Provider Advisory Groups

 
Medicare Hospital Provider Communication Advisory Group (PCOM) Meeting
Pinnacle Medicare Services

Paul Cunningham and Tanya Brooks welcomed everyone to the meeting. Paul opened the floor for introductions.

Tanya stated the primary focus of this group is to provide input from the provider side on our education and communication program and give us input as to how we can improve. While discussion of specific problems may help to illustrate areas to focus on, the resolution of specific issues is outside the scope of this group. Tanya stated if there are individual claim issues you wish to discuss please speak to one of our staff members after the meeting. Tanya emphasized to the group how much we would like to hear their inputs. We want to know your suggestions and thoughts on how we can improve our communication and education programs.

The floor was open for any comments or corrections to the July 20, 2005 minutes. There were no comments and a motion was moved and seconded to accept the minutes as printed.

Tanya shared with the group that we planned to implement an action item spreadsheet which will allow us to log specific items discussed during the meeting that require additional follow-up. At each meeting we will go over any item along with the resolution. This will also assist us in developing our Frequently Asked Questions (FAQs).

• The group was asked if they thought this tool would assist them and others in helping to resolve issues they may be dealing with. The group agreed this would be a great educational tool.
• They were asked if they liked the format or do they have any suggestions on how you would like to have this formatted? The group agreed to the format.
• Besides posting the questions on a FAQ the group was asked if they had any other suggestions how we can use this data? The group did not give any suggestions but Tanya encouraged them to email any suggestions they may have at any time.

Greg went over the following questions from our last meeting.

• Question #1: Top 10 Reasons for Denials - How is this information pulled for larger facilities and how do we determine the correct percentages?
  • Answer: This data is pulled based on number of denials. The higher volume submitters will show up even though their percentage of denials may be lower than a smaller provider. Our primary goal is to reduce the volume of claims submission errors. We attempt to periodically review the providers with the top percentage of denials to see how we might help them as well.
     
• Question #2: How do you handle duplicate claims and will this affect our numbers?
  • Answer: We base the duplicate claims on volume as well, but the duplicate denials are handled outside the rest of the claims submission errors.
     
• Question #3: If the claims that were paid under the old method (per diem) need to be sent through the new PPS systems?
  • Answer: Tanya reported on behalf of Michele Clark and she stated the claims should run automatically and if they are having any problems to please contact Tracy Futrell at 501-378-2000.

On September 22, 2005 an ACT was conducted and the topic was Medicare Secondary Payer (MSP). There were 114 participants and at least two of the attendees stated they participated on the call. Tanya asked the group if they felt the teleconferences were beneficial the provider community.

• Do you feel this was beneficial to the provider community? The group as a whole agreed the teleconferences were very informative.
• The group was asked for topic suggestions, but at this time no one had any suggestions. Again the group was encouraged to submit any suggestions to Greg via email. The group did not have any suggestions on how we could improve the calls.
• Tanya explained the format consisted of a thirty minute presentation on a specific topic and then the lines would be open for questions. If time allows and there are not other questions pertaining to the subject matter the lines would then be opened to accept questions on all subjects. Everyone was in agreement that they liked the format of the calls. The group didn’t have any suggestions on how to improve the calls.
• Greg Hart is the facilitator of the ACT teleconferences. There is an Audio clip and a copy of the material that was covered during the meeting for all of the calls, and they are available 24/7 on our website at http://www.arkmedicare.com/providers/act/default.asp. The next ACT call is December 15, 2005, and we post the time on our website. We will have Paul to include this announcement in "The Notebook" as well.

• Arkansas Blue Cross and Blue Shield have established a new corporation for the administration of our public program contracts and new public programs business endeavors. The headquarters is located at 515 West Pershing Blvd in North Little Rock, AR, with satellite offices in AR, LA, OK, NM, MO, RI, FL, and MD. Medicare beneficiaries and providers who are currently being serviced by Arkansas Blue Cross and Blue Shield have been notified of the formation of the corporation and new name. Tanya asked the group if they received their notifications and if they had any concerns. The group stated they received their notifications in a timely fashion. The group did not have any concerns about the new corporation.

• Tanya discussed a need to review our membership to be sure we continue to meet the guidelines established by CMS. When this group was initially started we had a representative from each of the regions of the Arkansas Hospital Association. We would like to be sure that we have participation from not only the different regions of the state but different types of facilities, size of provider, etc. If you have someone you feel could bring ideas and suggestions to the forum, please have them contact us. The group was asked to submit the names of possible new members they feel would be an asset to this group.
• Paul expressed that we need to get more participation, from certain areas of the state. Tanya asked, do you think we will get more participation by using teleconference? One group member said she would prefer to see the participants in person.
• Greg suggested that we can look at both avenues on increasing our membership.

For the 2006 Fiscal Year we will be conducting a Medicare Part A Advance Medicare Billing and General Update workshop. We will also have a "Navigate the Web" workshop. These workshops will concentrate on MSP, CERT, and review of claims, website reviews, FISS DDE, and UB-92.

• Tanya asked what would you like to see presented in these meetings. Paula Archer stated she would like to see a workshop on Inpatient Rehab Facilities as well as PPS. Paula had several issues she would like to see incorporated into an educational event.
• Members were asked if they would be interested in partnering with us and allow us to present at various functions.
  • Michele Wilkins Paula Archer welcomed the opportunity to partner with us.
  • We went over the approval process we must follow but if it could not be implemented this year we would definitely submit a recommendation to include these educational efforts in the budget for next year.
• Currently we present at the Healthcare Financial Management Association (HFMA) and Arkansas Department of Health (ADH) meeting as well as partnering with the Arkansas Hospital Association (AHA) to present the Medicare Advance Billing and General Update workshop.
• We welcome opportunities to come and present Medicare updates and answer questions as long as our schedule and budget allow.
• Members were asked if they would be willing to sponsor these meetings by providing a meeting room and materials.
  • Several attendees agreed this would not be a problem.

Tanya asked the group if they were familiar with Medlearns Matters and everyone stated they were. Tanya asked if they were beneficial to their staff. Everyone agreed they were beneficial for their staff.

• CR 4106 - Effective 8/21/05 - Implemented 10/3/05: To accommodate the emergency health care needs of beneficiaries and providers affected by Hurricane Katrina and any future disasters, CMS has created the following condition code and modifier, effective for dates of service on and after 8/21/05. The new condition code is "DR (Disaster related)" and the new modifier is "CR (Catastrophe/Disaster Related)". Tanya reminded the group to access our website at www.arkmedicare.com for and updates concerning Hurricane Katrina. A teleconference will be held November 9, 2005 at 12:00 p.m. to discuss Hurricane Recovery Assistance. Tanya encouraged the group to call in if they desire a more detailed explanation on the changes and mandates CMS has made. Tanya asked the group if we should continue to add this information in our workshop presentation and they agreed that we should.
• CR 3627 – Effective 10/1/05 – Implemented 10/3/05: This CR gives specific instructions to FIs for voiding, canceling, and deleting claims. Providers should note that some claims they were able to delete in the past will no longer be deleted from Medicare’s system, but will instead become denied claims. The OIG has indicated that Medicare must maintain an audit trail for voided, cancelled, and deleted claims.
• CR 4035 – Effective 10/1/05 – Implemented 10/3/05: This CR gives the update for the Hospital Outpatient Prospective Payment System.
• CR 3530 – Effective – Revisions to Medicare Appeals Process for Fiscal Intermediaries

• CMS will be administering the national Medicare Contractor Provider Satisfaction Survey (MCPSS) beginning in January 2006. The MCPSS is designed to measure provider satisfaction with and perceptions about the services that we provide as a Medicare contractor. MCPSS will give healthcare providers the opportunity to rate their contractor on seven business functions: provider communications, provider inquiries, claims processing, appeals, medical review, provider enrollment, and provider reimbursement. The survey will be sent to a sample of approximately 30,000 Medicare provider and suppliers (400 per contractor).

Claims ~ Sandy Tribble and Darlene Rhodes

Sandy stated we are adding new customer service representatives to our department. Darlene explained that the OIG is mandating that we keep and audit trail on all claims which are voided, canceled, or deleted per CR 3627. Darlene stated that all credit balance reports were due on October 31, 2005. The reminder letters are going out soon which will notify providers that all payments are being suspended. We are keeping an audit trail on claims. Credit balance reports were due on October 31, 2005. Greg asked is this was a large problem? There are several providers who have not sent their report in. The money will be held from your claims if money has not been received in fifteen days. One member suggested that CMS should use the AIM Health Care system which will work your credit balance the same day.

Tanya went over the data analysis report with the group and she focused on the top 3 reasons for each report.

• Effective July 1, we stopped all paper remit. We have very few paper claims and effective January 1, 2006; all Part B paper remit will be stopped.

National Provider Identifier (NPI): The NPI will replace all current Medicare numbers. We continue to urge everyone to apply for the NPI now.

CMS Prescription Drug Program: The Prescription Drug Plan Finder is located on www.medicare.gov. The site has information that will assist partners and beneficiaries in learning more about the various plans. The Plan Finder will ultimately let people check to see if they qualify for extra help paying for a Medicare drug plan. The enrollment process will run from November 15 through May 15, 2006.

• CERT continues to be a hot topic in all our meetings. We can’t stress enough the importance that you must respond quickly to each request. There’s a website you can access to verify that your mailing address is the correct one where the request is being sent www.arkmedicare.com/provider/cert/cert/asp (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.

• The Arkansas Chapter of the Healthcare Financial Management Association (HFMA) invited us to continue to participate in their meetings and Chambers Memorial Hospital and St Vincent Health Services offered free space for meetings.

The next meeting will be held on Wednesday, January 18, 2006 at 10:30 a.m.

The facilitator thanked the members for the feedback and participation. The meeting adjourned at 12:00.

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