Cindy Cote, RN Medical Review Nurse, RI Medicare Services
Andrea Zito, RN Medical Review Nurse, RI Medicare Services
Carol DeMelo, Provider Education Representative, RI Medicare Services
Lori Langevin, Provider Education Representative, RI Medicare Services
Greg Hart, Senior Provider Education Representative, Arkansas Blue Cross & Blue Shield
Susana Astros, Provider Education Specialist, RI Medicare Services
David Bailey, Provider Education Representative, Arkansas Blue Cross & Blue Shield
Michele Paolino, University Medicine Foundation
Julie Sylvestre, Comprehensive Practice Management
Renne Van Coughen, RI Physical Therapy Association

Carol DeMelo introduced a new member, Renee Van Coughen, from RI Physical Therapy Association.

1. Review of 02/26/04 Meeting

   Julie Sylvestre in our last meeting expressed concern about time frame to process Provider Enrollment applications, but she has noticed a little improve in this area since our last meeting. She did however mention the following:

   • When she’s calling for information usually is disconnected
   • She sent the paper work in order to get a Medicare number for a group and their provider, but each application was assigned to different employee making very difficult the certification process, especially when she called requesting information.

   Carol DeMelo emphasizes the difficult steps that we are dealing due to transition process and the implementation of PECOS software. Also, the Provider Enrollment Dept has added two additional phone lines for provider inquiries.
    

2. Part B updates
   Informed the group about the New MedLearn Website as a useful educational resource for Medicare Providers.
   • Medicare Redeterminations
     The appeal process will be changed. The effective date for the implementation of these changes is October 1, 2004 and the time frame to make a decision is 60 days. Lori Langevin encourages the audience to check the samples in our website.
   • Elimination of 90 Day Grace Period for Discontinued ICD.9 codes
     In October 1, 2004 Medicare will implement the updated version of ICD-9-CM and the 90 Day Grace Period is eliminated. New codes have to be adopted for services rendered on or after that time to guarantee prompt payment of your claims.
   • Elimination of 90 Day Grace Period for HCPCS Codes
     In January 1, 2005 Medicare providers will no longer have the 90 day grace period. Therefore, in order to avoid any payment delay you must be sure to adopt the new codes.
   • Medicare Secondary Fact Sheet
     Carol refers to Fact Sheet and emphasizes the material when Medicare is the secondary payer and identifies different scenarios that can help providers.
   • 04/01/04 requirement for Block 32
     It is requirement to write the name & address of the facility where the provider rendered the services.
     Q. – (Renne Van Coughen) I know that code 49 is for Independent Clinic and 11 for Office visit. But, what is the difference for billing, payment and services purpose?

     Carol will research and respond to Renee.

3. EDI Updates – David Bailey, Arkansas BCBS
   • We have some providers that are still sending paper claims to BCBSRI and we are trying to continue for an extended period of 30 day. However, in the meantime we are working with these providers to move to electronic submission. So far we don’t know the exactly number of providers in this situation. This is only the big concern in Rhode Island.
   • David advice about submission on non-HIPAA electronic claims to Medicare after July 1, 2004 will take an additional 13 days for payment over the pay guidelines. The systems automatically flag these claims.
   • About 220 providers have not completed the test and moved into production. David indicated that his staff will communicate with provider by phone and mail and that the EDI staff are very accessible by phone and also by e-mail.
   • It is very important to clarify that this is CMS contingency plan.
   • Julie Silvestre expresses her gratitude for the excellent customer services that her company has been receiving from EDI representative.
4. Data Analysis
   • Claim Submission Errors- Carol DeMelo, RI Medicare Services
   • This data analysis reflects the number of denial and duplicates claims received. Carol referred the group to the totals for duplicate claims submission. For the months of February and March the totals added up to 75,000, which is quite high. However it was noted that this could have been a result of the transition since many providers were resending files during that period.
   • As a result of many duplicate claims, we are in the process to identify these providers. Then we’ll send letter in order to help our providers to correct this problem.
5. Medical Review
   • Physical Therapy Update/Cindy Cote RI Medicare Services
   • Physician / non physician practitioner must be recertify at least once every 30 days for the review of the plan
   • Therapy service continues past the 60 day, individual must be seen physician.
   • Provider’s writing must be legible.
   • Persuade the audience to send the requested record in order to avoid denial.
6. Future Workshops
   • Carol and Greg informed the group about upcoming workshops such as an "Introduction to Medicare" which will probably be offered sometime in August or September of 2004.
   • There will be a charge of 30.00 per person to attend the Workshop.
7. Schedule next meeting / Agenda Items
   • To Be determined