Representatives from: Arkansas Hospital Association, White County Medical Center, Medical Park Hospital Hope, Arkansas Department of Health, St. Vincent North Rehab Hospital, St. Vincent Health System, MidSouth Credit Bureau, Chambers Memorial Hospital

Tanya Brooks, Professional Services
Amanda Crosby, Manager, Provider Audit and Reimbursement
Charlotte Garlington, Senior Nurse, Medicare Post Pay Review
Greg Hart, Professional Services
Linda Lewis, Supervisor, Medicare Part A Claims and Customer Service
Theresa Milligan, Director, Medicare Administrative Support
Kelley Vaughan, Analyst, EDI
Kay Werner, Manager, MSP Operations

1. Arkansas Hospital Association

• A representative from the Arkansas Hospital Association introduced a representative with the Mid South Credit Bureau who is also a longtime member of the Hospital Provider Communication Advisory Group.

2. Greg Hart - Updates

• Physician Fee Schedule - With the delay of the Physician Fee Schedule and subsequent increase, CMS had originally planned to have claims adjusted for those processed after March 1 for DOS in January and February on the 2003 fee schedule. CMS has elected not to pursue those collections.
• Therapy caps of $1590 for PT/ST and OT have been delayed until September 1, 2003 as of this time.
• A representative of the Arkansas Hospital Association noted that the Arkansas Hospital Association (AHA) sent out a notice last week to the staffs in the hospitals and other healthcare providers who utilize the UB-92 billing manual developed by the AHA. This is a historic process, which has been in place since 1984. In 2001, the National Uniform Billing Committee (NUBC) began making the changes to the UB-92 available via the Internet. Now, the AHA has decided to quit updating the local billing manual and advised the subscribers to go to the NUBC Internet site for the updates. There is a subscription for the service, which costs approximately $50. If there are questions regarding state specific changes due to Medicaid, etc. the AHA will continue to notify the providers in Arkansas.
• A representative of the Arkansas Hospital Association also noted unofficially that Medicaid is considering a change to their handling of Emergency Room claims. Now, every Emergency Room claim goes straight to the Peer Review Organization (PRO) for determination of "emergency" for payment on a 100% basis. Over the years, the denial rate has decreased on these claims and thus Medicaid will now pay claims submitted as emergency as emergency with a post-pay review of those claims. If the claims are determined not to be emergency, then the claims will be recouped. The potential start date is September 1, 2003. The draft notice states that if the claim is determined on post-pay to not be emergency, then the provider cannot re-bill as an outpatient visit or assessment. This will be discussed at the AHA meeting later this summer. If there is an official notice, it should be out by August 1, 2003. The post-pay review would be a sample and done by the PRO.

• About 2 years ago Arkansas Blue Cross and Blue Shield worked some old account receivables to clean them out for terminated providers, change of intermediaries, etc. Now, CMS has provided more guidelines on the processes to collect the outstanding account receivables. Still, the majority will be terminated providers or units or change of intermediary providers. This will be an on-going process for working these claims accounts receivables. If not paid, they will be referred to the Department of Treasury. The demands for payment will come from the Provider Audit and Reimbursement area.
• The provider based status issue will be addressed at the next workshop. There is an attestation that should be completed and forwarded to the intermediary when a provider feels they have a provider-based unit. If the attestation is not on file, and a determination is made that the unit is not provider-based, then the penalties may be higher. The review may be done on a random basis or as a part of our knowledge of the provider's situation. A representative of the CMS Regional Office will give a presentation on this issue at the hospital workshop. There is a sample attestation form provided by CMS and is available on the CMS web-site (http://cms.hhs.gov) with the Program Memorandum, A03-030, on this subject.
• We are approaching the end of our fiscal year and are working on several initiatives, which must be completed. We must adhere more strictly to timeliness standards set by CMS with regard to the submission by the providers of requested information. If the data is not received timely, then we will have to make our determinations based on the information at hand. If the information is provided after the fact, we will not be inclined to accept the information if we cannot go back into the field to substantiate the information. This may require the provider to request an official appeal since the information was not received timely. Appeals will need to be made to the Appeals Board, which can take years.

4. Arkansas State Health Department

• A representative noted that there is one hospital (DeQueen) in the Critical Access Hospital application process, which will make 18. Greg noted that a Critical Access Hospital workshop will be held tomorrow on July 17, 2003.

5. Linda Lewis - Claims

• Linda Lewis noted that the volume of inquiries in the Service area has increased on billing questions this last quarter along with overlapping dates. We are having problems with some providers using the 01discharge when, in reality, the patient went to another provider instead of home. This creates a problem for the second hospital. The two hospitals need to work together to be sure that this situation does not occur. This does slow down the claims processing timeliness. We are also getting calls on the Medicare Service line for Medicare Secondary Payer (MSP). Requests to release claims are handled as returns to the provider so that they can correct the claims themselves. Reason codes are usually the same ones from quarter to quarter. Linda will address these next week at the hospital workshop.
• Timeliness is an issue because providers are submitting claims from years ago where they want to add items to the claims. The timely filing deadlines are the same for adjusted claims as for new claims. We are seeing a big increase in the number of claims being resubmitted when they are denied as medical. These must be filed as requests for review and not submitted as new claims. There are issues with digital mammographies in that the providers must be certified and set up in our system. There are separate certifications for digital and film mammographies. With the 141 type of bill, we have several providers with returned claims because they used a 7 or 2 source code. We have an edit for this. On a 141 type of bill, the source code should be 1. Another problem we see, is when some providers have two ambulance trips on one claim, this is causing a problem on which we are currently working. Copies of the July 2003 update of the Hospital Outpatient Prospective Payment System (OPPS) was distributed. On the Arkansas Medicare web-site (www.arkmedicare.com), there is a lot of information regarding new changes, the rehab caps, NDC, etc.
• A representative of the Arkansas Hospital Association noted that there are about 7500 calls per quarter, how many can be handled via remote? Linda stated that the vast majority could be resolved via the remote. Some of the providers don't have enough machines and they are in the habit of just calling Medicare instead of using the technology.
• Kay Werner noted that there has been a problem with the remote providers getting an error message when they attempted to gain access. It was noted that the problem was corrected around the first of July. However, if it had been long term, they may not know that the issue has been corrected and they have reverted to the phone.
• Kelly Vaughn noted that sometimes the providers have staff who do not have the ProComm on their individual PCs and can't use someone else's due to security. We will be glad to provide as many IDs as they need as long as they get the technology needed to support the remote. The provider would need to purchase a license from ProComm. There is a need for a separate modem line for each PC. Providers can contact EDI at 866-582-3247.
• A representative of MidSouth Credit Bureau noted that some providers are not getting callbacks on issues, which are left with Medicare. Also, we need to have a provider education presentation with HFMA and other provider organizations to show them how the remote works and what can be accessed. Linda noted that we still offer free remote training. The providers just need to let us know if they need it.
• Linda noted that some providers are sending in their Medicare correspondence and claims with one cover letter. At that point, it is placed under one control number and then has to be separated for controlling in the other internal locations. We are asking that they be sent in under separate cover letters by type of document (i.e., claims, correspondence, review requests).
• ABCBS needs to load the remote manual along with a list of the Top 10 things you can accomplish by using the remote on the web-site. Joe will get a notice out to the Arkansas HFMA and A representative of the Arkansas Hospital Association will put it in the Notebook.
• Kelly explained that "remote" goes straight into the Part A FISS system. AHIN is access to everything else.
• Linda reported on the Common Working File (CWF) issues where G adjustments are sent back to us involving claims which are several years old. To work these, we have to go back to the time that the beneficiary gained Medicare entitlement. This process assists us in finding when a benefit period ended and subsequent claims were paid. In one case, we had to go back and make 50 adjustments, all to collect the payments to the providers. Needless to say, this is very involved and causes the providers problems since the cost reports are closed. This can be major dollars.
• One provider noted that a provider in Texas stated their intermediary had set up a process where they file on one day and get paid on the next - he corrected this and meant that the fiscal intermediary pays on a daily basis. At present, ABCBS does not have plans to go to daily payments from the twice-weekly payment cycles.
• St. Vincent questioned an issue with their Electronic Remittance Advice (ERA). For the past couple of weeks they have not been able to post their accounts because they are stating there is an issue between their vendors system and the ERA. They are getting the Electronic Funds Transfer (EFT), but having an issue with the Electronic Remittance Advice (ERA). The issue will need to be researched to determine where the problem is.

6. Kay Werner - Medicare Secondary Payer

• Kay noted that we have made a lot of improvement in the aged claims pending, it is now down from 2600 to about 1000. Hopeful this will be down to normal by the end of this quarter. Currently, we have about 400 pieces of correspondence beyond 45 days out of the approximate 800 pieces pending. We have hired additional staff and are working overtime to get this down to a manageable level. Kay distributed a final Program Memorandum AB-03-011 regarding multiple Payers and how/who to bill.
• Kay noted that all MSP claims could be filed electronically. Some providers are dealing with limitations in their software, which should be eliminated with the ANSI conversions by October 16, 2003. Electronic submissions can be processed faster.
• Kay distributed information regarding the Coordination of Benefits (COB) Contractor, which is located in New York. They are responsible for developing all MSP claims for the nation.

• Charlotte noted that wound care would be addressed in the hospital workshop next week. Wound care will also be addressed in a specialty workshop next year, as it is an area of focus for 2004. Chronic wound care seems to be the area of most abuse.
• A provider from Ashley County Medical Center submitted a question concerning observation care. They stated that some of the providers are having some problems with observation care. We will get specifics from that provider and address at our next meeting.
• On the PT/OT and ST financial limitations, it states that after an outpatient type of bill provider reaches its limit, the patient can go to an inpatient setting for further covered care. The question is whether CAH can provide the care without it applying to the limitation. A representative of the Arkansas Hospital Association will bring it up at their Dallas CMS meeting.
• LRMP for electrical stimulation - One provider compared our policy with one that uses Alabama for their intermediary. The differences are significant. He provided information to take back to Dr. Hayes for consideration in changing our LMRP.
• Charlotte noted that her calls are increasing because the providers’ staffs do not have PCs or they do not have access to the Internet. Information, which is provided, is not being shared with all their staff.
• Greg noted that CMS is moving us toward using the web-site in lieu of paper. Henceforth, all newsletters will be on the web-site. If a hardcopy is requested, a request form must be completed and there will be a subscription fee.
• If a patient continues to go for therapy after the limitation, a special notice, NEMB (Notice of Exclusion from Medicare Benefits) (not the ABN) is available on the CMS website, www.cms.gov/medlearn/refabn.asp, to let the patient know that Medicare will not be paying and the patient is liable.

8. Kelly Vaughan - EDI/HIPAA

• Kelly noted that testing is improving and some are actually passing. There are very few in production at this time. We are also experiencing problems with getting the Trading Partner Agreements (TPAs) completed and back in. Several have contacted their lawyers wanting us to change the wording of the TPA. Our legal counsel will not allow changes. The agreement can become very complex where there is an entity that owns multiple providers, yet they will be completing only one TPA with all the information for the providers and the transaction types each will be submitted, requesting, etc.
• There are issues with providers transposing their own provider numbers causing them to be set up incorrectly. We have several vendors who are testing at this time. We are encouraging the vendors to include all the providers for whom they are submitting. This will reduce the number of potential testing scenarios. SSI is the only one that has passed testing which covers their software and status as a clearinghouse. WebMD has passed the testing for their clearinghouse for Medicare A, but has not signed the TPA.
• As far as Arkansas hospitals, they are in pretty good shape.
• There is an article in the next newsletter regarding the status of small providers and the Medicare requirement for all providers to file electronically for Medicare. We do have HIPAA compliant software for individual providers, which is totally free. This software does not interface with business office management software and would thus be double entry for the provider.
• Most hospital providers use vendor supplied software with a few using clearinghouses.
• HIPAA information is available via a link on the Arkansas Medicare web-site.
• Kelly noted that she has been receiving a lot of calls from providers because they feel it is easier to call Medicare Services than use the remote. Then, when the lines are tied up with providers doing this to get status, the providers get aggravated at the hold time they incur while waiting for our Service staff to answer the phones. They can solve their own problems by using the remote for the status, etc., and save the phone lines for the real problems.
• If anyone is interested in getting test 835s for HIPAA testing, just call and let us know. However, you have to be currently set up to receive electronic remittance advice.

9. Greg Hart - Provider Education

• Greg noted that the CAH workshop is tomorrow (July 17^th) and distributed the agenda. The hospital workshop is next week with CMS staff making a presentation on Provider Based status.
• CMS makes quarterly updates to their web-site and does have a number of listservs. There is information available by provider type. Also, there is a listing of the upcoming "Open Forums" which are helpful to the various provider groups if they wish to call in with any issues.
• Greg asked about the capability of the AHA supporting video conferencing of the PCOMAG. A representative of the Arkansas Hospital Association noted that there is a capability via the AHEC network. A representative of the Arkansas Hospital Association and Greg will work together to determine the potential in order to expand our participation in the PCOMAG and other workshops.
• Greg asked if we could move our PCOMAG meeting to October 8, 2003 instead of the scheduled date set for October 15, 2003.
• A representative of the Arkansas Hospital Association noted that as far as communications, we use the AHA Notebook for posting the minutes. He will use the Notebook to help determine potential for video conferencing.