Welcome and Introduction
The meeting facilitator began the meeting by thanking everyone for participating in the third quarterly meeting. It was emphasized that the goal of this meeting is to provide timely, useful and relevant educational opportunities to our providers. The members were also reminded that the focus and goals of this meeting is for all of you as members, to act as consultants and provide us with your suggestions and ideas on how to communicate and educate hospitals on areas that need more educational efforts.

Old Business ~ Review of January 20, 2005 meeting minutes
The prior meeting minutes were noted and the minutes were accepted as written.

Hospital Topics

• Consolidated Billing
  As a carry over topic from our last meeting, Lori discussed SNF Consolidated Billing. Many of you advised that more training needs to be conducted on this and that there are system issues causing your denial, this is not the case. I wanted to share with you the updates that I have received from CMS along with our plans to educate SNFs on this issue. As a reminder, the issue was for Emergency Room services where the dates of service span over two different dates on the claim. I have received more calls from you since our January meeting on claims that have denied due to SNFs claims not reporting a Leave of Absence (LOA). My research shows that your claim initially pays but once the SNF claim is submitted, CWF automatically take backs your payment because the SNF did not report the leave of absence so the system looks at this as an overlap. This is not all SNFs but there are many that need additional training and we will look to our SNF Advisory Group for suggestions to accomplish this ASAP.

  Lori distributed transmittal No-00-35, which is the Outpatient Code Editor (OCE) correction to the members, which clarifies that ER claims can have a span date of service and FISS can process correctly. I agree with CMS that there is not a system problem as every example that I have research has denied due to the SNF claim being submitted incorrectly without reporting the LOA. To answer your concerns as to what you can do in the meantime, I have been advised from our Claims Manager that if your services have been denied you can call our Customer Service Dept. and advise them of the SNF involved with your claim. Medicare will make the initial contact to the SNF to advise them of the error. If they do not adjust their claim, we may need your medical records so that we can make the adjustment from our end so that your claim can be processed correctly. You can also contact me for assistance as we want to educate these particular SNFs ASAP. If you need any additional copies, you can download at: http://www.cms.hhs.gov/manuals/pm_trans/A003560.pdf
  
  Response from Advisory Group:
  Is there a way to pay the hospital claim when the patient is in the hospital and deny the SNF claim for the specified date that patient was in the hospital.

  Lori advised that since the hospital claims normally comes in first as the SNFs submit every 30 days and their bill is an inpatient stay this is not possible until their claim is submitted correctly. As a reminder, every quarter CWF automatically conducts a mass adjustment to take back any overlapping claims.

  Why does the system take from hospital and not from SNF?
  Lori advised that the nursing homes services are submitted as an inpatient stay. When the system reads that this patient has inpatient services in one facility and outpatient services in another facility, there is an edit in FISS that rejects the overlapping outpatient services when the LOAs are not reported. At this point it is a matter of education and it not all the skilled nursing homes, but it only takes a few to mess up your claims.

  Greg advised to the members that consolidated billing (CB) has been a very difficult program with many exceptions and different rules to follow. However, within the last two years CMS has developed a lot of material to clarify different related issues. This year we have some special emphasis in SNF training on this issue.

  Some of the nursing homes use third party billing to do their billing; do you think that those third party organization are aware of CB issues when submitting claims? At Landmark Medical Center, we are making many attempts to be in compliant with all the requirements in order to avoid this situation.
  Lori commented that Landmark has been very helpful in resolving this issue. I have been working with your department for the last couple months and we know that you are doing many efforts to minimize this situation. Please continue to send me all your concerns by e-mail, fax or call me, and then we combine all your ideas, suggestions and concerns to help us to prepare an educational workshop. Lori advised that there is a billing company named ACS Billing which submits electronic claims for almost 40 nursing homes. I had the opportunity to speak with one of their representatives about these issues and they are aware about reporting leave of absences with revenue code 180 and so forth.

New Business
Hospital Topics

• HIQA ~ Posting of Frequency Tests ~ Instructions emailed to all members
  Per your suggestion at a previous meeting, I have recently been informed of HIQA, which is another way to check posting frequency test; i.e. mammogram screening, pap smear and PSA as well as checking eligibility. Providers who bill electronically and have access to our mainframe are asked to utilize the Health Insurance Query (HIQA) screen to verify the eligibility of a person with Medicare. You must have the following information about the beneficiary in order to check eligibility:
  1. Health Insurance Claim Number
  2. First Name and last name
  3. Date of Birth (MMDDCCYY format)
  4. Your provider ID

  Lori asked the members for feedback on this topic and some of the members expressed their knowledge and satisfaction with this screen. The advisory group suggested that HIQA should be incorporated in our workshops.

• Website posting of claim issues on FISS
  This has been a great suggestion by this group and Rhode Island is working closely with Arkansas to develop this project. We are very committed to keep you updated in all related issues affecting you. Lori asked the members if they have any comments of suggestions. The members just want to see this information posted ASAP so that they can be aware of issues that are holding up their claims for payment.

• Upcoming Hospital Workshops~ Fundamentals and General Billing Updates
  Lori explained to the group that although these workshops were suppose to be held by now that other CMS mandated training workshops and workload has prevented that. However, it is our obligation to hold these workshops by the end of this fiscal year. Lori also encouraged the advisory group to continue sending suggestions and topics for these workshops. Lori advised that as soon as she completes the PowerPoint Presentation, these workshop will be scheduled.

  For those of you that do Part B 1500 billing at your facility these workshops may be helpful:

  June 8 & September 14, 2005 ~ Fundamental of Medicare Part B

  This is a full day of basic Medicare Part B Billing, such as completing the CMS 1500 form, modifiers, understanding the Medicare Remittance Advice.

• "Ask the Contractor"
  We now offer quarterly teleconferences through a toll free number, which is called "Ask the Contractor". You have the opportunity to interact directly with representatives from various departments within the Medicare organization and serve to identify problems in timely manner with no cost for participation. If you have any ideas or suggestions that will help us focus the call on your hospital needs, please feel free to share with us. The first teleconference was on February 23, 2005 and the next teleconference will be on:

• FISS-Top 10 Provider Inquiry Reason Codes / Top 10 Claim Submission Errors
  Lori reviewed the top 10 provider inquiry reason codes and the top 10 claim submission errors and asked members for their input on why these are happening so that we can conduct the appropriate training to decrease these inquires and claim submission errors. .

CERT (Comprehensive Error Rate Testing)
As we always discuss at these meeting, this is a reminder about record request(s) from AdvanceMed, who is the CMS contractor for CERT. AdvanceMed selects a random sample of claims from each contractor for medical review. Through the information collected and reviews conducted, a national and contractor specific error rates are produced. When you get their request remember to respond to them with the required documentation, because this could affect your payment and future reconsiderations. The flow chart provided in your handouts is very descriptive and a helpful guide for you to under the CERT process. When the report is generated and sent to the FI, it reflects how we are doing as a contractor.

The top errors are:

The types of bills with high error rate are outpatient services, lab services, occupation therapy, radiology, pharmacy and MRI.

Open Discussion
Members would like to meet with the SNF members in order to discuss and find a solution about the overlapping claims. Lori will share this suggestion with the SNF members at the afternoon meeting.

We have noted that the draft medical policies that are posted on the Part B section of the website can affect Part A, but this information is not posted in Part A draft section. Dr. Gilson advised some policies may or may not affect Part A, but when the policy is finalized that we do post in Part A website section. At our CAC meeting last night we discussed thirteen established policies in other states. These thirteen policies are on our website open for comments for 30 days; please take time to scan and all your comments are very welcome.

Dr. Gilson also stated that we have an open position for a part-time consultant to assist with Medicare policies, who is certified and has a minimum 5 years experience and well recognized in the medical community. Feel free to submit any input on this topic.

Rick Hoover, CMS Boston Regional Office, advised members on the Medicare Modernization Act of 2003. He passed around information regarding the drug discount cards, new and improved preventive benefits, prescription drug plans and contact phone numbers. Rick advised members to do their best to assist to educate the beneficiaries on this issue and to just be able to tell them where to go for assistance would be a big help. We understand that this is time consuming, but many of you directly or indirectly through your staff has contact with the beneficiaries. Medicare beneficiaries will soon be receiving a letter from the Social Security to educate them on this matter. At CMS, we are trying to use our staff and resources to go through provider and beneficiary network programs to educate people. Please visit our website at www.cms.hhs.gov under provider information where you can find useful information that you can download, and then make copies to place in visible areas to the beneficiaries. Some of the many fact sheets available on our website are the following:

• Part B Benefit Eligibility and Enrollment
  http://www.cms.hhs.gov/medicarereform/issuepapers/title1and2/files/issue_paper_19_-_part_d_eligibility_&_enrollment.pdf
• The Facts About Medicare Prescription Drug Plans
  http://www.medicare.gov/Publications/Pubs/pdf/11065.pdf
• Guide to choosing a Medicare Approved Drug Discount Card
  http://www.medicare.gov/Publications/Pubs/pdf/11062.pdf

Schedule next meeting
The next meeting will be held on Friday, July 22, 2005 at 9:00 am at the Warwick Public Library.