Attendees:
Representatives from: Ashley County Medical Center, Arkansas Hospital Association, Arkansas Department of Health, North Arkansas Regional Medical Center, Piggot Community Hospital, Saint Vincent’s Infirmary Medical Center, Chambers
Memorial Hospital
ABCBS Staff:
Tanya Brooks, Professional Services
Charlie Clem, Vice President of Public Programs
Amanda Crosby, Manager, Provider Audit and Reimbursement
Charlotte Garlington, Senior Nurse, Medicare Pre Pay Review
Greg Hart, Professional Services
Dr. Sidney Hayes, Medical Director, Medical Review
Theresa Milligan, Director, Medicare Administrative Support
Dennis Robertson, Senior Vice President of Public Programs
Pam Robinett, Manager, Medical Review
Barbara Shepherd, Senior Hearing Officer, Hearings and Appeals
Kelly Vaughan, Analyst, EDI
Forrest Wolfe, Manager, Medicare Claims
Meeting was called to order at 10:30 a.m.
- A representative of the Arkansas Hospital Association called the meeting to order
A representative of the Arkansas Hospital Association gave opening remarks and welcomed everyone.
The representative noted that Medicaid, in terms of HIPAA compliance, would do their crossover to the new format, as stated before, on October 13, 2003 so that it will be at the beginning of the billing cycle. There is concern that the
vendors and clearinghouses are not ready to begin as yet. Medicaid will not be running a dual system. As of Monday, the providers will have to file compliant claims or they will not be paid. A special notice will be sent from the Arkansas Hospital
Association (AHA) today to reminding the hospitals of this.
Medicaid is provisioning in the HIPAA format for a physician identifier to be on the claim. It was originally mentioned that the identifier would be the National Provider Identification Number (NPIN), which has not been issued. Because
there is not an NPIN, the hospital will have to include the physician's social security number or Employer Identification Number (EIN). This field is a requirement for Medicaid and will be edited. The AHA is hearing that some physicians are balking at
providing the social security number to the hospital. One member noted that this was happening on the 1500 format for Medicare.
It has been suggested that the hospitals be allowed to put 9's in the field until the NPINs are issued. It was noted they had heard that some Fiscal Intermediaries (FI) are turning the edit off. This is not the case with Medicaid. A
representative of North Arkansas Regional Medical Center, noted that the emergency room and drug claims are being very slow to process under Medicaid.
A representative from Ashley County Medical Center, noted that NDC (one of the largest clearinghouses) would not be compliant by Monday. They are currently in development and have not begun to test with Medicaid. This hospital is
planning to use the software, which will require them to key all their Medicaid claims manually until NDC is compliant and testing with Medicaid. There are still issues, which need to be resolved before we can even get the claims to NDC.
Charlie Clem noted that he just read an e-mail today before the meeting that Medicaid would be taking the old formats for crossovers until December 31, 2003 and this could mean for all claims also. We will need to check into this and
submit a follow up.
Introductions were made of all the members.
- UPDATES - Greg Hart
Greg introduced Dennis Robertson, the new Senior Vice President of Public Programs at ABCBS.
Dennis Robertson noted that he was glad to be a part of the Medicare operation at Arkansas Blue Cross and Blue Shield (ABCBS). We are looking at some restructuring to stay in line with the contractor reform. Our operations will for the
most part be moving to a new location in North Little Rock. We will also be going through the novation process, which will restructure us to be at arms length from ABCBS as a Medicare contractor. CMS is making us go through certain steps to conform. There
are 32 contractors currently and it is anticipated that the reduction in contractors will be streamlined over the next 5 - 7 years.
Greg noted that the NLR building for Medicare is located on Pershing Blvd and the scheduled move in date is set for January – February of 2004.
Charlie Clem noted that the Fiscal Intermediary Shared System (FISS) maintenance is going well.
The CMS website has been updated and now includes all the Medicare manuals. They are moving to a total web-based maintenance of manuals. Greg distributed a handout outlining what's new on the website. Our newsletters are all electronic
now with the exception of the subscription service for $100 annually. Providers can subscribe to the listserves for our newsletter and for various sections of the CMS website. That will be the primary way for the providers to be kept current.
Today at 1:00 p.m. is the Open Forum for hospitals as well as
a HIPAA forum.
A representative from Arkansas Hospital Association noted that some of the higher-ranking CMS officials generally attend the Open Forums and it is a good way to get your issues heard at a high level.
Greg advised that the Correct Coding Initiative (CCI) bundling edits are now available on the website and can be downloaded. Formerly, they were proprietary. What's out on the site is the Part B edits which are provided a quarter in
advance of the Part A edits. Charlotte Garlington asked about the effective date for the edits in Part A if they are on a delay. She also wanted to know if CMS has said anything about holding the claims if the CCI edits are a quarter behind. Greg said
that it is being looked into and updates will be issued.
Greg noted that the CMS website, http://www.cms.gov/hospitals, has links to the proposed notices and final notices in the Federal Register.
ADH Facilities Management - Representatives of Arkansas Department of Health
A representative of Arkansas Department of Health noted that we now have 17 Critical Access Hospitals (CAH) (20% of acute care hospitals in AR) and 6 Long-Term Care (LTC) hospitals. Amanda Crosby noted that Arkansas Blue Cross is not
the Fiscal Intermediary for any of the LTCs. The most recent CAH is DeQueen.
Claims - Forrest Wolfe
Forrest Wolfe distributed an analysis of telephone calls and provider submission errors. The statistics rarely change as to categories. We have noticed that the status calls are finally dropping off some due to the providers using the
remote. In checking with the claims staff, there were not major problems noted. However, there is a CMS requirement that providers must provide a credit balance statement each quarter regardless of whether they have any balances. It is important that the
providers submit these reports since it could result in some actions against the providers if not provided.
A representative from Ashley County Medical Center noted that she is getting denials from Medicaid/QIO for their psyche patients, not Medicare, which results in the patients showing up in their ER. If the patients are meeting the
criteria and are still being denied, we have a problem. The representative talked with one of the physicians and did not get an answer. It was noted that this has been a problem around the state and is one that needs to be addressed with Medicaid. A
representative from Ashley County Medical Center noted that the documentation on a specific very sick patient was excellent. On the very day that she was no longer hallucinating, she was discharged - yet it was denied.
Medical Review - Dr. Sidney Hayes
Dr. Hayes noted that on October 28- 29, 2003 the CMDs for Regions IV and VI will meet to go over the advisory group process to determine if changes should be made. Inpatient rehab is a very hot subject right now. There is a policy in
several states, which is being reviewed. There are situations where a patient might have a knee replacement then shortly thereafter the patient was transferred to the Inpatient Rehab Facility (IRF). Charlotte noted that lots of data analysis was done in
one of the regions.
Charlotte Garlington noted that the provider education will have more focus on problems, even small ones. We are creating new Local Medical Review Policies (LMRP) and retiring some of the older ones. We will be doing more one-on-one
education either in person or by letter. For Inpatient Rehab Facilities, the 75% rule is now the 65% rule and it could change back at anytime.
Hearing and Appeals - Barbara Shepherd
Barbara Shepherd noted that there are no apparent issues. However, some of the files are lacking documentation such as the discharge statement, H&P, etc.
She reminded the group that the appeal rights are a part of the ANSI codes on the RA - MA01 - MA04. Need to be sure that this is monitored in order to meet the 120 days timeline for filing an appeal.
HIPAA/EDI - Kelly Vaughan
Kelly stated that we have 34 submitters testing for Part A. Currently 4 have passed and 13 are approved for production. SSI has been approved which represents about 20 hospitals. It is the only clearinghouse that has cleared for
production for Part A. Medicare will continue to run dual systems - NSF or 4010.A1 - "for a limited time". The providers must make a good faith effort to come into compliance in order to stay on the NSF. We have to monitor the number coming in to test to
keep CMS advised. We are also having problems with the providers completing their Trading Partner Agreements (TPA). These are usually the complex, multi-type providers. If any of the providers need help, they can call 866-582-3247. It is very busy right
now and some of the employees are new and have to have assistance in responding to some questions. It is a little less stressful for staff now that we have the reprieve to allow both NSF and ANSI. We have contractors who review the test results and some
providers are having trouble understanding them. The Medicare supplied software for Part A is PC-ACE and Part B is MCE. Each software is HIPAA compliant and does not have to be tested. However, we do encourage you to test. These packages are free, but do
not interface with any practice management systems and must have the individual claims entered manually. The CD has the software, TPA, dialing instructions, and a lot of information in the form of a user’s guide. We are encouraging the providers to put
the pressure on the billers, vendors and clearinghouses to become compliant and test with Medicare since that is their job. If you are using remote you don't have to have any new numbers to use for billing. Just about any type of communications package
will work with the remote. If you are currently on remote, you just need to fax in a note if you want additional terminals.
A representative of Arkansas Hospital Association asked if the issue about the social security number has been brought up to the Medicare EDI area. Kelly said that she is not directly in EDI, but has not seen anything on it. A
representative of Chambers Memorial Hospital noted that the only problems with 1500 testing were the taxonomy codes and the physician's social security numbers.
A representative of North Arkansas Regional Medical Center noted that his provider went live yesterday with SSI. It was asked, "If they send claims without the social security number, will this hold up their money?" Kelly noted that
during the testing the claims went through Medicare claims systems testing as a component.
A representative of Ashley county Medical Center stated that as of Monday there is a change in the requirements for Medicaid from "z" codes to CPT codes, which is a big change.
Provider Audit & Reimbursement - Amanda Crosby
Amanda Crosby noted that in the applications for provider enrollment the social security numbers of key employees and directors are required. We have a provider, which has refused to provide them for their directors. We have contacted
CMS and were advised not to withhold money at this time and allow them 2 weeks to get the information in. If not, refer to the Regional Office and they will take steps to decertify them.
A representative of Ashley county Medical Center noted that during a Medicare Maze at their facility an AFMC representative was advising beneficiaries not to give out their social security numbers and do not carry their Medicare cards
with them since they should have to provide this only once to a provider. This was very distressing to her. Arkansas Blue Cross and Blue Shield will get in touch with the Quality Improvement Organization.
Amanda Crosby noted that CMS has to approve accelerated payments if the providers get in trouble with compliance with HIPAA. Also, the paper claim floor is 27 days instead of the 14 days for Electronic Media Claims (EMC).
We have been working over the last couple of years to make settlements of cost reports faster. During 2004, we will be settling unaudited cost reports within 12 months. We will use the same process as we currently do for unaudited cost
reports. We will also be moving cost report appeals through faster. The Provider Reimbursement Review Board has a hugh caseload with some cases taking 10 years to get to the board and a year to get the hearing. Most of the appeals in Arkansas do not have
to go to hearing because they are settled locally. Be sure that all requests for information are answered timely and totally.
Provider-based attestations have not come in. They are not required, but we did expect to receive some. However, we will be initiating a request for information on some units and it would be best if the information had been provided
already.
On audited cost reports, we will agree on certain documentation that is needed at the exit conference with a timeline for providing. We have to settle the report within 75 days of the exit conference or the date of waiver of the exit
conference by the provider.
Provider Education - Greg Hart
We had several seminars and meetings with provider groups during the past quarter. Workshops during August and September included Skilled Nursing Facility, Hospital, and Critical Access Hospital. In 2004, we are going to have a workshop
for providers on wound care and rehabilitation. We will have 2 Part A basic billing workshops during the first 2 quarters and the 4th quarter of 2004. We do have a calendar for scheduling our workshops on our website. We are working with the associations
on conducting our workshops. The Arkansas Rural Health Care Association is asking for CMS and us to work with them to set up a workshop and will include Trailblazers Healthcare Enterprise for freestanding Rural Health Centers (RHC).
A representative of North Arkansas Regional Medical Center noted that his employees always return from the Medicare workshops with positive comments. Please don't stop having them.
Meeting adjourned at 12:04 p.m.
