Representatives from: AR Anesthesia Network, UAMS/MCPC Compliance, AR Physical Therapy Association, AR Medical Society, AR Chiropractic Society, AR Clinical Lab Management Association, AR Chiropractic Association, AR Optometric Association, Medical Practice Consultants, Inc, Arkansas Ambulance Association, AR Health Group,

Pat Bonnette, Senior Medicare Services, Technical Support Specialist
Tanya Brooks, Professional Services
Merle Francis, Manager, Professional Services
Greg Hart, Professional Services
Sidney Hayes, MD, Medicare Medical Director
Paulette Jones, Manager, Medicare Customer Service and Collections
Theresa Milligan, Director, Medicare Administrative Support
Susan Moore, Senior RN, Medical Review
Wanda Remington, Lead Statistical Analyst, Medical Review Audit and Analysis
Priscilla Secrest, Supervisor, Medical Review
Barbara Shepherd, Supervisor, Hearings and Appeals
Kelly Vaughan, EDI Analyst
Terri White, Manager, Government Programs
Forrest Wolfe, Manager, Medicare Claims

The meeting was called to order at 10:08 a.m.

• Greg Hart noted that Dennis Robertson has recently joined Arkansas Blue Cross and Blue Shield Medicare Services as the Senior Vice President for Public Programs. Merle Francis, Manager of Professional Services in our Louisiana office, was introduced as a guest.
• Greg noted that the Medicare staff would be moving to a new building in North Little Rock in late January. At that time, the Provider Communication Advisory Group (PCOMAG) meetings will probably be held in that office.
• The 2003 fee schedule year adjustments have been cancelled. CMS decided that it would cost more to recover the money than the amount that would be recovered.
• Physical Therapy, Speech Therapy, and Occupational Therapy annual coverage limitations have been delayed until September 1, 2003.
• We want to encourage providers and PCOMAG members to utilize the newly updated CMS web-site in addition to Arkansas Medicare's web-site.
• The proposed rule for the 2004 physician fee schedule is now on the CMS web-site. It was published in the Federal Register August 15, 2003. There is a Proposed 4.2% decrease in the conversion factor. The comment period ends on October 7, 2003. The article also contains the history of the fee schedule calculations.
• A news release from CMS has come out about a revised methodology for payment for Medicare covered drugs. This is a proposed rule and open for comment. http://www.cms.gov under the Public Affairs menu.
• Open forums – http://www.cms.gov/openforum - there is a newsletter, which comes out monthly from CMS advising of the upcoming forums (conference calls). The last one for physicians was August 11, 2003.
• Physician resource information is available on the CMS web-site covering a variety of topics in a Provider Update section, http://www.cms.gov/providerupdate. Providers can subscribe to any of these special areas to receive a listserv notice when they are changed.
• A representative of the Arkansas Medical Society, noted that CMS has published a specialty by specialty breakdown of the impact of the proposed reduced fee schedule. He noted that in addition to the 4.2% reduction there are individual decreases to some codes based on changes to Relative Value Units (RVUs) for some specialties, such as, ortho and oncology. Greg noted each year the RVUs are reviewed and may change, either direction. The 4.2% is a reduction in the conversion factor which is one part of the reimbursement formula.
• A representative of the Arkansas Medical Society, asked about the changes in the participation levels over the past years. ABCBS will develop the data and provide via e-mail to the PCOMAG or via an article on the web-site.
• Greg Hart noted that ABCBS is utilizing Tumbleweed as a virus and PHI screener, which quite often places the attachment in a special location on the Internet. Some PCOMAG members have experienced problems in receiving attachments. We will check into changing this or just putting the information on the web-site with a notice.

2. Claims/OCR - Forrest Wolfe

• Forrest noted that we have converted to the Optical Character Recognition (OCR) scanning of hardcopy claims. This has been quite a learning issue both internally and externally. We have developed a backlog over the past 3 months, but it is now turning around and we should be back to normal shortly. Corrections to issues can be made to the software or by the providers depending on what the issue is. We are expecting about 10 changes over the next few weeks.
• Providers can help by being sure that the print quality is good. This is especially true with dot matrix printers. On Medigap claims, if the In-Key is not in locator 9D, then the claim will not cross over. The In-Key listing is on the web-site. This is also an issue with EMC if the number is not in the appropriate field.
• Another help would be if the providers would total each page of multi-page claims. It would be easier for us as we could handle each page faster. Forrest asked if anyone was experiencing any problems and no one noted any. Forrest also noted that the signature is required on the hardcopy claims in the appropriate field.

3. Medicare Provider Services/Fee Schedule Update - Pat Bonnette

• Pat Bonnette noted that we are behind in our provider correspondence and reviews because of our shifting of tenured staff to the Missouri workload. We expect to be current by mid-September. Greg noted that there is a link on the www.arkmedicare.com web-site in the "Contact US, Provider information" area, regarding telephone reviews which explains the criteria for using the phone review process.
• Greg noted that in the future there would be a requirement that all claims status checks will have to go through the Automatic Response Unit (ARU). This is something we have been doing in our other states and will now do in Arkansas. This will free up the phone lines for other issues.

4. Medical Review Update - Susan Moore and Wanda Remington

• Quality Assurance results show that most providers are doing well based on the reviews which have been done. The new staff recently added to the Medical Review department, has been trained and now they are working at full capacity.
• Monitored Anesthesia - Denied claims will have to be reviewed by written request not via telephone since it is a medical issue. If the appropriate modifier (G8, G9, and QS) is submitted with an asterisk code in column B, the claims should pay. The cases which were given, as examples did not all have the G8 modifier, could be a systems problem by the provider’s system. No claims are being denied automatically.
• A suggestion was made by a provider to annotate newsletter articles in the future (if appropriate) when they contain only a summary of the LMRP. This way providers will know that this does not represent the policy in it's entirety.
• Dr. Hayes noted that the new information regarding the drug pricing is now out on the CMS and Medicare web-sites.
• There is a question regarding the reimbursement for administration of medication. When a provider injects a non-covered drug brought in by the beneficiary, will the provider be paid for the administration? Dr. Hayes noted that this is covered; yet a representative of the Arkansas Health Group stated that Provider Relations Service staff has advised him that it is not and he is developing a refund and collecting from the patients. This needs to be clarified quickly and the providers advised.
• Another issue concerning the 36620 surgical code for placing an arterial line - bundling denials are an issue. The provider was told that a modifier to identify whether it was a CRNA or MD that performed the service was not needed. Then, told that it was by another area. Need to get this clarified and the providers notified.
• A question was asked about same day service for post-op bleeding/other services. Is there a modifier for anesthesia? Medical Review staff noted that 58, 59, or 79 (depending on the circumstances) would be appropriate - just started denying this year - we need examples.
• Wanda Remington gave the Wound Care presentation that was developed for focused education of providers. This is an example of the type of presentations, which will be provided over the next year based on data analysis. (See presentation attached)

5. EDI/HIPAA - Kelly Vaughan

• We are getting calls when Medicare is primary and the claims are not crossing to the secondary. It appears to be a case of providers using an In-Key when in reality it is a complimentary claim.
• There are some providers who are still handwriting their claims - this is causing problems with OCR.
• HIPAA Update - There are only about 255 testing out of 11,000 tester and 19 of the Part B billers are in production. We have 2 that are approved but not yet billing. The Trading Partner Agreement (TPA) is the hold up on about 25 additional billers who are approved but have not submitted their TPA.
• Only a couple of Clearinghouses have passed and are in production. WebMD has passed but has not completed their TPA. Once they do, we will have about 2,000 providers associated with them that will be compliant. It is imperative that the providers test.
• Kelly noted that we are sending out the free software (MCE) on a CD with a users guide, how to dial in, and the TPA. The software was mailed out late last week to approximately 6,000 providers (in our 5-state jurisdiction). IntelliMark will be the vendor who will man a phone line for answering questions about the free software. The free software can only be used for Medicare Part B. It does not have to be HIPAA tested to be deemed compliant. However, it is suggested that testing be done to be sure that the provider understands how to complete the fields.
• There is the on-going issue with providers who think they are exempt or vice versa. It is CMS direction that all Medicare claims are to be electronic effective October 16, 2003.
• A representative of the Arkansas Medical Society again asked about the small provider exemption and how it will apply to Medicare and their requirement for electronic claims. Greg noted that there was an interim final rule published August 18, 2003 to clarify what the rules are and the circumstances, which would allow the submission of hardcopy claims. The exceptions are very strict. There is a listing of other special exceptions. The small provider exemption allows for the submission of hardcopy claims. At this time, CMS has advised the contractors they are to accept the claims unless there is a complaint stating that the exemption should not apply.
• Where are we on 270/271 and 276/277 electronic transactions? We are in the process of working out the issues between IVANS and us. Anyone interested in these transactions should let their vendors know - some will contract directly with IVANS. 276/277 will be batch and 270/271 will be real time. The Claims Division has requested some providers to be testers. These are the transactions for status and eligibility, which will be ready October 16, 2003. The free software is only the billing software (837). The 835 is not included on the software.
• Bulletin Board Service immediately responds saying we got XX claims, this is not saying that they were acceptable. About ten minutes later you will get a report, which shows the accepted and rejected claims, the category of claims, amount billed, etc. After the claims split and run into the Medicare system, you will get another report on the next day saying whether the claims were accepted or rejected. Some of the codes on the report are confusing and cause calls into the Kelly to determine what it means. It is important for providers to retrieve both of their messages daily to be sure they know what has happened with their claims file.
• Merle suggested that the various front-end reports should be defined and explanations placed on the web-site for reference and provided to new submitters. Once everyone converts to the 4010.A.1, some of the confusion will be reduced with the elimination of some of the reports.

6. Hearings and Appeals - Barbara Shepherd

• Barbara noted that the one issue we are seeing more is trigger point injection lacking documentation. She reminded everyone that the initial appeal period for a review is 120 days instead of 6 months.

7. Provider Communications - Terri White

• Terri noted that we are on-track going electronic with our newsletters effective October 1, 2003. There should be Remittance Advice (RA) stuffers letting providers know about this change. Additionally, there will be a pop-up on the web-site, notifying providers of this. We are also building a list-serv by specialty. This should go into effect on October 1, 2003. We encourage all providers to subscribe to the list-serv so that they can get automatic notification of changes to the web-site. We plan to update the web-site on a monthly basis. The providers who can’t use electronic and want hardcopy will get them quarterly (the 3 monthly editions) for an annual fee of $100. So far, we have received 2 requests from Arkansas providers.

8. Provider Education - Greg Hart

• Merle updated us on the Web-based training available on the http://www.arkmedicare.com site. Merle stated that we have developed a course that is on how to use the LMRPs. The LMRPs for all our states are being consolidated and thus should be consistent in format and content. The course is available on all of the ABCBS Medicare web-sites. There are continuing education credits and APC credits. The continuing education credits are through Tulane University in Louisiana. The next course is on modifiers. It is rather lengthy and should be available in October. There will be 3 to 4 more courses available during 2003. You can use these as part of your compliance training requirements. There will be a certificate of completion provided for documentation. There have been about 850 sign up for the course, thus far.
• Greg noted that there is a seminar for PT, OT, and ST scheduled for September 9, 2003 and an Independent Diagnostic Testing Facility (IDTF) workshop scheduled for September 10, 2003 here in Little Rock. Next year we will have quarterly Introduction to Medicare workshops around the state.
• The next PCOMAG meeting will be on November 19, 2003 here at USAble Corporate Center. The room has not been confirmed at this time due to an ongoing construction project. Everyone will be notified of the exact location.
• Medicare staff is speaking at the Arkansas Chiropractic meeting this Saturday and the Arkansas Chiropractic Association in March.