Provider Advisory Groups

Welcome and Introduction:

The meeting was called to order at 10:05 a.m. Pat Clements welcomed everyone and introduced Tanya Brooks as the new Arkansas Provider Education and Training Representative. Introductions were then made around the room.

Old Business ~ Review of May 11, 2005, Minutes

Pat asked the group if there were any corrections to the minutes from the last meeting. No corrections were made to the minutes and a motion was moved and second to accept the minutes as printed. Members were informed they could find copies of the previous minutes on our web site, as well as future meeting dates and time. You may access this information by clicking on the following link: http://www.arkmedicare.com/provider/pcomag/default.htm                                   

New Business ~ Pat Clements

CMS Change Request 3376 Initiatives / Ask the Contractor Teleconference

(ACT) ~ Pat Clements

The last ACT teleconference was held on June 7, 2005 and the topic was Comprehensive Error Rate Testing (CERT). There were 16 providers who participated. Pat asked the group if they were able to participate on the call.

• One representative stated she participated on the call.
• The next ACT teleconference will be held on September 22, 2005 from 12:00 p.m. until 1:00 p.m. The topic will be Medicare Secondary Payer (MSP). You may access the call by dialing 1-800-260-6066 and tell the operator you would like the "Ask the Contractor" call.
• The group was asked their thoughts on the time of the meeting. The group agreed that the time worked well. The time and agenda will be posted in the newsletters, on website and it will be announced at workshops.

Training Tailored For Small Providers ~ Pat Clements

• CMS has instructed local carriers to offer outreach efforts to reach small providers. We conducted workshops statewide to educated provider’s on "How to Navigate the Web Site" This course gives providers a good understanding on how to access and navigate the Arkansas and CMS Website. Our last workshop was held on August 10, 2005 in Monticello.

• The group was asked if they had any suggestion or topics they would like to see covered within the small provider community.
• The group suggested topics such as, more advanced classes on the web site an also a training session on how to search the MedGuide.

Enhanced use of the Internet ~ Pat Clements

We continue to work on enhancing the Arkansas Medicare website, www.arkmedicare.com, to make it a useful tool for providers. We are including information in our workshops about what is available and how to access information through the website.

Pat asked the group for suggestions on how to improve or enhance the website. The group didn’t have any suggestions at this time.

Training Tailored to Reduce the Claims Error Rate ~ Pat Clements

Part of our program to reduce claims submission errors is to mail letters to the providers with the highest number of denials. Letters are mailed to the top three providers in each of the ten top denial reason codes. The data is being pulled from the MCS system .The purpose is to educate the provider on how to reduce their claim errors.

• We will initially send a letter, and then follow up with a telephone call if they continue to be a top provider. If necessary, an educational visit is scheduled to assist the provider in determining ways to avoid these errors.
• The group was asked if anyone had received a denial management letter from us. No one within the group has received a letter. If you want a drill down, you can contact us at 1-866-345-0274 and we will pull the data and mail it to you.

• The number one denial is duplicate claims.

The group was asked if we were getting the information out to them that they need to have to address duplicate claim errors. The group agreed that we have been very helpful.

The group was asked the number of people who attended the General Update, and the Fundamental workshops. Within those two workshops we address denials and the steps a provider should take to process a clean claim. We asked the group what else we could do to improve the process and to get this information to their staff. A representative stated that we were doing a good job at getting the information our but suggested more training sessions.

A representative stated they are having a lot of problems with the name not matching the Medicare card. We asked them to continue to request that they make a copy of the Medicare card at each visit.

A representative suggested we incorporate this information in every workshop as well as include Medicare Secondary Payer (MSP).

Comprehensive Error Rate Testing (CERT) Cheryl Allison

CERT continues to be a hot topic in all our meeting. The non-responder is not the primary issue any longer. The top areas have been E&M and Lab services. The documentation for these does not support the level of service billed. Another problem involved claims spanning several dates of service. Providers need to be sure to provide all the documentation requested. Many times the documentation only supports one of the days causing the entire claim to be denied or down coded. The LPET department continues to do workshops to stress the importance of documentation. You may access the CERT newsletter through www.certprovider.org (read only).

The group was asked if for suggestions on how to communicate the importance of getting the word out about CERT.

A representative asked, "Do we verify the provider number or group number?

Answer: The group answer was that both the provider number and group number need to be checked.

The other issues would be to communicate these items in the workshop and newsletter to help with the denials.

• The important of receiving the correct address (returned mail)
• How to handle the provider is no longer with a clinic
• Check with provider enrollment, to update their 855’s
• Providers only call when they don’t receive payment.

The Overall Error Rate including Non Responders

The Provider Compliance – Claims Errors

Web Base Training ~ Tanya Brooks

The Web Base Training courses are great educational tools for Medicare providers and their office staff. These courses give an in-depth knowledge on Medicare, which covers how to file claims correctly, correct modifier usage and many more. The classes are free and available to your staff 24 hours a day, 7 days a week. The group was asked if they found the courses to be helpful. Many representatives stated that the courses have been very beneficial for there staff. Some representatives stated they have made the courses a requirement for their current staff and any new staff members they hire. The group was told that no additional courses will be added to the current course list. The current courses will be update as changes are made by CMS.

2005 Workshop Schedule ~ Tanya Brooks

The 2005 Workshop Schedule will conclude on August 30, 2005 with our Podiatry Requirement workshop in Fort Smith. The course is free and you may access the web site to register for the course. A handout was given to each attendee and they were asked to please share the information with their staff members, as well as, other providers.

2006 Workshop Schedule – Cheryl Allison

• We are in the process of scheduling Evaluation and Management General Updates, Fundamentals workshop. CMS has asked us add a new workshop "Welcome to Medicare for new providers. The group was asked if they had any suggestion or ideas? Some of the suggestions are:

• The provider number needs to be correct on the claim form/ID card.
• On the claim form in 24K and in box 33, group or provider numbering these boxes
• This is included in the February Newsletter
• Clearinghouses need to know about Third Party Administrators (TPA)

The question was asked: Do you have question for one-half day workshop for Ambulance? Answer: The group said we will schedule some ambulance workshops at a later date.

The question was asked: Can we assign a Third Party Administrator (TPA) with an individual provider? Answer: Yes, we can set up a call with the provider and discuss TPX...

HIPAA End of Contingency - Kelly Vaughan

• Medlearn Matters 3440 – Administrative Simplification Compliance Act (ASCA )

Enforcement of Mandatory Electronic Submission of Medicare Claims.

Effective July 1, 2005, Medlearn Matters 3440, we have start monitoring who are sending claims in that are Non-HIPAA compliance. Also, letters are being sent out to provider that is Non – HIPAA compliance. The providers have 45 days to response to why they are not filing with the HIPAA compliance. There is some exception to this electronic claim submission requirement.

• Medlearn Matters 3883 – Access Process for Beneficiary Eligibility Inquires/Replies (HIPAA 270/271 Transactions) (Extranet Only)

Effective May 20, 2005, Medlearn Matters 3883, is the change request that states CMS is making changes to its IT infrastructure to address standards for Medicare beneficiary eligibility inquiries. This IT change will create the necessary database and infrastructure to provider a centralized HIPAA-compliant 270/271 beneficiary health care eligibility inquiry and response in real-time. CMS software vendors are:

• IVANS: http://www.ivans.com
• McKesson: http://www.mckesson.com

• Medlearn Matters 3956 – Medicare Announces End of HIPAA Contingency Plan for Claims Submissions

Effective October 1, 2005, The Centers for Medicare and Medicaid Service (CMS is ending its contingency plan that allowed providers to submit claims formats electronically that were not in the format required by the Health Insurance Portability and Accountability Act (HIPAA). As of October 1, 2005, all providers must use the HIPAA compliant format for claims submitted to Medicare. In June 2005, over 99% of claims submitted to Medicare were in HIPAA compliant formats.

• The group asked: How many providers are not HIPAA Compliance?

Answer: Eighteen providers in the six states are not HIPAA compliant.

The group was asked what suggestions or ideas that we could give us on how we can better communicate in getting the word out?

Annual Disclosure, "Dear Doctor: Letter and Participation Enrollment Material, CD-ROM - Pat Clements

Medicare Service will be sending the 2006 Medicare Participation Enrollment and Physician Fee Schedule (MPFS) on a CD-ROM this November. Supplemental information will be included and can be used for refreshing the knowledge of your existing staff and as training material for new office staff.

Medicare Services will begin mailing the MPFS/Participation Enrollment information to providers via first class mail or equivalent delivery for receipt no later than November 15, 2005.

The content of the CD-ROM will include the following information:

• 2006 MPFS Disclosure Report
• Medicare Participation Agreement
• Advanced Beneficiary Notice (ABN) requirements
• Provider Enrollment Instructions
• EDI instructions
• Indicators/Global Surgery Percentages/Endoscopies for 2006
• Health Professional Shortage Area Information and
• Numerous other Medicare Billing Information

The purpose for the CD-ROM is for those who do not have Intranet. The extra copies are: Paper $17.00 and CD-ROM $10.00.

The group was asked what suggestions or ideas that we could give us on how we can better communicate on the CD-ROM?

National Provider Identifier (NPI) Enumerator Contractor and Information on Obtaining NPIs – Cheryl Allison

Medlearn Matters SE0528 – We are reminding all providers if you have not applied for NPI. This will affect all providers nationwide.

• Fox System is the contractor to perform support operation for the NPI project.

• The effective date for all health plans and clearinghouses must accept NPIs standard transactions by May 23, 2007. Small health plans have until May 23, 2008.
• All Health care providers including individuals, such as physicians, dentists, and pharmacists, and organizations, such as hospital nursing homes, pharmacies, and group practices are eligible to apply for and receive and NPI.
• https://nppes.cms.hhs.gov

• For more information, refer to Medlearn matters or the newsletter for the most recent information

The group asked the question: Would customer service give information on approved or denial claims? Answer: Yes, customer service will give answers to these questions.

The group asked the question: Misplaced or missing EOB pages, if the business office loses it, what is the number of pages before they start charging for replacement? Answer: This has to be requested in writing, and then they review and determine the cost.

Prescription Benefits Changes ~ Greg Hart

CMS is encouraging all providers of the changes in the prescriptions drug benefits.

• Prescription Drug Benefits – This was sent out to all providers about the free literature, newsletters, posters, and workshop through out the state. www.medicare.gov     

The next meeting is November 16, 2005

Adjournment at 11:40

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