Representatives from:
AR Physical Therapy Association, AR Medical Society, AR Occupational Health Association, UAMS Asst. Director of Compliance, AirEvac, EMS, Inc, West Plains, Missouri - Via Conference Call, AR Physical Therapy Association, AR Chiropractic Society, CMS RO, Dallas, TX, AR Chiropractic Association, AR Optometric Association, AirEvac, EMS, Inc, West Plains, Missouri - Via Conference Call, Arkansas Ambulance Association, AR Health Group, AR Medical Society

David Bailey, Supervisor, EDI
Tanya Brooks, Professional Services
Paulette Jones, Manager, Medicare Customer Service and Collections
Theresa Milligan, Director, Medicare Administrative Support
Susan Moore, Senior RN, Medical Review
Barbara Shepherd, Supervisor, Hearings and Appeals
Terri White, Manager, Government Programs
Forrest Wolfe, Manager, Medicare Claims

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

1. Welcome and Introductions - Theresa Milligan

   Introduced a representative from CMS -RO, Dallas, TX
    

2. Updates

   ABCBS has purchased a new building for Medicare Services. The target move in date is slated for Dec 03. Meetings in 2004 will be held in the new building. More information will follow as plans are finalized.
    

3. Remittance Advice.

   In the past when someone wanted an extra copy we would just respond to the request. We have received clarification from CMS stating, that if it's a duplicate copy of material that have already gone out, then it will need to go under Freedom of Information (FOI) and we can charge for it. We were not charging for them and we asked CMS for clarification again and they came back and stated, as they have stated before, you are to provide the duplicate RAs under FOI and charge for them. After the Missouri transition in April all FOI requests go to the Louisiana office for all states. For duplicate RAs, the request needs to be in writing and sent to that office. If you did not get the first copy, it would be free and we would investigate to see why you didn't receive your copy. We are looking to have everything automated through our telephone system. Our auto response unit will give providers the capability to go into the system and request duplicate RAs. The provider will be instructed to push a button and then it will automatically generate a duplicate RA for that provider. We are waiting to get approval from CMS. We are working with CMS and the vendor of our software. A representative asked what was the charge for a duplicate RA? The charge is $.10 a page. A representative asked how long will it take from the time it's received to the time the provider gets the RA. There is a 10-day turn around on FOIs. The releasing of the RAs is limited to providers' own RAs and they are not releasable to the public.
    

4. Missouri Transition

   The transition was completed on May 2, 2003. The workloads have been transitioned to our other locations in OK, LA, and AR. New staff has been hired and trained to take on the new workloads at each location.
    

5. Budget

• The 2003 Budget was reversed funded for provider relations and the same thing will happen for the 2004 Budget. We have been told in the draft that PCOM will not have any type of increase, it will stay at the same level. We are having trouble staying within budget this year. We are going to be looking at our budget process real closely. We want to make sure we are doing the things that are most important and most helpful to the providers. We want to stay within the budget but provide the level of service that you expect.

• There are two items of note in the Budget Performance Requirements this year. Every year CMS puts in what Congress may implement. CMS's talking very seriously about charging for duplicate claims this year. Instead of it being a $1.50 a claim, it's $2.50 a claim. They are proposing that if this legislation passes and a claim comes in, and is a duplicate of another claim in our system, the provider will be charged $2.50 a claim. If we are unable to process the claim because it doesn't have the required information on it, then the provider will be charged when we reject it back. CMS wants to drive home that some providers have their claims automatically rebilling every 14 days before we even have a chance to process the claims. This is a way CMS will be able to streamline the process and get people's attention. Providers may want to look at how your billing systems are set up concerning resubmission of your claims. It was asked if it was in the appropriation bill and Theresa confirmed that it was.

• Susan stated that she was very impressed with the medical quality review. Our goal is to make sure claims are processed correctly the first time. There are a couple of issues that we are currently addressing. One issue is with modifiers and provider education, and another issue is with provider addresses and contact numbers. Both issues are being addressed. We are asking all providers to please keep any changes current.

• It was asked what modifiers are MR looking at? Susan stated that the modifiers at issue were found as a result of our work in Missouri. We are conducting one-on-one modifier education training plus an article will be added in the newsletter. A representative from UAMS stated that they are having problems with diagnosis codes on chest x-rays and EKGs. After researching them, they are finding that the local medical review policy and, the national policy, are sometimes conflicting as far as the diagnoses that are covered. You make a correction in one place but they are still getting denied because something in the Medicare system has to be changed to reflect the national policy. The billing manager has been in contact with ABCBS and we are working to have this resolved. Susan asked if they could write down a few examples and this would give them something to look at and research.

9. Forrest Wolfe - Claims/OCR

• A year ago it was decided that hard-copy claims would go to Optical Character Reader (OCR) to eliminate manual data entry. The decision was based on cost savings for Medicare. In March of this year, we converted Arkansas hard copy claims, which represented about 13-14%, to OCR. We are still in the learning process. Additional staff is being added. Our goal is to have all of the other 3 states completely on the OCR system by the end of the year. All claims come through the Little Rock office. A large percentage of the paper claims are Medicare Secondary Payor (MSP). A lot of the claims are from chiropractors and ambulance. Most of the paper claims are from small providers. It was asked if there had been an increase in paper claims since the April 14, 2003 deadline for HIPAA. Forrest stated that there has not been an increase.

• A representative stated that a lot of smaller providers continue to submit hard-copies because they found out that they could be exempt from HIPAA if they have less then 10 employees. A question was asked if a lot of claims were coming from Optometry and Forrest stated that he would need to research this particular specialty. Theresa Milligan interjected that a monthly report is generated that shows by provider how many are electronic and how many are hard copies. No one is 100% electronic due to MSP and if there is something they may want to send with a special note. It was suggested that an EMC report be done by specialty.

10. Paulette Jones - Medicare Provider Services/Fee Schedule Update

• The 2003 Fee Schedule was implement in early March 2003. According to the CMS guidelines the 2003 Fee Schedule is effective for DOS on or after March 1, 2003. All January and February 2003 DOS that were processed in January and February 2003 were processed correctly with the 2002 Fee Schedule. All claims with January and February DOS processed in March 2003 were processed with 2003 Fee Schedule incorrectly. Sometime in July we will be asked to go back and correct those DOS processed in March 2003 and this can result in collections. The Fee Schedule was increased in 2003 by 1.6% over that of 2002. Please be aware that you may be receiving collection letters in July 2003 for those DOS. A representative asked how does that effect the co-pay that patients were required to pay? It changes the allowable and therefore resulting in the provider owing the patient. A corrected remittance advice will be sent out that will show all the adjustments. You will see the proper allowable charge. Theresa Milligan stated that this is a nationwide issue with providers. It is going to be a major project for us and for the providers. It will also effect the 3^rd Party Payors, because they have paid too much. This is getting a lot of national attention. It is going to cost the system, including the federal government, more money to make this refund than what they are going to get in a refund. Paulette stated that originally it was anticipated that we could not actually pay the proper fee schedule amount for the January and February services until July. That would take a system change and would be very complicated in the MCS system. A motion was made to send a message to the regional office to take a closer look at the refund process. The motion was properly second and a vote was taken. No one opposed the motion. Paulette will draft the letter for the group and it will be given to the representative from CMS-RO. A representative from CMS-RO stated that any correspondences that have resulted from a meeting must be turned in within 2 weeks.

• Provider Telephones: Paulette wanted to find out the thoughts of the providers on adding an additional WATS phone line. We received a report from the company who oversees our WATS line. The report shows the percentage of how often we are busy during the day. CMS has a target percent that they prefer that we do not go over, and currently, we are over the mark. The lines are busy 40% of the day. They are receiving a busy signal. It has been suggested that the WATS line would ring directly into customer service. Currently, we have the one 800 line that rings in to the Automated Response Unit (ARU). If this is implemented you will not have the option when you dial the new 800 number to option out and go to the service rep. You will need to hang up and call the service number. All status calls must go through the ARU. A customer service representative will only assist with a status call if there is a problem with a denial that a provider office would like to discuss. Otherwise, status requests would go through the ARU, and the customer service representatives would be free to handle the more complex issues. We would transfer the current 800 number to the ARU and a new number would be assigned to customer service.

• One of the reasons this would benefit everyone is because this would free up more lines and will not have the ARU tying up customer service lines. Paulette stated that her target is to have 20% busy and that way it would free up 80% that will allow callers to be able to call in without a busy. The current percentage today is 30/40 busy a day. In Missouri an additional WATS line was added and it worked out really well. The main reasons for calls are claim status. The providers were in agreement for the additional line. Paulette will be submitting a request for an additional WATS line.

• Paulette reported that the revised review deadline has been moved from 6 months to 120 days. A lot of refusals have gone out due to the revised filing timeline.

11. Theresa Milligan - MSP

    MSP (Medicare Secondary Payor) is a hot issue right now for the providers. The backlog is shrinking but it is a slow process. Additional staff has been added. If you have any issues you can contact Greg Hart or Theresa Milligan.
     

12. David Bailey - EDI/HIPAA

• HIPAA web base services affords providers the capability to look up claim status and therefore bypassing the ARU system. We currently are working on the 270, which is an eligibility transaction, and the 276, which is the claim status transaction. We have five months remaining until October 16, 2003. There are a large number of providers remaining to test. We have about 6800 submitters that need to complete a HIPAA test. We only have four people in production. If you do not carry out one of the stated electronic transactions you are not a covered entity. You are not a covered entity if you are a small provider with less than 10 full-time employees. The small provider exemption only applies to Medicare electronic claims regulations. Providers will need to first see if they are a covered entity. If so then they would look to see if they are excluded. We need everyone to talk HIPAA up. It is very important that everyone become HIPAA compliant. People are thinking that we may get another extension but we are encouraging everyone to become compliant as soon as possible. If you have not tested by October 16, 2003 you will be disconnected from our electronic claim submission bulletin board. You must pass your test and be in production by October 16, 2003. If you are a covered entity and have not become HIPAA compliant by October 16, 2003 you will not be able to submit paper claims. With the 270 transaction that allows you to create an eligibility request it will be real time for Medicare. You will be able to submit a transaction from your terminal and within 15 to 25 seconds you will get a response back on someone's eligibility on Medicare. This will be a vital tool for providers.

• Theresa Milligan stated that the Southern Consortium, which is in the Atlanta/Dallas regions have come up with some new training materials for HIPAA. One of the presentations is a summary of the different guidelines in very plain language. These will be going out for everyone to view and you will be able to pass them on within you associations. We are expecting them in the next couple of weeks. A question was asked inquiring about the most common reason we are getting for providers not testing. A poll has not been conducted at this moment. The majority of people are waiting on the 40101A, which is the Addendum to the 4010 HIPAA adopted format. David reported that no one in Arkansas has passed and it's due to a lot of providers' use SSI and it is taking a little time to test. Once you go into production you cannot go back per CMS. Please send a sample of all specialty claims to test. There is a minimum of 10 claims and a maximum of 25 claims that can be submitted for testing. Once all testing is done you will be required to sign a Trading Partner Agreement (TPA). You will receive a copy of the X12 user guide, which has all the Medicare requirements. If you are using a billing agency or clearing house, we will allow them to send us a file with a listing of all the providers they do business for and we will grant compliance to those providers. They will be covered once the HIPAA test is complete. Currently no one in Arkansas has passed the test and gone into production. It is the provider's responsibility to contact their clearing house or billing agent to obtain the status of their HIPAA solution. A letter will be going out to all providers that will outline the legal repercussions for not becoming HIPAA compliant. The 270 & 271 real time eligibility transaction is expected to be available to providers some time in July. A provider will need to get a connection to Medicare. IVANS is a company that a provider can use to setup the connection to Medicare for a nominal fee. More information will be coming out soon concerning IVANS. The 276 and 277 transactions are for claim status and request and response and this available today. The 40101A version is what everyone will need to use when submitting claims. A provider does not need to send a Business Associate Agreement. If you are using electronic claims you are a covered entity and you will only need a Trading Partner Agreement (TPA).

13. Barbara Shepherd - Hearings and Appeals

    Currently we do not have any backlogs to report. Ambulance appeals have leveled off. There have not been any increases in Administrative Law Judge (ALJ) hearing requests for Arkansas. We are getting things done in the 120 days time frame.
     

14. Terry White - Provider Communications

All communications will now come out of the Government Programs department in Little Rock, which is headed by Terri White. We currently distribute the newsletter every quarter. A proposal has been submitted to have the newsletter strictly electronic and hard copies will be mailed only upon request and justification. The newsletter is currently on the web-site and that will mean that we could go from a quarterly letter to a monthly letter. We encourage everyone to signup on our listserve. This will ensure that you receive all updates in a timely fashion and this will allow all information to be at your fingertips at all times. The next update of the MedGuide, which is the provider manual, will be distributed on CD only. If a hardcopy is needed, the provider can request a copy, which will result in a charge. You may print it off yourself or take it to your local copy center and have a hard copy made for you.

The next meeting will be August 20, 2003