Provider Advisory Groups

Attendees:
A representative of the following facilities was in attendance:
Baird, Kurtz, and Dodson, St. Vincent Health Hospital, Ashley County Medical Center, Arkansas Hospital Association, St. Bernard Medical Center, Medical Park Hospital, Health Park Hospital, MidSouth Credit Bureau, Inc.

ABCBS Staff:
Cheryl Allison, Provider Education & Training Representative
Tanya Brooks, Provider Education & Training Representative
Michelle Clark, Provider Audit and Reimbursement
Pat Clements, Provider Education & Training Representative
Gary Eads, Claims Manager
Greg Hart, Senior Education Coordinator (Via Teleconference)
Lekisha Langston, Provider Education Specialist
Linda Myers, Provider Education Specialist
Sherry Price, Supervisor of MSP
Kelly Vaughan, Medicare Systems Analysis

Meeting was called to order at 10:33 a.m.

1. Welcome and Introductions
   
   A representative of Arkansas Hospital Association gave opening remarks and welcomed everyone. After introductions, a brief overview of the purpose of this group was given. This group was established to help get information out from CMS to various organizations. This group is tasked to develop and direct the best means to communicate CMS changes and updates as they occur.

   Pat Clements introduced the new staff member, Tanya Brooks, who is the new Provider Education and Training Representative for Medicare Services
    

2. Old Business – Pat Clements
   • Pat Clements asked if there were any corrections to the minutes from the last meeting. No corrections were made. After the motion was moved and second the minutes were accepted. Members were informed that they can find copies of past minutes on our website, as well as, information about the upcoming meeting dates and times. Please refer to following link for all upcoming meetings: http://www.arkmedicare.com/provider/pcomag/default.htm
      

3. New Business – Pat Clements

   • The second "Ask the Contractor" call was held on June 7, 2005. This is a one hour teleconference for Part A and Part B. The topics for each meeting are listed on the website. The topic last month was on Comprehensive Error Rate Testing (CERT). The next call will be September 22, 2005, at 10:00 a.m. and the topic will be Medicare Secondary Payor (MSP). Pat asked the group if they had any suggestions on how we can make meeting productive and how we can get the word out to the provider community. A representative of Arkansas Hospital Association stated that they will post the announcement on their website and also in their newsletter. Pat asked if 10:00 a.m. was a good time to have the call. Several representatives stated that it would be better to hold the call in the afternoon. It was agreed by everyone to have the December call in the afternoon. All information concerning the upcoming call will be on the listserv. A representative asked who we are trying to recruit for these calls. Pat stated that the calls are primarily for the billing staff and managers. Pat asked the group for topic suggestions. No suggestions were given. A representative asked how the hospitals have been notified in the past. Pat stated that all announcements have been posted on the website, articles in the newsletters, and announcements at the various workshops. A representative suggested that we forward an announcement to the HFMA and have them post the information on their listserv as well.
      

4. Training Tailored for Small Provider Outreach – Pat Clements

   • We have developed specific training sessions for small providers and will be conducting throughout rural areas in Arkansas. Our next meeting will be in Monticello, AR on August 10, 2005. The topic is Navigating the Websites. This is a three hour workshop geared toward teaching providers how to navigate our website for A and Part. The benefits of conducting these workshop are, smaller groups which allow one-on-one training and free. This allows training to be offered in rural areas to providers who desire to attend but are unable to attend due to travel constraints. The group was asked, "What other topics would you like to see discussed and where would you like to have the workshops? Suggestions were made to consider discussing the PPS rules regarding the transfer policy, Web-R, and Remote. Kelly Vaughan instructed the group to contact Carl Carter at 501-210-9096 to set up training for the Remote system. The group was asked if doing the workshop if a teleconference would be better. The group was in agreement that their staff preferred the workshop setting with hands on capabilities. A representative asked if it was possible to have a stair step type of Medicare training. For example a Basic Billing, Intermediate Billing, and Advanced Billing course which would give each participant a certificate of completion.
      

Training Tailored to Reduce the Claim Error Rate – Pat Clements

A letter will be mailed to the top providers with the highest denial rate listed in the Top 10 Reasons under our Denial Management Data Analysis. The data is collected from the FISS system. With this information will allow us to educate the providers, that will lead to a reduction of claims error rate.

A representative suggested that we attach copies of the information along with the denial letters.

• Pat went over several reports that showed the Top 10 FISS Reason Codes, Top 10 Claim Submission Errors, Top 25 Codes for the Written Inquiry that were identified for the third quarter.

TOP 3 FISS Reason Codes

1. Inactive Claims
2. Status claim rejected
3.Other – In error

Top 3 Claim Submission Errors

1. Patient name & or initial not matching Bene Record
2. Invalid Payer ID
3. Outpatient OPPS TOB where history claim has overlapping dates

• The group was asked if there were any suggestions on how we can help communicate this information to provider community. A suggestion was made to place some information on the EOB that will give them a contact number

6. Enhanced use of the Internet – Pat Clements

• We are constantly improving our websites to make sure it is user friendly. All workshops, medical policies, and newsletters are posted on the website.

• Web Base Training – Our Skilled Nursing Facilities Courses will be coming out next year. These courses are free and available around the clock. This is on the CMS website and published on the list serv.

7. Workshops – Pat Clements

• A tentative agenda for our first Part A Fundamentals and General Update workshops has been given to everyone. The workshop has been scheduled for September 7, 2005. The morning session will be on Basic Billing Fundamentals from 8:00 a.m. – 12:00 p.m. and the General Update will be from 12:30 p.m. – 4:00 p.m. The meeting location has not been confirmed (Attachment)

• Amanda Crosby with Provider Audit and Reimbursement will speak at the HFMA on August 25, 2005 at the Embassy Suites, Hot Springs, AR. We want to target the right audience. All information can be found on our website and also the Arkansas Hospital Association website (www.arkhospitals.org)

• The Critical Access Hospital workshop is tentatively scheduled for September 13, 2005. Once the date is confirmed the information will be place on our website.

8. Comprehensive Error Rate Testing Program (CERT) – Cheryl Allison

• CERT continues to be and hot topic in all our meetings. We can’t stress enough the importance that you must respond quickly to each response. The group was asked if anyone had received a CERT request. Many stated that they have received a CERT request. Here is the following website that is available for all providers to verify that their mailing address is the correct one where the request is being sent www.certproviders.org (read only). However, there is an email link on the website that will allow you to send any corrections you may have. You may also contact customer service at 1-301-957-2380 to update information. Once this information is received, you will receive a call to verify and confirm that your information is correct.

• ACTION ITEM: A representative asked, "How do you handle duplicate claims and will this affect our numbers. Greg stated that he would research this matter and present at the next meeting.

9. HIPAA – Kelly Vaughan

• Med Learn Matters MM3883 – Access Process for Beneficiary Eligibility Inquiries/Replies (HIPAA270/271 Transaction) (Extranet Only)

• This IT change will create the necessary database and infrastructure to provide a centralized HIPAA-compliant 270/271 beneficiary health care eligibility inquiry and response in real-time.
• To access the MDCN, an entity must on its own obtain the necessary telecommunication software from the AT & T reseller.
  • IVANS: http://www.ivans.com
  • McKesson: http://www.mckesson.com

• Medlearn Matters MM3645 – Fiscal Intermediary (FI) Standard Paper Remittance (SPR) Advice Changes.
  • Effective July 1, 2005, CMS has instructed FIs to discontinue sending SPRs to providers, billing agents, clearinghouses, or other entities representing providers that have received electronic remittance advice.

• Medlearn Matters MM3440 – Administrative Simplification Compliance Act (ASCA) Enforcement of Mandatory Electronic Submission of Medicare Claims
  • The CR went into effect July 2005. If you submit a paper claim this information will go on a report that will generate a letter to the provider requesting that they submit proof that allows them to send in paper claims. You must meet CMS guidelines that will allow you to submit paper claims.

• Kelly stated that all electronic Remittance Advice that were mailed on July 19, 2005 were wrong and they will be re-issued. The notice has been placed on the website.

• The Vendor workshop will be held September 13, 2005 in St. Louis, MO. During this workshop they will be introducing the Web Enrollment process.

10. National Provider Identifier – Cheryl Allison

• Medlearn Matters SE0528 – CMS Announces the National Provider Identifier (NPI) Enumerator Contractor and Information on Obtaining NPIs. This is affecting all providers nationwide so please apply for the NPI. In "The Notebook" provided by the Arkansas Hospital Association, they have supplied a good article "Countdown to NPI", which gives good information pertaining to the transition. The website is located at http://www.cms.hhs.gov/hipaa/hipaa2/ .

11. Other Business
     

    • Medicare Services are striving to give more access to Part A providers when seeking comments on any new drafts LCD. The new process for Part A LCD Drafts will start on September 1, 2005. We are separating Part A and Part B LCD comments periods. Part B will be submitted first for comments and three months later Part A will be submitted for comments. This information will be listed in our newsletters.
       

    • We are updating all our LCDs to Mirror the National Coverage Determination.
       

12. MSP – Sherry Price
     

    • The February 2005 newsletter had specific information pertaining to the Top 30 Error Reasons. The information is located on pages 54-61. In-depth explanations have been listed which will assist providers in correcting their errors. File your claims with Medicare if you are primary or secondary and this way you are covered under the timely filing rule. The new law to file claims is eighteen months.
       

13. Medicare Audit – Michele Clark
     

    • Outpatient claims – Edit on units 1000was sufficient until they changed the units. CR requires $50,000 edit to suspense claims for outpatients. We are working to lower the dollar amount.
       

    • Provider Base Attestations. – Outpatients clinics should be sure they are provider base and not free standing. This is a benefit to you so they can not adjust claims as that filing date.

• Provider Enrollment – information in on the 855A

Greg Hart asked the group if we needed to include the information discussed by Provider Audit and Reimbursement in the upcoming HFMA meeting. The group responded that this would be good to discuss in further details.

The group was asked to submit any suggestions they may have for the upcoming MSP, "Ask the Contractor" teleconference.

Meeting adjourned at 12:25 p.m.

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