Representatives from:

AR Anesthesia Network; UAMS Compliance; AR Podiatric Medical Association; Arkansas Health Financial Mgmt. Association; AR Clinical Lab Mgmt. Association; AR Chiropractic Association; AR Osteopathic Medical Association; Medical Practice Consultants, Inc.; AR Health Group; Arkansas Medicaid/EDS; Arkansas Ambulance Association

Bobbye Garner, Director, Provider Services and Claims
Greg Hart, Professional Services
Dr. Sidney Hayes, Medical Director, Part A and Part B
Paulette Jones, Manager, Medicare Customer Service and Collections
Theresa Milligan, Director, Medicare Administrative Support
Debbie Mullican, Medicare Part B Medical Review
Barbara Shepherd, Supervisor, Hearings and Appeals
Kelly Vaughan, Electronic Services
Kay Werner, Manager, MSP
Rhonda Cordon, Sr. Hearings Officer, Hearing and Appeals

The meeting was called to order at 10:00 A.M.

1. 2003 Physician Fee Schedule

   • Congress has been working to get a bill passed prior to the March 1, 2003, effective date. We have received guidelines as to how to adjudicate claims for services prior to March 1, 2003. After March 1, 2003, claims will be paid at the 2003 rate. After July, adjustments will be made to the claims, which are processed, in the interim period depending on the final instructions. There was general discussion of the process, which will be followed. The 2002 DOSs will not be impacted.
      

2. The moratorium has been extended on the PT limitation.
    

3. Missouri Office Closure - ABCBS announced that we would be closing the office effective May 8, 2003. The workload will be transitioned to our other locations in OK, LA, and AR. New staff has been and is being hired to be trained to take on the new workloads at each location.
    

4. Medicare Services - Paulette Jones distributed handouts, which contained an analysis of inquiries and written inquiries. The number one reason was once again "Status". The handout also contained analysis of the review reasons.

   • There was a question regarding any appeals of which are submitted late based on the new timely filing deadline. It was noted that the claimant will have to provide rationale for a late filing - there are very few reasons, which will allow us to extend the filing limit. There was a note that "dups" came in as number three on the review list. It was probably because staffs were cleaning out their files for the year-end and when in doubt they filed.
   • There was a note that if the data were provider specific it would be more helpful. The consultants can use it in a general sense.
   • The 1099 information was sent out in January with inaccurate information. The corrected 1099s have been sent out with the word "Revised" printed on the form. Also, a stuffer was sent in the RAs.
   • MEMS asked about the volume of reviews on ambulance. It did not make the top listing, which was provided. Paulette noted that ambulance was not a major issue in AR.
      
5. Debbie Mullican noted that the MO transition would impact MR in that additional staff will be needed. Also, any provider education letters, which you have received, are being generated to provide information about patterns, which are being seen. This is just an alert for education. Another area is critical care - there has been a lot of billing for respiratory care at critical care level when in reality it is pneumonia and the services provided were at a lower level. The key issue relates to billing critical care in the ER.
    
6. Kay Werner - the COB fact sheet was distributed which outlines information explaining the COB Contractor functions and who they are. They make determinations as to who is liable in liability cases. Claims specific inquiries will come to the local contractor.
   • Another issue involves telephone inquiries - we have received some complaints regarding provider’s ability to get through to MSP. A study was conducted and some calls are being diverted to regular service keeping the MSP lines open for MSP issues. Another issue involves the pending in our MSP claims processing - additional training has been provided to ensure that MSP specific data is being entered into the claims records to prevent denials and development. We are also going to imaging, which will help with our staff’s ability to see the actual attachments, which are submitted with the hardcopy claims. The MSP staff is working overtime to relieve the backlog situation.
   • Coordination with the VA is not something that Medicare does. It is real important for the providers to determine on the front-end with the beneficiary who the primary insurer will be. If the patient chooses the VA on a fee basis, then Medicare will not make any supplemental payment. If they choose Medicare, the provider can bill the patient for coinsurance and deductible.
7. Kelly Vaughan - HIPAA testing - we need providers to come in and test with us.
   • On February 13, the 4010-A1 is now the standard format. Now, providers should begin testing in the new format. If a provider has tested in 4010, it is not required that they retest in 4010-A1. It is recommended that they do, but not required. Testing must be completed by October 13, 2003. If you are transmitting with a billing service or clearinghouse, the providers need to push them to get the testing completed.
   • A question was asked whether we would post the information on the website. They will be posted once they have passed the testing, signed their TPA, and are productional.
   • What will happen if the testing has not begun by April 13, 2003 - is there a financial penalty? No, we have not been provided with instructions as to what to do at that time.
   • Another issues; a lot of providers are getting new PCs, which have XP. The communications package being used is generally PROCOM32, which is not compatible with XP. The Windows XP has its own communication package, which is called Hyperterminal. If you need help setting up the dialing, you can call 866-582-3247 (EDI) for assistance.
   • Is AHIN able to help some of the medical manager offices? AHIN is a clearinghouse and you can file through them to Medicare.
   • MEMS noted that their vendor (Pinpoint out of Boulder) said they have tested and passed. Kelly was not aware of this. However, once a vendor has passed, they need to provide EDI with a listing of their providers for which they tested and the providers do not have to test separately.
   • If you have a vendor who does business with all five of our Medicare states, they have to submit a test file for each state since they have a separate submitter number for each state. Private business has to have a separate test from Medicare.
   • The CMS provided software will be provided for $25.00 - MCE. We are also testing QuickClaim - for an additional $200.00, which you can also do your private business.
   • 4010-A1 did have changes for ambulance and chiropractic - not sure what all was included.
   • If you use QuickClaim, it will go through the gateway; next it will flow through the AHIN front-end edits.
   • If a vendor passes the test, signs their TPA and then does not go productional, it is possible that they would mess with their software and once they go productional, their claims would not go into the Medicare system. This can be an issue.
   • CMS is monitoring the level of testing. They have come back to ask why we are not getting more people to test.

   • If you use the MCE or QuickClaim software, you do not have to test.
      
8. Greg Hart - Privacy of HIPAA is going in April. The Security portion of HIPAA will be in the Federal Register tomorrow (February 20).
    
9. Barbara Shepherd - not seeing any significant issues. Please be sure to file the appeals timely and not wait until the last minute. Also, indicate on the front-end what type of hearing you want. If you have not received an acknowledgement within 30 days, please check to be sure that we did receive the appeal. We are running about 90 days to process an appeal. You can call 378-3255 to check on your appeals - Sarah Lewis or Charlene Jones. If you have a problem on which you need more assistance, you can call Barbara Shepherd at 378-2338. Also, it was noted that we have the option of performing a preliminary on the record hearing, which in some cases eliminates the need for an in-person or telephone hearing. In some cases, we can go ahead and pay. In other cases, it will allow the claimant to go on to an ALJ in a faster timeframe. Also, a pay and dismiss may be conducted if it is noted on the front that there is information provided which immediately makes it possible to make payment and dismiss the hearing.
    
10. Medicaid - A representative from EDS/Medicaid noted that they would be implementing a new type of an advanced mailing for hardcopy submitted crossovers. Based on prior year information, Medicaid will provide their crossover forms automatically to the providers.
    • Another project is having their manuals electronically on ACD. Initially, the smaller programs will be rolled out electronically. They will ask for feedback before going on to the larger programs.

    • HIPAA - A representative from EDS/Medicaid noted that testing for Medicaid is ready. Some vendors to begin testing have contacted them. They will begin training in June on how to bill using their new software based on HIPAA. Their new software (Provider Electronic Solutions - PES) will have training available in June. The training schedule will be on their website (www.HIPAA.state.AR.us). The companion guides will be out on their website prior to the testing date. The Emeralds and OMNIs will go away on October 1, 2003, since they are not HIPAA compliant. There will be a replacement for them; however, there will be a limited number available. There may be a fee and the criteria will be very stiff in order to get one - probably about 10% of those who have one today. The web application similar to PES will be available in the near future - however, you will have to check the website to find the specific date.

    • It was noted that some of the clinics have done away with PCs and have gone to terminals hooked to the mainframe.

    • Medicaid does not charge for paper claims at this time. It was noted that some states do charge.

    • Greg Hart - We do continue to get some crossover problems. Generally, it is a billing number issue. Providers need to be sure that Medicaid Provider Enrollment is aware and set up for any changes, such as beginning to bill with the group provider number instead of the individual provider number.

    • If Medicare does make some payment, then the Medicaid claim should be filed on the crossover claim form. If there is no payment by Medicare, then the Medicaid claims must be filed on a regular claim form.

    • Paper Medicaid claims take a minimum of 30 days where the electronical crossover can be done in about 7 days.
11. BI - there is a new PSC contractor for AR - AdvancedMed. Providers will start seeing development letters from them and they are appropriate. This change will take place on March 15, 2003. They will be following AR LMRPs and procedures.
     
12. Greg Hart– Specialty workshops will include Physical Therapy and Occupational Therapy, and one other to be announced.
    • There was a data sheet distributed on specialty analysis and another on CLIA changes. Also, on the CMS website there was a fact sheet on ABN.
    • The list-serve feature was noted as a good method for obtaining information in a timely manner.
    • CMS came out with a change where the minutes for the PAG must be out in 7 days and posted to the website.
    • Provider Education funding - Greg Hart noted that the budget for 2003 was reverse-funded. It was about $1 million less than in 2002. Now we are exceeding the budget. Some of the changes we are considering include:
    • There was discussion about the MEDGUIDE - whether to keep or eliminate. In order to keep, we will honor this year’s subscriptions for hardcopy. After 03-01-03, any requests will only be filled CD or referred to website. We are looking at charging for the web access. The policies will not be a part of the MEDGUIDE in the future - they will be on the web.
    • Data analysis is also being limited due to funding in 2003. One of the discretionary items is provider specific analysis.
    • We will be going to quarterly newsletter next year - dependent on budget. The novel is an extra newsletter which may not be issued and only available on the web, if there. We did get feedback last year that doing away with electronic newsletters was not desirable in the rural areas.
    • We are looking at our fee structure for seminars.
    • One contractor charges the providers for PR visits as consultant services at $50.00 per hour. Another contractor has gone to only electronic newsletters.
       
13. Chiropractic Question: Member felt that the education was not consistent. After discussion
    Medical Review will review examples.
     
14. The next meeting will be May 21.
     
15. The meeting adjourned at 11:35.