Arkansas Blue Cross and Blue Shield Staff
Pat Bonnette, Senior Medicare Services, Technical Support Specialist
Tanya Brooks, Provider Education Specialist
Connie Cogshell, Provider Education and Training Representative
Rhonda Cordon, Sr. Hearing Officer, Hearings and Appeals
Greg Hart, Professional Services
Dr. Sidney Hayes, Medical Director
Wanda King, Manager, Medicare Secondary Payor
Sherry Price, Medicare Secondary Payor
Sharon Robinson, Supervisor, Medicare Claims
Kelly Vaughan, Medicare EDI Analyst
The meeting was called to order at 10:07 a.m.

1. Welcome and Introductions - Greg Hart

• Greg welcomed everyone and introductions were made around the table.

• Revision to the 2005 Physician Fee Schedule, Final Rule – The Final Rule was released on November 14, 2004. You can access the final rule through CMS Physician Information Resource Page at www.access.gpo.gov/su_docs/fedreg/a041115c.html. Once the Final Rule is published the Participation Agreement and Fee Schedules are then mailed.
• Fee Schedule (CD-ROM): CDs were mailed on November 13, 2004. CMS announced on November 15, 2004 that 2700 codes were published incorrectly in the Fee Schedule. The correct Fee Schedule will be available through the web-site. Corrected CDs will not be mailed out. CMS is asking that everyone please check the web-site on next week for the corrected version. You may access the fee schedule at www.arkmedicare.com A representative asked if we knew which codes were published incorrectly. Greg stated that CMS held an Open Door Forum on the Fee Schedule and they spoke about the errors. The codes in error were primarily Cardiology. Greg asked the group if they had any suggestions on how to notify providers of the errors. Greg stated that a notice will be placed on the web-site, listserv and newsletters. A representative suggested that a notice be inserted in the various associations’ bulletins. Greg asked if anyone participated in CMS Open Door Forums. Many of the representatives responded that they have participated. (Follow on note: The CD that were mailed to Arkansas providers was correct. There were files sent on different days and the day we extracted the file to use was a correct file.)
• A representative asked if any additional bonus payments will be given for physicians in rural areas and what are the requirements. Greg answered that the Physician Scarcity Area (PSA) is 5% and the Health Professional Shortage Area (HPSA) is 10% and it is based on the zip code, where the service is provided and the specialty. You can find this information in MedLearn Matters by accessing the CMS web-site by entering link http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0449. You can also download the zip code file from the CMS web-site. A representative asked in which box on the claim form you will enter the zip code. Greg stated that on the CMS form 1500 you will record the zip code in Box 32 but this could vary for electronic submitters, depending on what software you are using. This information has been in the newsletters as well.
• Greg also passed out a handout on Chiropractic Practice Demonstration that speaks on the 2 year demonstration in certain states (not Arkansas) that expanded the codes available for Chiropractors to use.
• Greg informed the group that as part of section 921 of the Medicare Modernization Act (Change Request 3376), effective January 1, 2005, contractors will be restructuring their Provider Customer service areas to provide better customer service. Greg noted that this would be a major change. The customer service areas will be structured into three tiers.
  • Tier I - This group will handle the general requests.
  • Tier II – This group will handle calls referred from Tier I, requiring more specific knowledge.
  • Tier III – This group will handle all complex requests that require extensive research.

• In addition, The Customer Service Representatives will become specialized in either beneficiary or provider calls. This will go into effect as of January 1, 2005.
• Our Automated Response system is being upgraded to an Interactive Voice Response System (IVR) which will allow you to receive eligibility and claim status. Please note that if a provider calls the customer service line with an issue that can be handled through the IVR they will be directed to use the IVR system.
  
  ACTION ITEM: A representative asked if ambulance providers would be able to use the IVR. Greg will research this

• Provider Education Workshops – Also under Section 921 of the Medicare Modernization Act (MMA) emphasis has been placed on providing education to the small providers. CMS has listed the requirements as any physician with less than 10 full-time equivalent employees and any facility with less than 25 full-time equivalent employees. We are working with the medical societies to help identify these small providers. We will be required to hold 6 workshops per year especially for the small providers beginning in April 2005.
• Arkansas Medicare Services will be holding teleconferences at least quarterly which will be similar to the CMS Open Door Forums. Greg asked the group for suggestions as to how best to structure these to be the most beneficial for them.. The group liked this initiative and felt it would also be great to have a few calls that were for specific specialties. The format will consist of an agenda with some general topics and time for open discussion. Notification will be placed on the website concerning the schedule for these calls.
• We are also planning to use denial management as a way to tailor training to reduce claims submission errors. Once the reasons and providers are identified we will conduct face-to-face training.
• A copy of the 2005 Workshop schedule was given to the members. The calendar has been posted to the web-site as well.

• Web Based Training – A listing was given to each member that consisted of the projected 2005 courses the date the class would be released. If you are on the listserv to review the classes you will receive notifications of any review periods. If you are not on the list and you wish to review the courses during the developmental stages you will need to contact Mary Kay Sunderhaus at 225-231-2184.

3. Data Analysis – Greg issued quarterly reports and the results are as follows.

• Providers in the top 10 for submitting duplicate claims have been receiving letters from us. If they remain in the top ten, then we will follow up with either a telephone call or a visit. A representative asked about information she received concerning IVAN, which is the Internet eligibility and claim status that isn’t available at this time. Kelly stated that it’s currently not available but they are working to get this up and going as soon as possible. Currently there isn’t an implementation date set.

4. EDI/HIPAA – Kelly Vaughan

• We have 1,778 AR Medicare Part B submitters and here are the current stats as of today
  • 16 Testing
  • 1,707 In Production
  • 1,723 Have been tested

• Last week we received 955,283 electronic claims that were HIPAA compliant and we received 578 that were not HIPAA compliant.
• CR 2981 Modification of CMS’s Medicare Contingency Plan for HIPAA Implementation, which can be accessed at www.cms.hhs.gov/manuals/pm_trans/R273CP, affects the payment floor for claims. Please review the contingency plan. If you submit non-HIPAA compliant electronic claims you will go from 14 days to 27 days payment floor.
• Electronic Remittance Advice, which is the 835 HIPAA Compliant Transactions, has a Corrective Action Plan (CAP) in place. We are currently not doing well on Electronic Remittance Advices. We currently have 342 in productions for receiving the electronic format. We are focusing our efforts on contacting the providers and assisting them in getting setup on electronic remits. A lot of the provider’s software does not have the capability for electronic remits. Kelly asked the group to please send their suggestions on how they can get the word out concerning the electronic remits.
• CMS has not stated when they will end the contingency plan for Remittance Advice. Greg stated that on the 835 they have placed information on the web-site in a pop-up box, in the newsletters, and on the listserv. Greg asked the group if there were any suggestions on how they could get the word out. A representative suggested a notice be placed on the Remittance Advice in bold print
• Reggie Favors stated that a couple of the outstanding issues with CMS is allowing the logo on the Remittance Advice and allowing a provider to file secondary payor. Reggie stated that it would help if the associations could give us some input or make sure you address this with your providers. A representative stated that they just attended a national convention and it was mostly all vendors who spoke about having electronic Remittance Advice. Kelly stated that we are going to provide you with the software that will allow you to download your Remittance Advice.
• We are monitoring electronic submitters who are HIPAA compliant but they are still sending in paper claims. We are contacting them personally. If you have a problem where you must send a paper claim due to technical difficulties then please call us first at 1-866-582-3247 between 8:00 a.m. and 4:30 p.m. If you can’t get the assistance you need please feel free to contact Kelly Vaughan at 501-210-9095.

5. Provider Enrollment – Greg Hart

• CMS stated that they will allow an additional grace period for signing the Participation Agreement because of the problems with the fee schedule. Once we are notified by CMS we will place this on the web-site. Provider Enrollment will start in 2005 conduction Provider Enrollment workshops. In formation will be place on the web-site as well as the newsletter.

• In the upcoming newsletter there will be specific articles printed pertaining to claims. Effective February 1, 2005, nine digit provider numbers must be linked if associated with a clinic. This information is also included in the workshops we are conducting.
• Unlisted procedures- Arkansas is the only carrier among the Consortium that develops that information if the provider does not give it. If you use a miscellaneous code and you are not using a description, we will send a development letter asking for that information. We will no longer ask for this information effective December 1, 2004. We will deny your claims as unprocessable. The regulation states in the CMS manual under section 80-3.2.1 that if Item K is not completed correctly it should be returned unprocessable. Any miscellaneous procedure codes can be listed in Item 19 with a description. This information has been in the newsletters and also covered at the workshops.
  • Reggie asked if we could identify those claims. Sharon stated that on paper claims we could but not on electronic claims because they are not linked. Sharon stated that a data analysis could be done to help identify those claims.
    
    ACTION ITEM: Reggie requested that a data analysis be conducted to identify the claims.

• Data Analysis conducts a report twice a year on Post Op. The latest report conducted showed that the quantity bill is being populated incorrectly. If the provider does 90 days of post op they are entering 90 days and they should be entering 1. Sharon has been contacting providers who are completing this incorrectly and explaining how they should record this information correctly. On paper claims in Item 19, they should give the dates and we will count the quantity.
• Dr. Hayes asked what is being done about Modifier 22, used to indicate unusual circumstance. Claims will assume responsibility for this modifier effective December 1, 2004. When a provider uses a Modifier 22 they must have an operative report and a concise statement attached. It will also become a paper claim. If these items are not attached we will send out a letter asking for the information. If not received it will process at that level of service and not go to Medicare Records to receive the additional payments for the other services.
• A representative asked if an Anesthesiologist conducts two surgeries in one day, what modifier would they use. A surgery is performed on a patient twice in one day. The second surgery is due to complication from the first surgery. Would the provider use modifiers 77 or 78?
  
  ACTION ITEM: Greg will work with Dr. Hayes to research this issue and issue a recommendation.

• Sherry stated that they have worked hard to eliminate their backlog. During this process they have discovered a problem among most providers. We are requesting that when you are sending in your Explanation of Benefits, which the provider receives from other insurance companies, please scan in the entire documents. They have special remarks that we need to see.
• MSP claims can be submitted electronically now. Sherry also gave each member a copy of CR 3407 Instructions on Processing Certain Types of Medicare Secondary Payer (MSP) Claims and to Balance the Outbound Remittance Advice, which can be accessed on the CMS web-site at www.cms.hhs.gov/manuals/pm_trans/R21MSP
• In Item 29 on the CMS form 1500, providers are indicating their amount paid and that is incorrect. This box is for the amount paid by the patient. We will be sending a letter asking who paid if this item is completed. Greg stated that we have been emphasizing this in our Fundamental workshops.

• Pat stated they are in the process of hiring the new staff for the dedicated provider and beneficiary customer service representatives to implement the three tier system outlined in CR 3376.

• A policy went into draft form in December 2002. In that policy there was an accreditation requirement. There was two years given for this policy and now providers are asking what this is. Dr. Hayes has requested a listserv to be set up for this and we had only one person to sign up. Dr. Hayes asked the group how we could get more people involved. A handout from the Program Memorandum was given to each member.
• A representative asked if the providers are aware of what is going to be discussed at the CAC or Advisory group meeting. Dr. Hayes stated that a packet is issued prior to the meetings that consist of the agenda, a copy of the last minutes, and a copy of each policy that will be discussed.
• Dr. Hayes reminded everyone of the Medical Review page on the web-site under the Provider Information section. You can find a list of audits that are being conducted and the documentation that is being requested.

10. CERT – Greg Hart

• In the past we contacted providers who did not submit documentation and through this procedure the percentage has decreased drastically to 1% of non-responders. CMS has also place more information concerning CERT on their web-site and they have also revamped their page.

• Rederterminations are to be done in 60 days instead of 45 days. CMS has awarded the Qualified Independent Contractors (QICs) contract to eight contractors. We do not know who the administrative contractor will be but CMS will announce soon. Qualified Independent Contractors (QICs) will go into effect October 1, 2005. Once the administrative contractor is in place we will have more information on the outline and the process. In addition the Administrative Law Judges (ALJs) will fall under Health and Human Services instead of the Social Security Administration. They will be dedicated to Medicare.