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Provider Communication Advisory Group Meeting
Medicare Services - Part "B"
| Meeting Date, Time & Place: |
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Wednesday April 20, 2005 ~ 9:00 am – 11:00 am |
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Rhode Island Medical Society |
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Providence, RI 02908 |
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(Teleconference capability as well)** |
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| Facilitator: |
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Carol DeMelo, Education & Training Representative |
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| Medicare Representative: |
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Greg Hart, Senior Provider Education Representative, AR |
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Susana Astros, RI Medicare Services |
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Lori Langevin, RI Medicare Services |
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| PCOM Advisory Group Members: |
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Beth Oldham, East Side Clinical Laboratory |
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Donna Gentes, East Side Clinical Laboratory |
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Patty Grover, Gateway Healthcare |
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Cheryl Adessi, Roger Williams Hospital |
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Katherine Viveiros, Roger Williams Hospital |
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| Teleconference attendees: |
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None |
Welcome and Introduction
The meeting facilitator opened the meeting by welcoming everyone. She advised the attendees that the purpose of the PCOM Advisory Group was to solicit feedback and input from the provider community regarding provider education and training topics,
as well as dissemination avenues and locations for educational forums.
Review of October 27, 2004 meeting minutes
The minutes were approved as written.
New Business:
Ask the Contractor Teleconference (ACT) ~ 03/18/05.
ACTs are similar to the CMS Open Door Forums. These teleconferences are scheduled quarterly. Medicare Representatives from various departments will be on hand to answer a variety of questions. On March 18, 2005 we had the first ACT with nine
people called in. Carol asked the members for feedback on this call and how to make them better.
- Cheryl Adessi from Roger William Hospital
said she attended the ACT call but indicated that the topics were not specific enough and this may prevent future participation.
She also suggested that the time frame was too short and that we should consider extending the time for the call. Carol stated that these calls serve to identify general problems in a timely fashion, provide methods of sharing information,
answer questions, and evaluate the needs of the providers and suppliers.
- Patty Grover-Gateway Healthcare-
had suggested adding information about these calls in the settlement that goes out. Carol informed the audience that this information is included in the workshop’s flyer. Also, an informative flyer will be included
in the enrollment package.
The next teleconference call will be in June 17, 2005. Any suggestions for agenda topic for the next call may be sent to Carol. Additional information will be posted in the Newsletter and our website
Training Tailored for Small Providers – Navigating The Medicare Web Site.
The education of small providers will be addressed by focusing on topics suited to their needs. Medicare will begin to offer free training tailored for small providers; such how to navigate the Medicare website. Carol distributed a PowerPoint presentation
on Navigating the Website. This presentation was used in MO and was very well received. Carol asked the group to review it and make any comments for changes or improvements. Members thought that this navigating the Website workshop would be a good for
small providers. The handout distributed contains lot information about the many useful tools available to our providers, such medical policies and free website training courses. Also, additional topics will be added to this training. Members were
encouraged to express their ideas or suggestions.
- Katherine Viveiros-Roger Williams Hospital.
This information should be disseminated to when providers call to the Customer Service Hot Line. Carol will be discussed this possibility with the Customer Service Manager.
- Patty Grover-Gateway Healthcare
. Medicare needs to be aware that many providers do not have internet access or do not have employees trained in how to navigate the website. We want to show providers how to navigate the Website and educate them as
to how much information is available to them so they will make an effort to get internet access in their office. Carol informed the members that the RI Provider Manual was put on our website the end of December. Carol mentioned that this is a good
education resource for providers and has included a slide in workshop presentations.
Greg also distributed the Preventative Quick Reference card that the Provider Education Reps developed for their workshops. The members were asked what they thought of this type of tool and for suggestions for others.
2005 General Updates Workshop-Attendance and Evaluations.
There is a $ 30.00 fees per attendee for the Medicare Fundamentals and the General Update Workshops. Providers will be able to register online, and then submit the fees and copy of the registration by mail. Carol reviewed the General Update &
Fundamentals Workshop evaluation results with the members. While the evaluations were very positive, Carol expressed concern with the low number of attendees. Carol asked the group for suggestions on how we can increase workshop attendance.
- Patty Grover-Gateway HealthCare.
Patty expressed disappointment with the way that the workshops were advertised. For example, their facility did not receive any invitation by mail about the scheduled workshops. Carol explained that all providers
were mailed workshop invitations near the beginning of the year. The Workshop schedule is also posted on our Website and an email goes out to everyone on our listserv when the website is updated. The schedule also appears in the newsletter. It was
suggested that a pop up message be put on the website advertising the workshops and instructing providers to go to the Events/Seminar section. Carol agreed to have something put on the first page of the Provider section of the web regarding workshops/ACT
calls. Patty suggested sending out the invitations in with the Remittance Advices. All agreed that this is a good idea and Carol will research this for future invitations.
- Beth Oldham-East Side Clinical Lab- Beth
thought it would be a good a good idea if you submitted information regarding workshops to Medical Associations. Carol agreed and will make sure information goes out to all the Associations.
The following schedule with details information about the upcoming workshop is posted in our website.
Data Analysis/FAQ’s and CSE’s
Carol presented a comparative data analysis and requests the member’s assistance on how to communicate with providers to reduce denial errors.
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Denial Reason |
July thru Sept 2004 |
Jan thru March 2005 |
| Duplicate denial |
76,575 |
62,920 |
| Bundling denials |
12,938 |
12,058 |
| Medical necessity denials |
20,277 |
18,961 |
| Claim not covered by this payer |
11,109 |
10,825 |
| Patient cannot be identified as our insured |
7,972 |
8,038 |
- Beth Oldham-East Side Clinical Lab-
discussed the difficult that a clinical lab has avoiding medical necessity denials. The doctor’s office needs to take responsibility and be educated to decrease the numbers of denials.
Beth also asked for more information about the denial message "provider does no have part B or name/number does not math." It is very difficult for us to identify the problem. These denials and how to avoid them are part of both the Fundamentals
and General Update workshops. Carol will research these issues further and see if further clarification is available for the provider community.
- Patty Grover-Gateway HealthCare.
Is there anyway to verify the Medicare Insurance? Carol reply that the HIPAA transaction to verify eligibility is in hold by CMS. How about to check claim status on line? Greg explains to the members that the HIPAA
transaction to check claim status online is available; first a provider needs to contact our EDI staff to perform the necessary tests for accuracy. This information is included in our workshop material.
- Katherine Viveiros-Roger Williams Hospital
asked about the ARU system and the information that was sometimes available. This system will be updated with the Interactive Voice Response System (IVR) in August. This system will have more information
available. Members discussed how an upgrade would benefit the providers and help reduce calls.
- Greg showed the members the Preventive Medicine Quick Reference Guide. We have been distributing this at workshops and it has been published in the newsletter and is available on the website. If any want to receive this colored reference feel free to
contact our office or feel free to download from our website at:
http://www.rimedicare.com/provider/reference/premedquickref.htm. Members felt guides like this would be useful for provider offices and were asked to suggest ideas for other
guides.
Open Discussion
Carol encourages the audience for any feedback, suggestions or any concern that would like to bring out.
Medicare is offering free of cost Part B Provider Enrollment Workshop. We had two sessions in December 08, 2004 and we are planning more in the near future. .
- The NPI is a standard unique health identifier for health care providers. The effective date of the rule is May 23, 2005 and the compliance date for all covered entities is May 23, 2007.
Greg asks the members for any feedback the new customer services systems and they responded that they haven’t noted a difference yet. Also, emphasis how important is to continue with their comments about draft medical policies.
Schedule Next Meeting
The next meeting will be held in Wednesday, July 20, 2005.
No further recommendations were received from the attending. The facilitator thanks the members for being there and for their feedback.
The meeting adjourned at 10:45 am.
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