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Medicare Part B Provider Communications Advisory Group
Arkansas Blue Cross and Blue Shield
Medicare Services
515 West Pershing Blvd-Argenta Room
North Little Rock, Arkansas 72114
May 11, 2005
| Meeting Date, Time & Place: |
Wednesday, May 11, 2005 ~10:05 - 11:15 |
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Argenta Room |
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North Little Rock, AR 72117 |
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| Facilitator: |
Pat Clements, Provider Education & Training Representative |
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| Medicare Representative: |
Cheryl Allison, Provider Education & Training Representative |
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Pat Clements, Provider Education & Training Representative |
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Dr. Sidney Hayes, Carrier Medical Director |
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Sharon Kelly, Supervisor, Medicare Claims |
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Linda Myers, Professional Education Specialist |
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Sherry Price, Supervisor, Medicare Secondary Payer |
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Kelly Vaughan, Medicare EDI Analyst |
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| PCOM Advisory Group Members: |
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Dr. Chris Cathey, Arkansas Chiropractic Society |
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Denese Estep, Arkansas Occupational Therapist Association |
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Julie Kettlewell, Arkansas Foundation for Medical Care |
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Dr. Karen Konarski-Hart, Arkansas Chiropractic Association |
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Tami Hill, HFMA/Professional Counseling |
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Pam Traylor Rosado, Prof. Billing and Consulting |
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Barbara F. Sowell, Cooper Management |
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Brett Tyhurst, Arkansas Anesthesia Network |
Welcome and Introduction
The meeting began the meeting with a note of thanks to everyone for taking time out to participate in the Provider Communication Advisory Group Meeting. The two new staff members Cheryl Allison, Provider Education and
Training Representative and Linda Myers, Provider Education Specialist were introduced.
Old Business ~ Review of February 16, 2005 meeting minutes
Review of the prior minutes was noted. Minutes were accepted as written. Members were informed that they can find previous meeting minutes in our web site, as well information about the upcoming meeting time; please refer to following link:
http://www.armedicare.com/provider/pcomag/default.htm
It was emphasized the goals of this meeting which is to provide timely, useful and relevant educational opportunities to our providers.
Agenda Items
Ask the Contractor Teleconference (ACT):
The group was asked how many called in on February 9, 2005. We had 18 providers to call in. Pat Clements was the facilitator, and all hot topic questions were answered by staff on the call. The group was asked what suggestion you can give us on how we
can better communicate these ACT calls. It was suggested the provider associations could put the word out on these calls. Some members suggested that they would like these calls to be provider specific. The next call is June 7, 2005; the time will be
announced in the newsletters, on website and at workshops.
Training Tailored For Small Providers Outreach - Navigation of the Website
CMS has instructed local carriers to offer outreach efforts in 2005 to reach small providers. We have set up workshops to be held statewide to educate theses providers in navigation of the AR and CMS Websites.
The dates are:
- May 24, 2005, Russellville
- June 22, West Memphis
- July 13, Ozarks
- July 15, Hope
- August 10, Monticello
Enhanced use of the Internet:
We continue to work on enhancing the Arkansas Medicare website, www.arkmedicare.com, to make it a useful tool for providers. We are including information in
our workshops about what is available and how to access information through the website. Member suggestions were requested.
The question was asked, "What can we do to improve or enhance the website?
Training Tailored to reduce the claims Denial Error Rate
We are starting a program to contact the top providers who have the highest denials in the top ten reasons, by the top three providers, this will be done by:
- Letter, telephone, or a visit
- The question was asked, "Are their any parameters and what the base line is? Such as duplicate claims.
- Answer: We will be using the CERT Data Based for this information, which may have an array of information. Identify the top ten denial reasons about these codes, duplicate denials, and requested additional information not received.
We will be working with the top three providers in each of the top ten reasons for claims submission errors. We will initially send a letter, then follow up with a telephone call, if they continue to be a top provider, then, if necessary a visit to
help avoid these errors.
Kelly Vaughan addressed, that if claims are filed not in the HIPAA compliant format, these claims are treated as paper and held for 27 days payment floor.
Web Based Training
Web Based Training is free to providers and is available 24 hours a day, seven days a week.
Members were directed to the hand out of all the classes offered. Pointed out there are new courses, SNF, MSP, Podiatry, CEU are available for taking these courses.
Workshops for 2005
- We just concluded our last General Updates workshop in Jonesboro. We are starting our Fundamental Workshops on June 10, 2005. This workshop is geared for new employees/billers, and addresses the basic of Medicare.
- In the past we had season billers to attend which is always beneficial if they go away from the workshop and learned something thing new.
Evaluation and Management workshops will focus on documentation requirement to support medical necessary, local provider education and training (LPET will be addressing the 1997 guidelines, common errors; our area will address several updates, and
website navigation.) The registration is free and the schedule is listed on the website.
HIPAA - Kelly Vaugan
Everything is going well.
We monitor the submitters that are not HIPAA compliance
Focus on Electronic Remittance Advice, we are currently at 85% which is good
No date from CMS on when the contingency end.
Monitoring paper claims, Electronic billing, and are offering free software to the small practices.
User group meeting in Pennsylvania in August on how to make the modification to the MSP, ERA in the software, print their remittance advice.
Comprehensive Error Rate Testing (CERT) - Dr. Sidney Hayes
Dr. Hayes addressed the latest information concerning CERT for Part B Providers
The comprehensive error rate started out as QA.
Small claim issues,
Insufficient documentation
Coding
Medical Necessaries issues
No documentation due to certain
Services billed but not rendered - big issue
No documentation all - big issue
Just getting the records in
AR & MO are in the same clusters; the big issue is insufficient documentation
Change in what we do and what we send back in
Incorrect coding up-coding and down-coding
AR & MO do well in absorption - very proud of Arkansas
Top services in the denials
E&M lead the way - 45 to 50% of the error rate in Arkansas
Consultation request letter, not sending in letter, down coding, in charts
Hospital Care
Turn into MR probes, and for the providers to send in
- There is no up coding, incomplete; we are not getting what we needed from the contractor
We looked at each state and the primary issues were:
- LA - no service documented
- MO- down-coding
- OK- up-coding
- RI- up-coding
- AR is leading the way, we are doing it better than the other states, but we have room to improve.
- Consultation was changed to office visit because they did not the referring physician, two hospital visits in one day; critical care audit was in Rhode Island only.
- Ambulance issues is LA & MO, Lab in OK, radiology doing well, EKG only RI, Chiropractor in MO, Drug issues all in one claims, 4 or five errors, in Rhode Island Pap Smears, in OK Lab
- If you receive a CERT letters, answer quickly
- E&M codes letters did go to the chiropractors. E & M is a non-covered service for the chiropractor and they are not sending in the claim.
Dr Hayes asked for members input and discussed some of the planned initiatives.
- Calling the CEO's – telling them about the CERT rate and the need for their records.
- Do I need to write letters to groups? Hospital visit?
- Physicians need to know, Wrong people coming to the training
- Training workshop - CFO, administrator, business director, identify the right people and the Hospital for letters
- Mail certified to the CFO, CEO
- Hospitals is OK, the provider would be by practice
- How we can improve the survey letter? Education training certified letter and a meeting on this date?
- Education training - certified letter
- Meeting to talk about the CERT error rate
- Arkansas is doing well. No other questions for Dr. Hayes
Other Business - Sherry Price
Sherry Price addressed the need for providers to use the Overpayment Refund Form on all refund
Overpayment Refund – We are asking you to use this form, it is out on the website and this is for MSP. This information is discussed in our workshops and in the newsletters.
Schedule next meeting
The next meeting will be held August 17, 2005.
- Any Agenda item that you would like to see let us know.
No further recommendations were received from the attending. The members were thanked for attending and for their feedback. The meeting adjourned at 11:15.
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