Representatives from: AR Physical Therapy Association, AR Chiropractic Society, AR Medical Society, AR Occupational Health Association, CMS Dallas Regional Office, Health Financial Management Association, AdvanceMed, AR Chiropractic Society, AR Clinical Lab Management Association, AR Osteopathic Medical Association, Medical Practice Consultants, Inc, AR Anesthesia Network, Arkansas Ambulance Association, AR Health Group

Pat Bonnette, Senior Medicare Services, Technical Support Specialist
Tanya Brooks, Professional Services
Pat Clements, Network Development Representative
Connie Cogshell, Network Development Representative
Rhonda Cordon, Sr. Hearing Officer, Hearings and Appeals
Greg Hart, Professional Services
Sidney Hayes, MD, Medicare Medical Director
Susan Moore, Senior RN, Medical Review
Wanda Remington, Lead Statistical Analyst, Medical Review Audit and Analysis
Sharon Robinson, Supervisor, Medicare Claims
Priscilla Secrest, Supervisor, Medical Review
Kelly Vaughan, EDI Analyst

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

• A representative for CMS Dallas Regional office was introduced as the Arkansas CMS Contractor Representative.

2. EDI/HIPAA - Kelly Vaughan

• Greg also noted that there were some reports received concerning problems with the WebMD clearinghouse. Kelly noted that WebMD has passed their HIPAA testing. One of the issues they were having is that they could not identify to us the providers for whom they submitted claims. They sent a list of providers and EDI tried to set up the connections based on the list they provided. Some of the providers were not linked to WebMD. When WebMD tried to send the claims they were rejected. When claims reject out that are sent through a clearinghouse the rejection is sent back to the clearinghouses. It's not sent to the doctor or the clinic or hospital because they are not sending the claims. WebMD did not notify the providers about the rejected claims. We are now taking care of this issue on a case-by-case basis. If you see a decrease in your payments please calls immediately, especially if you are utilizing a clearinghouse. All of the other clearinghouses are a smaller volume than WebMD and therefore we may face issues such as this one. Greg stated that our web-site has a new listserv that you can sign up for to receive EDI specific updates.

3. Updates - Greg Hart

• 2004 Physician Fee Schedule - The announcement came out and the final rule was published November 7, 2003 and is available through the CMS web-site. Attached to the Medicare drug bill are some corrections to the Fee Schedule but that has to be finalized and signed into law. Providers should have received their participation packets with the current Fee Schedule in it. It reflects about a -4% decrease in the conversion factor for that Physician Fee Schedule. The actual reduction will vary with the RVUs of the CPT codes. Please check the CMS web-site for updates and more information.
   
• A handout was presented about the Improper Medicare Fee for Service Payment. On the bottom on the handout the link, http://www.cms.gov/pcs/cert, to the CERT information is listed. There you will also find a list of Frequently Asked Questions (FAQs) about the CERT process and the review. One of the things you will see in the analysis is two different percentages for denials. One was for the total claims denied while the other was "denials excluding denials for non-response". A lot of providers never sent back medical records when they received the letter asking for documentation. Greg pointed out that Al Hobby with AdvancedMed is our Program Safeguard Contractor (PSC). This report is available through the PSC portion of the CMS web-site.
   
• Rhode Island – Arkansas Blue Cross and Blue Shield was awarded the Part A & B Medicare contracts. We have begun our transition period. We will officially become the contractor on February 1, 2004.
   
• Other Updates - CMS Dallas Regional Office has developed a new newsletter called "The Pulse" which will be sent out quarterly. The first issue was published this month and a copy was passed out to everyone.

• Arkansas is the only one of our five states currently utilizing the Optical Character Recognition (OCR) system for Medicare paper claims. A newsletter was sent out to all paper claims submitters. The newsletter stressed the importance tips for successful processing of paper claims through this system. These included; using a laser printer versus a dot matrix printer and making sure the form is correctly aligned. We are experiencing problems with hand written claims. We still have a large volume of claims that are handwritten.
   
• Ambulance claims issues. Ambulance claims can be submitted on a CMS form 1500 and they can go through just like a regular claims. We are still receiving claims on the Blue CMS form 1491, please check to be sure. This is causing a delay because of the method of getting those claims into our MCS system. The claims will have to be scanned because we no longer use microfilm. The claim specialist will go out to our file network and manually key those claims into the system.
   
• Our electronic claims volume has drastically increased, but the claims are not going through and providers are calling to find out what is causing the delay in payment on electronic claims. Anytime there's a clinic involved and you have a performing provider who is in that clinic, it is required that the performing provider be linked to the clinic. The claims that are submitted under the new HIPAA guidelines are not linked and this is something that we are working to resolve. We have hired additional temporary employees to assist us in processing the claims. We are finding that 80% of those claims need the providers to be linked.
   
• A representative from AR Health Group asked a question on Northeast Arkansas Anesthesia and the Arkansas Anesthesia Network behalf. A letter was received showing the new providers Medicare number, but all the claims have been denied because they are saying he does not have an active provider number. Why did they receive a letter stating that the provider has an active provider number but once claims are submitted they are being denied for a non-active provider number? The letter was received as of July 7, 2003. Sharon asked for a number so that she could contact the representative at Northeast Arkansas Anesthesia and obtain a copy of the letter so that she could investigate this particular issue.

• Sharon stated that we are seeing issues with Item 31 on the CMS 1500 claim form, which is for the provider signature. Sometimes the scanner is unable to read the provider signature even though the signature is on the form. Our system is set to auto deny if a provider signature is not there. When a claim comes in with a provider signature and the system auto deny we are trying to catch these. We are able to catch most of them but we still have those, which do manage to get past us. We are trying to get the level raised from a medium confidence level to a high confidence level for the signature field.

5. Medicare Provider Services - Pat Bonnette

• Prior to November 1, 2003 we had one service line and as of today we have two service lines. One will be for status inquires only while the other will be for other issues in which the provider needs to talk with a customer service representative. We are asking all providers to not call the customer service line for status inquiries. We are backlogged on our reviews and routine correspondence. We are receiving a lot of unprocessable denials and the providers are calling and sending in the corrected claims. We are asking all providers to go ahead and file a new claim. This will prevent those corrective claims from going into our backlog. It will also avoid the 45 days for processing a review.
   
• A question was asked, if a provider got partial payment on a claim would they need to ask for an adjustment on the denied line item or are they able to submit a new claim? In the instance of a partial payment on a claim, it must be adjusted as you cannot submit a new claim.

• Wanda gave the group an overview presentation on Medical Review Data Analysis. Her overview covered the data analysis purpose and process, then went into some examples of the specific reports that are generated and how they are used. A representative of AR Health Group asked if this information could be obtained for individual providers. The comparative billing reports do not cover the areas of the Dataline analysis. Wanda explained that it has not been available in the past but could be obtained on a group basis if we were given the individual providers in the group.

• All Prepay reviews are current and we do not have any backlogs. We are focusing on new ways to do audits.
   
• Dr. Hayes stated that we are in the process of consolidating policies. We had to do a lot of data analysis and look at edits. There are over 100 policies that are being retired. They are being retired because they did not have any edits in place or didn't have any variances on data analysis. We have 20 draft policies to be presented to the Arkansas CAC in December.

1. The American Society of Anesthesiologist crosswalk directions instructed anesthesia to file an anesthesia procedure based on the surgery that was performed. This did not coincide with the medical review policy for MAC, which resulted in numerous denials.

• We are coordinating our efforts with Medical Review to make sure we are not duplicating our work. We don't want to put unnecessary burdens on the provider.

• We receive referrals from Arkansas Blue Cross and Blue Shield Medicare Pre & Post Pay Medical Reviews.

• We receive referrals from the complaint clearinghouse.

• Our main office for Arkansas is located in Nashville, TN. There is a satellite office here in Little Rock. You may receive correspondences from either of those offices. Please respond by the time outlined in your correspondences. If you do not respond by the deadline the claim will be denied for lack of response.

• Web-Based Training - We have a new Modifier course coming out soon, please be on the look out for this course. A question was asked if this was a national course? The web-based training is for the 6 states that are under Arkansas Blue Cross and Blue Shield. CMS also have some computer based training classes.

• Our educational schedule for this year will be on the web-site soon.

• Greg asked for suggestions on how we can better reach a larger number of providers in our education program. The billing staff primarily attends our workshops. They are an important part of the process but there are several things that the provider needs to hear directly. The best results for presenting to the provider has been when we are on the agenda to speak at a professional organization’s meeting.
  • A suggestion was made to hold workshops on the weekend, as it is easier for providers to schedule instead of during the week when most patients are seen. We have concentrated on the weekdays to have more of our subject matter experts available to answer provider specific questions. Further suggestions included breakfast, lunch or supper meetings for specific topics.
  • It was also pointed out that the provider is interested in a focused presentation and not in covering the entire spectrum of change. That type of presentation works for the billers but if the meetings for providers could be concentrated in one specific area geared for the provider we would have better response.
  • Teleconferencing was discussed. In the past, the cost was prohibitive. We will investigate further to find out the current costs.

11. Open items

• A representative asked about rumors she had been hearing concerning a tax on provider services. No one else was aware of any for Medicare. There has been periodic talk for Medicaid funding.

• A representative asked how the minutes were accomplished, as some of the details she had hoped to see were not recorded. Greg explained that the minutes were a summary of the events. He asked that when the minutes are sent to the members that they review them and if there are any corrections needed to be sure to let either Tanya Brooks or Greg Hart know. We will continue to prove a summary and will explore ways to provide clear and comprehensive answers to specific questions.

2004 Meeting Dates February 18 May 19 August 18 November 17