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Medicare Part A Hospital PCOM Advisory Group
Meeting Minutes
April 27, 2004
9:00 am – 11:00 am
Warwick Public Library
Attendees:
Andrea Zito, RN, RI Medicare Services
Cynthia Cote, RN, RI Medicare Services
Lori Langevin, Professional Relations, RI Medicare Services
Carol DeMelo, Professional Relations, RI Medicare Services
Greg Hart, Professional Relations, Arkansas Medicare Services
Susana Astros, Professional Relations, RI Medicare Services
Rocco Bruno, Manager, Audit & Reimbursement, RI Medicare Services
Joanne Hernandez, RI Medicare Services
Nancy Porrazzo, RI Medicare Services
Gail Mihalakos, Quality Partners RI
Lynne Gauvin, Kent Hospital
Doreen Maynard, Kent Hospital
Mickey Lourenco, Kent Hospital
Katherine Viveiros, Roger Williams Hospital
Nilda Mendoza, Roger Williams Hospital
Lisa Randall, South County Hospital
Lori Sullivan, South County Hospital
Arleen Palazzo, South County Hospital
Kathleen Petrarca, Women & Infants Hospital
Paula Poirier, Landmark Medical Center
Carol Foldes, Landmark Medical Center
Felicia J Sanders, Memorial Hospital
Godiva Laliberte, Eleanor Slater Hospital
Tom Thomas, Eleanor Slater Hospital
Lorraine Laverty, Eleanor Slater Hospital
Joan Kornacki, Eleanor Slater Hospital
Gert Champagne, Lifespan
Christine Rawnsley, Lifespan
I.- Old Business:
Review of 02/24/04 meeting minutes and action items
- Representatives from Arkansas and RI Medicare Services were introduced to the group. The representatives from the hospitals also introduced themselves.
- Lori Langevin as a lead of the forum provided a summary about the issues to discuss and informed about the availability of previous meeting minutes in our website
www.rimedicare.com
. In addition, website training, seminars /events are continuously posted in our website.
- The action items from previous meeting were reviewed and completed.
II. New Business
A) FISS Issues
Payment Cycle Change
Payment cycle change from Wednesday night to Tuesday night, therefore you will receive check payments with a Wednesday date. Feel free to call me if you have any concern regarding payments.
Issue Log ~ Wednesday 10:00 am 1-800-411-0160 pass code # 242199
Anyone that has any concern relating to transition, EDI or FISS issues is encourage to be present in the weekly conference call where specialists for each department will be available to answer
questions. Also, all issues are logged and tracked for future research and references.
Top 10 FISS Reason Codes / Top Claim Submission Errors
- A detailed explanation of each one of the top FISS reason codes was given (see attachment)
- It is very important to write the same beneficiary’s information in every page / sections of the claim.
- Carol DeMelo refers to the 1500 Form procedures. If the provider renders the services in the hospital, it is very important to report the Hospital ID as well as the address on the 1500 Form.
- Joanne Hernandez (Claim’s Supervisor) advised the audience to refer to the Medicare Provider’s News Spring Edition 2004 for supporting information regarding this matter.
- Lori Langevin advised the providers to feel free to call or e-mail her for any concerns related to the FISS transitions that seem different from the APASS system. (suspense/ status/ appeal). Examples of any problem are always very helpful.
HBO Therapy Billing ~ Daily vs. Monthly
CMS does not have any regulations that you have to bill on a monthly basis. However, for medical review purposes and consistency in billing, it is the recommended way to bill.
Pulmonary Rehab ~ Use G Codes
Lori reminded the audience about the G-codes that should be used and the advisory that Medicare has developed.
RI Medical Review Issues – (Handouts distributed to group)
1). Recertification for Physical Therapy
30 day requirement – Cindy distributed CR 2859 & 2779 to the group.
Cindy referred to this change request and stated that there has been no change in the requirement that either the physician, or non-physician practitioner, must periodically review a plan established by a physical therapist (also speech-language
pathologist and occupational therapist) and must recertify the plan of treatment at intervals of at least once every 30 days from the date last seen by the referring physician or non-physician practitioner. Obtain the recertification at the time the plan
of treatment is reviewed since the same interval (at least once every 30 days) is required for the review of the plan.
60 day requirement – Outpatient Therapy must be under the care of a physician. Outpatient physical therapy (and occupational therapy and speech-language pathology) must be furnished to an individual who us under the care of a physician or
non-physician practitioner who certifies the patient’s outpatient therapy services. Cindy informed the group that if the therapy service continues past the 60th day, there must be evidence in the patient’s clinical record that a physician, or
non-physician practitioner, has seen him/her within 60 days after the therapy began and every 30 days past the 60th day.
2.) Physical Therapy - Time Based Codes
Cindy reviewed and reinforced that when billing for time based codes, the treatment time must be recorded in the patient’s medical record along with the note describing the treatment to justify the number of units of service provided. The medical
record must contain sufficient information to determine both the amount of direct treatment time spent with the patient and the content of the treatment program. The beginning and ending time of the treatment can also be recorded, but this is not
required. Refer to the one page handout from Change Request 842.
3.) EPO Advisory
Cindy stated she has recently received several phone calls regarding denial of EPO for non-ESRD (Q0136). She distributed the EPO Advisory to the group. She reminded the group that in instances of a cancer diagnosis, the chemo indicator needs to be
present to support that the patient is receiving or has been on a recent course of chemotherapy. Refer to the Advisory for coding.
C). Part A Updates - (Handout distributed to group)
Appeals to be called Redeterminations ~ Effective 10/01/04
(MRN) Medicare Redetermination Notice – Medicare has 60 days to complete
Effective 10/1/04, the first level appeals will be called "Redetermination" . Medicare will have 60 days to complete, then the notification letter MRN-Medicare Redetermination Notice will be sent out. In the section "Additional Information" (Handout
Medlearn Matters Number MM2620) you can find the required elements for this topic.
Elimination of 90 day grace period for discontinued ICD.9 codes is effective 10/01/04)
Elimination of 90 day grace period for discontinued HCPCs codes is effective 1/01/05
Medicare systems will begin enforcing HIPAA standards on October 1, 2004, requiring that IDC-9 codes submitted on claims must be valid at the time the service is provided. As a result, the 90 day grace period is discontinued. HCPCs codes with effective
date January 1, 2005. (Handout Medlearn Matters Number MM3094)
D) CERT ~ Reminder for Non-responders (CR3157)
This is a highly discussed issue. CERT reminder again to the providers about the submission of medical records previously requested. Unfortunately, many providers did not respond and services have to be denied
due to lack of documentation. It is a very sensitive situation, but is a mandatory regulation from CMS and as a contractor we have to comply in an accurate manner.
It is also important to submit medical records upon request in a timely manner. Non-responders contribute significantly to the Medicare Fee-For-Service error rate.
E) ABN’s ~ Advance Beneficiary Notice – Reminder
As a reminder, when claims for noncovered services are submitted without the proper modifiers (GX, GZ, GY), it will indicate that an ABN was not given to the patient. This will create a very sensitive situation
for the beneficiary and for the providers. Medicare will send a "not cover" letter to the beneficiary advising that they are not liable as no ABN was given. In turn, the provider bills the beneficiary because they have the ABN on file. Medicare will then
receive a beneficiary appeal. With the use of the proper modifier, this can be avoided. Greg Hart informed the group that Medicare has a new CERT change request (CR3115) that just came out for noncovered services, especially for Part "A" services.
F) Audit & Reimbursement ~ 838 Reports.
Rocco Bruno, Manager of Audit & Reimbursement, advised the group that this report is due April 30, 2004. Please use mailing address PO Box 249, Providence, RI 02901. The Warwick address is not a deliverable address. You may drop them off there, if you
wish,
G) Open Discussion
Website ~ New Look and Website Training Now Available
Lori informed the audience about the new website, such as appearance, functional options and training information.
Medicare Secondary Fact Sheet Handout
Lori refers to Handout Fact Sheet for Provider Billing Staff March 2004 – Medicare Secondary Payer
May 1, 2004 – Deadline for 90 day extension EMC providers HIPAA Updates
If BCBSRI is your vendor, May 1, 2004 is the deadline for them to be sending your electronic claims to Arkansas. If you have any system problems feel free to call or e-mail Lori Langevin.
HIPAA Updates
Lori Langevin distributed Medlearn Matters numbers MM2981, MM3050 & MM3031 for the recent HIPAA documents.
During the open forum the audience refers to the following points:
- Providers want more training, on EPO with G-codes and dialysis treatment.
Lori Langevin to follow-up with billing guidelines.
- How long are we going to have the Wednesday’ conference call? Is it possible to have conference call in a monthly basis?
Effective May 12, 2004, this call is now every other Wednesday.
- When do you plan to update the systems and release the claims holding in the system?
There are some issues that the System Analysts are still working on but all claim issues should be reported to Customer Service. There are some claims that are being held so that Medicare can work the claims.
You can also contact Lori Langevin, if you feel claims are being held too long.
- Inpatient vs. outpatient codes that have to be used (admission code 44)
Joanne Hernandez explained the best way to bill two inpatient bills on the same day, but two different conditions is that the second claim has to be submitted first and then the first claim. There is a CR in
effect to address this issue but for now this is the directive we have received from CMS.
- Billing’s representatives have problems when they submit adjustment claims over 18 months old.
This issue pertains to LTCH PPS billing and some missing claims data with history was converted from APASS to FISS. CMS is working on this issue with the Arkansas Data Center.
- The next meeting has not been schedule. Most likely to be in late July or early August.
Please send agenda items or training issues to Lori Langevin
ACTION ITEMS
Lori Langevin to send RI contact sheet to Eleanor Slater Hospital
Email information on April 28, 2004
Lori Langevin to send claims with IB9997 status to Roger Williams Hospital
Faxed claim’s information on May 5, 2004. |
