Representative of: Baird, Kurtz, and Dobson, Arkansas HIMA, Practice Plus/Baptist-Health, AR Chiropractic Society, AR Medical Society, Arkansas Occupational Therapist Association, AR Ambulance Association, CMS Dallas Regional Office, AR Osteopathic Medical Association, Medical Practice Consultant, Inc, Professional Billing and Consulting, AR Anesthesia Network

Tanya Brooks, Provider Education Specialist
Kristi Buckholz, Provider Education and Training Representative
Pat Clements, Provider Education and Training Representative
Connie Cogshell, Provider Education and Training Representative
Jim Cook, Medical Review Audit and Analysis
JoAnne Coombs, Supervisor, Medicare Services
Rhonda Cordon, Sr. Hearing Officer, Hearings and Appeals
Gary Eads, Manager Part A and Part B Claims
Greg Hart, Professional Services
Dr. Sidney Hayes, Medical Director
Wanda King, Manager, Medicare Secondary Payor
Sharon Robinson, Supervisor, Medicare Claims
Priscilla Secrest, Supervisor, Medical Review
Tony Shields, Senior RN, Medical Review
Mary Kay Sunderhaus, Web Based Training (Teleconference)
Geneva VanBuren, Supervisor, Provider Enrollment
Kelly Vaughan, Medicare EDI Analyst
Kay Werner, Director, Medicare Operations

The meeting was called to order at 10:05 a.m.

• Greg welcomed everyone and introductions were made around the table.

• Provider Communication Advisory Group (PCOMAG) Focus (Attachment) – The primary focus of this group is to help us communicate information to the provider community. The overall design of the group is to provide feedback on training topics, educational materials, and workshops. We need the group’s feedback on how best to get this information out to everyone. We want to know how we are doing, what more needs to be done, and ideas on how to make it better. We will continue to hear from the various Medicare sections and members on updates and issues. Claim specific issues can be discussed with the intent of deciding on best to instruct providers on avoiding the problem or resolving the issue. Problems that are provider specific will be deferred for resolution outside of this meeting. The format of the agenda has been changed from the past meeting to be inline with the purpose of this group. One of the past things we have discussed in past meetings is membership. We continue to work with various groups and we look for people who are interested in helping us review our material as well as assist by distributing the information among their organizations. Greg asked if the group had any suggestions as to how we could get the information out to others in the provider community. The group as a whole agreed that we were doing a good job.

3. Pam Kanawyer Dallas Regional Office CMS – Pam reinforced the focus of the PCOMAG meetings. She informed everyone that this is what CMS wants contractors to accomplish in these meetings. Pam encouraged everyone to participate in the Open Door Forums and if they needed any help in getting access to these meetings she would be more than happy to help direct them to the website.

• There will be a few changes coming soon before the end of this year that will go into effect in January 2005. All contractors should receive their issue of CR3376 in final form by the end of this month. This CR is calling for consistent, accurate, complete, and timely responses on both provider written inquiries and telephone inquiries. The contractor is going to be required to do some reorganization. They will be required to triage more complex inquiries and they are going to be required to direct providers to the IVR. CMS wants providers to be able to have information available in a "self-service" format. Pam stated that we as a contractor had moved towards this very well. We have developed and implemented a web based training and an excellent web-site. They are also sending e-bulletins via the email. Also contractors are now required to respond to written inquiries in 45 days and in an attempt to capture all written inquiries, they will now have 45 business days. This will be an extension on some of the inquiries but not all of them.

Fundamentals of Medicare Part B Billing Workshop August 25, 2004 Little Rock, AR
Wound Care and Toenail Debridement Workshop September 8, 2004 Little Rock, AR
Fundamentals of Medicare Part B Billing Workshop September 21, 2004 Hope, AR
Fundamentals of Medicare Part B Billing Workshop October 8, 2004 Jonesboro, AR

Greg asked had everyone heard of the upcoming Medicare workshops and have they attended any  of them in the past. Greg also asked if anyone had any feedback. Dr. Lagley stated that he has been hearing about them and the feedback has been good. He is signed up for the Wound Care workshop on September 8, 2004 and he looks forward to attending. Connie Cogshell gave a brief summary on what the Fundamentals of Billing Workshop entails. The first workshop was held August 4, 2004 in Little Rock, AR. She also circulated a copy of the workshop material among the group. According to the evaluations the majority viewed this as a beneficial workshop. Connie asked if anyone would like a copy of the materials to please see her after the meeting and she would make arrangements to get a copy to them. It was agreed to send everyone in attendance a copy of the workshop manual.

• It takes 3 months to get a course released. A course goes through many stages of reviews. The Remittance Advice course will be going out in the next few weeks. We ask that everyone please submit their correct email address so that Mary Kay can respond to your comments and questions.

• All courses have been approved by the American Academy of Professional Coders and by the Center for Continuing Education of Tulane Hospital.

• Our evaluations give us a lot of important information that we need. We need to know how many users have taken our courses. We can see which courses are more popular than others. They informed us on how satisfying the training has been for the participant. Each course is set up with a Pre Test and Post Test.

• On the evaluations we ask that the reviewer let us know if the class was geared towards beginner, intermediate, or advance level. We have received over 95% of responses stating that the courses were either intermediate or advance.

• 2005 Web Based Training Classes scheduled for development.
   

  • Ambulance

  • Podiatry

  • Evaluation and Management

  • Skilled Nursing Facility
     

• Mary Kay stated that we are looking for people to review our courses and provide us feedback on content accuracy. We want to know if the appearance is pleasing to the eye. Is the interactivity designed for you to learn, and is it user friendly. Mary Kay encouraged everyone to participate in the review process. This will allow us to have a better quality product. Mary Kay asked if the group had any questions at this time. The group did not have any questions at this time.

• Pam Kanawyer stated she would like for CMS Policy Specialist to be added to the list of reviewers.

• A representative asked if they will receive any type of certification besides CEUs in the future. It’s been an issue in the past with Medicare and just wanted to know if this will be looked at in the future? Mary Kay stated that the courses currently are set up more on an FYI basis.

6. 2005 Provider Education Strategy – Greg Hart – The Medicare fiscal year will start as of October 1, 2004. Our main focus is how to get information out to providers and what needs to be communicated. We will continue to work with Arkansas professional organizations to present at their meetings. For example, we will be speaking to the Arkansas Ambulance Association on August 27, 2004. During our regular workshops it’s difficult to talk to the actual providers because most attendees are a make up of office managers and billers. We normally get to speak with the actual provider during the professional association meetings. We are planning to have 4 Fundamental of Medicare Billing Workshops in 2005. We will also be conducting our Update Workshops throughout the state, usually about 10 sessions. We are in the process of setting dates for future workshops

• Greg asked for suggestions on locations and topics for future workshops. Greg asked the group if how they have been doing it seems to work. A representative stated that it may be too early to tell. Greg stated that if they have any suggestions or ideas to please send them to Tanya Brooks at tybrooks@arkbluecross.com.

7. DATA ANALYSIS – Greg Hart – Handouts were given of various reports. One proposed Fact Sheet was presented on the Top 10 Inquiries for Claim Submission Errors. This summary is for April 2004 – June 2004. Greg gave a brief summary on how to read the reports. Greg stated that during our workshops we go over the Top 10 reasons and how to avoid them. Greg asked if this information is helpful for the group. Greg stated that we could begin referencing the newsletter articles in the resolution as well and on the web-site we could add the link. A representative stated that they liked the format but would like to have the ranking with the number of denials. A representative asked how specific can the report get. Can you show by provider or group? Greg stated that now we have the comparative billing, which is by individual provider and their most common denials. We are looking at how to pull this information by a group. Pam stated that this would probably be more beneficial for a manager to review. Greg asked if we should post this on the web-site, newsletter, or via email. A representative stated that it would be great to post it on the web-site. Most of the group agreed with posting the information to the web-site.

• Pam Kanawyer asked if there was a way to give definitions for the denials when it comes to duplicate claims. Pam suggested that a chart be started with the denial code and the definitions.

• Pam Kanawyer stated that she would like to know how many of the denials were exact duplicates. This will show that there is inefficiency in the doctor’s office and that is important for them to know. Greg said we will work to see how we can break this out.

• The analysis on Provider Appeals is a new report. We are looking at reasons why a provider is asking for an appeal. We want to see if it’s something we can do to help them resolve their issues and have their claims submitted correctly the first time. Greg stated that we have incorporated this information in our workshops and will be working with the providers with the highest volume to be sure they understand how to submit their claims and have them paid the first time they are submitted if possible. We have sent letters to the top 10 providers who are submitting duplicate claims but if the duplicate claims continue over several quarters we either call them or go visit them. If it continues to be a problem it would result in a news article being printed. Greg asked the group how we could better communicate this information to the provider community. The group was okay with how we are getting the information out.

8. EDI/HIPAA – Kelly Vaughan – A handout was distributed for electronic submitters. (Attached) This information was sent out to all electronic submitters in the newsletter and on the web-site. Any electronic submitters transmitting to this system as of September 1, 2004 you will not be able to transmit to this system any more. Most submitters have transitioned to the Netscape Gateway system. We are in the process of contacting providers that are still transmitting on the old system and informing them of the changes.

• CR2931 was issued on February 1, 2004 and it became effect July 1, 2004. It states that any claim that is submitted in a non-HIPAA compliant format will go from a payment floor of 14 days to a payment floor of 27 days. We encourage providers to submit their claims electronically so they can receive their money faster. Kelly stated that one of the issues they are facing is that some providers believe their claims are being submitted in a HIPAA compliant format but the billing agency or clearinghouse is not submitting them in HIPAA compliant format. If you have not received a check in a while you need to give us a call. Kelly stated that most clearinghouses have over 20 sets of software and it depends on the version of the software that you are using. If you are on version 3 and the clearinghouse is using version 5 then your claims will not be in HIPAA compliant format. A representative asked if we knew what percentage of electronic claims are being submitted in the HIPAA compliant format. Kelly estimated around 88% are submitting correctly. A representative asked if Kelly could get a list of the versions under each clearinghouse so that way the providers would know which one they were using and if it was the correct version. Kelly agreed that this was a good idea but it would be something for the clearinghouse to put together. They have numerous platforms and we are not aware of what they have.

• A representative asked if we were taking steps to assist the providers who thought they were submitting HIPAA compliant claims. Kelly stated that they have been contacting these providers. We will do what ever is needed to get them switched over. Kelly stated that these issues have been covered in the workshops and we will continue to educate the providers.

• The 835 is the HIPAA transaction for electronic remittance advice. This transaction allows you to download a file from us and it automatically post payments to their account if the provider’s software will allow. A small percentage of providers are getting this information. We encourage all providers to use this transaction. We are placing this information on the web-site, the newsletters and on the remittance advice. We are contacting all providers that are not using this transaction.

• If your claims are rejected at the 997 Functional Acknowledgement levels there could be a formatting problem with your software and you will need to contact your vendor. All claims accepted on the 997 Functional Acknowledgements will go to the Batch Processing Report. This report is usually received in 10 to 30 minutes. It’s not a guarantee of payment report but it does let you know you have submitted a good clean claim.

• Greg stated that the reason he asked Kelly to talk about the various reports is because many providers are not downloading these helpful reports. We are asking providers in all workshops to look at the reports they are receiving particularly, from their clearinghouses. A representative stated that the FI should demand from the clearinghouse what reports the providers should be receiving. They stated that a list should be formulated that list all the different types of reports. A representative asked if we had an article that they could post on their web-site that would list questions a provider should ask their clearinghouse. Kelly agreed to working on developing this information.

9. Provider Enrollment – Geneva VanBuren – This year CMS implemented a new enrollment system called Provider Enrollment Chain Organization System (PECOS). The transition process caused a large back log which has been expunged. Provider Enrollment is currently up to date.

• Beginning August 23, 2004, when you call into Provider Enrollment you will not be instructed to leave a voice message you will now be able to speak to a Provider Enrollment Specialist. The hours for the customer service line have changed. The new hours are from 9:00 a.m – 3:00 p.m.

• Beginning in 2005 we will start conducting Provider Enrollment workshops. We would like feedback from the providers telling us what they would like to see in these workshops.

• When you are submitting your applications that have changes, make sure on the first page you are marking what changes you are making and place the effective date of that change on the application. Also, on the 855 note the person who you have listed as the first person on the original application and this person will be the only signature we will accept on any changes. If you have no idea whose name is on the original application you need to call us so you can update your information. You need to have an authorized representative and also a delegated official because if one leaves the company or is out of the office you will still have someone listed who make changes.

• Greg asked the group if anyone had any thoughts on the workshop and what items should be covered? The group did not list anything at this time. Geneva stated that they can submit their comments and suggestions via the web-site.

• We are having an issue with the billing of Arkansas provider numbers. For processing purpose, any time there is a group involved and there is an individual PIN#, in Item 24K on the paper claims we need the 9-digit number. If you do not connect the number we will do it for you but we are asking that you do it. On electronic claims (NSF BA0 record and the ANSI electronic equivalent) when we are asking who performed that service we want to see a 9-digit number which consists of the first 5-digits of the individual PIN number and the last 4-digits of the group number. This will assist us in processing your claims faster. Greg stated that this has been stressed in the workshops and through the newsletters. Greg also asked the group has this been adequately communicated to the provider community. The group indicated that we were doing a good job in getting the information out to providers.

• On Arkansas ADS codes, we are sending out a questionnaire asking who paid the service. Anytime you submit a MSP or COB claim and it has a payment indicate in Item 29, we will send a questionnaire out to find out who paid it. If the other insurance paid the amount we will remove the amount from that field. If the patient paid that amount we will leave that money there so the patient can be reimbursed. To keep from altering you claims that’s the only way we can do this legally.

11. Medicare Secondary Payer (MSP) – Wanda King – MSP is currently working through their backlog and as of Friday, August 13, 2004 there are 1,490 claims in suspense and of those only 135 are aged. We have 3,197 pieces of correspondence and of those only 400 are 45 days old.

• Some of the problems our customer service reps are seeing are they still are having Medicare Part B providers not sending in the EOB. When you submit a claim you need to attach the EOB and all the denial messages must be on there. If it’s not there we will deny for insufficient information. We need to make sure the EOBs are for the services you are filing claims for. Wanda stated that if you are submitting electronic claims you will submit the narrative in the remarks section. Greg stated that we will make sure this information is discussed in the workshops.

12. Medicare Services – Jo Anne Coombs – In just a few weeks we will be separating our telephone lines. We will have customer service reps dedicated to beneficiaries and some customer service reps dedicated to providers. There’s a great advantage for the providers because they will now speak to the same representative each time they call and the reps will now have a main focus.

• We are purchasing a new IVR and we are so excited about this. We will be able to provide eligibility through this and more status information than our current IVR. It will be voice activated as well.

• A representative asked what the time line AdvanceMed used in the CERT process. Jim stated that he believed it is 60 days. A representative stated that a physician says they have been paid by Medicare and it goes to CERT review and AdvanceMed say no, you improperly paid this and you must pay the money back. Will the physician have to pay the money back immediately? Do the physician appeal and wait until the end of the appeal process? Jim answered that it’s just like a normal appeals process. Greg stated that it’s handled as an overpayment.

• The group discussed the CERT process and several members expressed concern about the lack of clarity in the requests that were sent to providers from AdvanceMed as well as their handling of the records returned. Providers need to call the number on the request if they need clarification about who AdvanceMed is, what they are asking for, or any other part of the process. The feedback we, as the contractor, have received has been channeled back to CMS and AdvanceMEd during periodic teleconferences.

15. Hearing and Appeals – Rhonda Cordon – The Quik process is still scheduled to take place in 2005. We will pass this information on as soon as it becomes available to us. Rhonda asked the group if it would be beneficial to have a Web Based Training on the Appeal Process. The group agreed that it would be very helpful and they would look forward to the course.

• As of October 2005 the Administrative Law Judge (ALJ) will be moving from the housing of the Social Security Administration to the Department of Health and Human Services and CMS has instructed them to clean out their pending files.

16. Updates – Greg Hart – CR 3376 will also be addressing the education needs of the small providers. We are trying to identify them and we need your help in assisting us in doing this. You will be hearing more from us as we receive further guidance from CMS.

• Greg asked if how we are getting information out to the provider community helpful. The group agreed that it was helpful. Greg asked the group to please give us their suggestions on what we are not as doing as well as what we are doing.

• A representative asked, with the changes coming on a national level with the AT modifiers for chiropractic, how is going to affect Arkansas. Priscilla states that all chiropractic providers will be sent a letter at the end of the month explaining the change. The providers we currently have or have had recently on provider specific audits are getting an individual letter from Medical Review about the changes that are coming through. Effective October 1, 2005 any claim that does not have the AT modifier will deny at the system entry level as a maintenance therapy. The AT modifier must be on every claim as of October 1, 2004 to indicate active care.