation Mixed Surveys that everyone sent in. Amanda wanted me to let you know that all hospitals responded. It was asked if we knew how this was going to play out. He stated that the reasoning behind it was to increase some rates and what I have been reading lately this may not happen. Nina stated that we just don’t know at this time.

• Effective April 1, 2004 we went to the Equalization of the National Adjusted Operating Standardized Amounts for Large Urban and other areas. We now have one standard rate for labor and non-labor. Also, effective April 1, 2004, if you have IME, the formula for IME changed. If you don’t have this just give Nina a call and she can locate this for you.

5. Billing/Claims Update – Sara Phillips (Handouts Attached)

• Sara reported that the one thing that would help to expedite your redeterminations/correction claims quickly would be to include a cover sheet on every individual claim. If you have several bills for one patient with different date of services please include them in the same envelope but give us a separate cover letter.

• On the G adjustments CMS is looking at every inpatient claim step-by-step. A member asked that with the 11G their claims are still being denied. They are being told that they can rebill and get the money back but they can’t fix them in the remote. Sara stated that CMS instructed CWF January 1, 2004 that this is the way this is going to happen. They put the information into the system and the system started canceling the claims. As a remedy of this we had suspended close to 1500 of them and they were worked individually. A letter was sent out to each provider stating that here’s your report and here are the claims we have that are in suspend status. They were to send them back corrected and they would manually correct them. Sara stated that CMS is really pushing us to get the providers to look at the web-site. The CR that CMS placed on the web-site was really short and generic which did not give you a lot of information.

• One of the main things the representatives pointed out was that they wanted to see information placed on the web-site as soon as possible when there are changes or issues. In cases they have seen where something has been posted on the web-site after they have known about it for several days.

• Sara stated that we have placed a notice concerning the cover letters in our Provider News hardcopy but we are still receiving claims without the separate cover letters. Connie stated that we are addressing this at the workshops statewide and this is one of the provider’s main issues. CMS has mandated that we must now look at every individual claim and we must know per claim what the provider is requesting. This is something we are telling everyone statewide.

• A representative stated that for Part B we are telling them to use the CMS 1964 form, "Request for Review," is Part A going to use this as well. This is a general cover letter. Sara stated that this is acceptable but they will also accept the provider’s letterhead as well. You can also place a note on plain paper to state what you would like done to a specific claim. Please do not use sticky notes on the claims or write on the claims.

• A member stated that they are getting claims denied for requested medical records. They look in the remote and it shows that you have never requested medical records to begin with. Sara stated that when a claim comes into the system it goes through what is called SuperOps, which looks for the codes you bill with and your diagnosis. If this doesn’t match it automatically denies the claim, no one manually looked at that claims. The system automatically generates a letter when a claim is denied and it requests medical records. If you are not receiving the letters and this is a continuing problem please contact us. Sara suggested that they look at their claim summary report daily. The member stated that he will send Sara some examples of what is happening so that they can make sure they are handling things correctly.

• There is a change request on the CMS web-site that explains billing for noncovered procedures. It is 97 pages and includes many examples. This can be accessed through www.cms.gov/manuals then transmittals; it is Change Request (CR) 3115.

• Claims are being processed within 2 days of receipt. Currently we do not have a back log. We are working on putting in a HBO audit. All claims will be suspended if greater than 3 units are billed on one date of service. We will request documentation for review which should include the reason why it’s greater than 3 units being billed, the medical reason, what condition the patient has, and documentation of two air breaks in a 90-minute event for the HBO treatment. We will be placing an article concerning this in the April Provide News.

• Greg stated that the CERT program is on the CMS web-site, www.cms.gov/cert. AdvanceMed is an independent contractor that looks to see how well we process claims and if we pay correctly. If you receive a letter from them, please respond, they are under a CMS contract. There will be more extensive efforts to contact providers with errors including not submitting the requested documentation.

• Beginning on July 6, 2004, if you are submitting electronic claims that are non-HIPAA compliant they will be treated as a paper claim. This means the payment floor will go to the 27 days before they release it for payment. We have several providers who have tested are ready to go into production but for whatever reason has not gone into production, CMS has stated that we are to contact them and give them 30 days to go into production. At an HFMA meeting held last week there was a handout that had a list of questions you should ask your payors concerning the other HIPAA transactions. This was passed on to David Bailey and we are working to answer them and post them on our web-site.

• The Vice President of Medicare/Medicaid contracts spoke to us on several issues. The biggest thing they have working is the MMA payment update. We are happy to announce that every hospital is registered for keynet exchange. 90% of the hospitals have already transmitted data to the warehouse. Arkansas is in the Top 10 for transmitting data. We worked with the Arkansas Hospital Association to help achieve that. The deadline is going to be first quarter discharges and you will have to submit that by July 1, 2004. There are different rules based on what you have submitted in the past. You will need to have this submitted by July 1, 2004 to receive your payment update. We have received 30 request forms and we are expecting to receive a form from all hospitals.

• Our quality conference is April 30, 2004 and if you are interested you can go to www.afmc.org and look at the agenda. You are invited to attend. We have been doing a lot of onsite workshops on improving hospital quality. We have conducted these workshops at about 50% of the hospitals. We will come onsite and we do the workshops. We will do them 2 to 3 times a day. We can give CME credits and nursing credits. If you are interested in having a workshop at your facility you can contact us.

• There have been changes on how we do the ER reviews. This was changed by Medicaid. Some of the representatives voice their opinions on how frustrating is to pull so much information to only have all claims denied and one approved. A representative from the Arkansas Hospital Associated stated that he has a meeting set up to discuss this issue. It was stated that they are offering to go to the hospitals to educate them on the process.

• On October 1, 2004 there is going to be change in the re-determination decisions that include Part A and Part B reviews and reconsiderations. This was in CR2620 dated February 5, 2004. It has all the instructions listed. The contractors will now have 60 days to do the written initial re-determination, reviews for Part A and Part B, and the reconsideration. Please make sure you gather all of your documentation before submitting your reconsideration.

• They have also given us model language to use in those reviews and reconsiderations. The language will be similar to the language we use in the hearing letters.

• On the Arkansas Hospital Association website, www.arkhospitals.org, you will find the information concerning the hospital workshop scheduled for August 3, 2004. We have other workshops scheduled that are on our web-site at www.arkmedicare.com. We have workshops such as Critical Access Hospital August 19, 2004, Skilled Nursing Facility August 17, 2004 and tentatively scheduled are, Outpatient Rehab and Inpatient Rehab on July 20, 2004. We are working on getting the Wound Care workshops finalized.

• Greg also distributed a handout from MSP that tells you how to submit MSP claims through remote.

The next meeting will be held July 21, 2004 at the Arkansas Hospital Association Corporate Center.