Andrea Zito, RN, Rhode Island Medicare Services
Cindy Cote, RN, Rhode Island Medicare Services
Lori Langevin, Professional Relations, RI Medicare Services
Carol DeMelo, Professional Relations, RI Medicare Services
Dr. Parker Staples, Medical Director, RI Medicare Services
Rocco Bruno, Manager, Audit & Reimbursement, RI Medicare Services
Greg Hart, Professional Services, Arkansas Medicare Services
Kelly Vaughn, EDI Specialist, Arkansas Medicare Services
Heidi Louro, Claims Manager, Lifespan
Christine Rawnsley, Billing Manager, Lifespan
Maria Parrillo, Senior Billing Rep., Lifespan
Marjorie Beal, Compliance Manager, Lifespan
Gert Champagne, Senior Billing Rep., Lifespan
Katherine Viveiros, A/R Coordinator, Roger Williams Hospital
Nilda Mendoza, A/R Specialist, Roger Williams Hospital
Mickey Lourenco, Patient Accounts Supervisor, Kent County Hospital
Lynn Gauvin, Patient Accounts Coordinator, Kent County Hospital
Doreen Maynard, Patient Accounts Supervisor, Kent County Hospital
Laurie Nelle, Compliance, Kent County Hospital
Pat Moran, HARI ~ Hospital Association of RI
Debra Dzialo, Outpatient Office Manager, Rehab Hospital of RI
Maria Figueroa, Asst. Director of Patient Accounts, Butler Hospital
Lisa Randall, Patient Account Rep., South County Hospital
Arleen Palazzo, Patient Account Rep., South County Hospital
Arlene Nimmo, Eleanor Slater Hospital
Paula Poirier, Asst. Director of Patient Accounts, Landmark /Rehab Hosp.
Carol Foldes, Supervisor of Patient Accounts, Landmark / Rehab Hosp.
Joann Maddox, Supervisor Patient Accounts, Women & Infants Hospital

1. Old Business:
   • Review of 11/20/03 meeting minutes

   No comments or suggestions about previous meeting

   Introduction

   • Lori Langevin introduced herself to the hospital representatives and advised that this meeting will be utilized for a FISS DDE overview of screens and helpful hints for claims processing as well as for our regular Provider Communication Advisory group meeting.
   • Representatives from Arkansas Medicare Services were introduced.
     Greg Hart (Professional Services) and Kellie Vaughn (EDI Specialist)
2. New Business
    
   1. Transition to Arkansas Blue Cross ~ RI Medicare Services
      • Electronic Fund Transfers available on Mondays
        EFT’s are now available on Mondays. However, testing efforts are underway to change this to Friday’s for EFT availability. This will involve changing the payment cycle from Wednesday night to Tuesday night. The effective date of this change has not been determined yet but March 8, 2004 is the target date.
      • New RI addresses and contact telephone numbers (handout given)
        Transition effective since 02/01/04
        The new name is RI Medicare Services
        Persuade people to be informed through our RI Medicare website (www.RIMedicare.org).
        All providers are invited, who have any concern relating to transition, EDI or FISS issues, to be present in the weekly conference call where specialists for each department will be available to answer questions. (1-800-411-0160 passcode 242199#) All issues will be log and tracked.
         
   2. FISS Transition ~ Fiscal Intermediary Standard System to process Part A claims (powerpoint presentation shown and handouts distributed to group)
      • Sign-on to FISS DDE ~ No issues mentioned
      • FISS DDE Screen Review ~ Helpful hints and navigating FISS DDE
      • FISS DDE Reports ~ How to access and what is available
      • Crossover Trading Partners ~ Plan 65 payments seem low
      • Open discussion ~ Questions & Answers

        Q: Are you having any problems with Plan 65 crossover payments?
        A: Two hospitals advised that were concerned about the frequency of payments.
        Lori Langevin to research this issue and get back to the group.

        Q: What does the reason code Jan04 mean?
        A: It is a pricing issue that is causing Medicare to have to hold the claims. These claims have to be work internally by our department.
        Lori L to advise group when this will be corrected

        Lifespan and Roger Williams Hospital advised that certain paper remits are missing. How can they get another copy?
        Lori L to find out how this is handled now.

        Lifespan advised that IME claims were first rejecting for invalid reason and now IME claims are not getting into FISS.
        Lori L. to refer as a system issue.
         

      • If any one gets a reason code with a blank description, please advise Lori L. at LJLangevin@arkbluecross.com. This information is very important because we need to load it or something is wrong in FISS.
         
      • If you have problems storing claims after any correction and the claims goes to medical location status we are working on this issue, unfortunately this is a systems problems.
         
      • Lori L gave a detailed explanation about each screen related to FISS DDE claims and Online Reports with a powerpoint presentation on FISS DDE screens. The audience expressed their understanding in these topics.
        
        Christine Rawnsley, Lifespan, suggested having an issue log to track all FISS, EDI and transition issues. Lori Langevin advised this was a great idea and a log will be created. This log will be utilized on the Wednesday provider call that has been discussed.
        
        Mickey Lourenco, Kent County Hospital, requested that the 201 online report be more specific to identify what locations claims are in. Lori Langevin advised she will research to see if the report can be enhanced.
        
        Lori L advised the 050 online report request is still in process to be a daily report.
         
   3. RI Medical Review Issues
      • Human Skin Equivalents (HSE) ~Documentation and Coding Requirements
        
        Cindy reported that there have been recent claim denials for HSE due to incomplete documentation and incorrect coding. She handed out to the group the RI LMRP for HSE which gives detailed coverage criteria of HSE and coding guidelines. She also handed out a separate list which clearly indicates the documentation requirements for complex review of HSE.
         
      • Update to Hyperbaric Oxygen (HBO) ~ Treatment Record Needed
        
        Cindy reported that there have been recent denials for HBO therapy because the treatment record is missing from the submitted documentation for complex review. Cindy reminded the group to submit the treatment record and also handed out, as a review, a list of the documentation requirements needed for complex review and coverage of HBO therapy.
         
      • Aranesp and EPO Coding Guidelines ~ Latest Update
        
        Cindy handed out to the group the most recent update on Aranesp and EPO guidelines for the treatment of anemia in ESRD patients who are on dialysis. CMS has established a new HCPCS code for Aranesp which is Q4054 for the treatment of anemia in ESRD patients who are on dialysis. The HCPCS code for EPO for the treatment of anemia in ESRD patients who are on dialysis has been changed to Q4055. All hematocrit linked published Q codes (Q9920-Q9940) have been deleted. This new coding became effective for services rendered on or after January 1, 2004.
         
   4. Consolidate Billing Guidelines
      • CMS’ web site in the MED Learn section has consolidated billing updates. Currently, we still have CWF issues. CWF was taking back portions of the claims that should not be included with consolidated billing. This situation is very frustrated for everyone. We do appreciate your patience with CFW correcting these problems. Any claims you have that were paid correct the first time and then were adjusted incorrectly should be forwarded to the Claims Dept.

      Lori L to get an update as to when these corrections will take place, since some of the issues have been going on since June 2003.
       

   5. Open Discussion
      Reminder CERT (Comprehensive Error Rate Testing)
      • CMS regularly is testing contractor’s performance; such as processing claims, medical review, and how the systems processes claims, and so forth. If you receive a medical record request from Advanced Med. this is a request from the contractor that CMS has contracted with to administer CERT.
      • As a clarification, you have 60 days send in the medical records to Advanced Med. If they do not receive any response, the claim will be adjusted to take back the money.
      • In addition, CMS will be tracking providers who constantly do not respond to Advanced Med medical record request. They are very strict in getting these medical records.

      Partial Hospitalization Billing ~ This was a request from one hospital.
      Billing guidelines were discussed. Four out of seven days must meet the medical criteria for partial hospitalization to be covered by Medicare. Also 41 condition code must be on the claim.

      EDI Update from Arkansas Medicare Services
      Kelly Vaughn-EDI Specialist, Arkansas Medicare Services emphasized on the following topics.

      • Capacity of the voicemail box has been expanded due to the large call volume. There are representatives that have been assigned to the EDI voice mailbox in an effort to give an answer as quickly as possible.
      • 3 new phone reps were hired for the Edi help desk.
      • Explained that Arkansas Medicare Services have a broad and useful information system.
      • PRO32 has two different versions. Arkansas has a different version than RI
      • Kelly invited anyone that has questions about compatible software to be in touch with her.

      Other Issues Discussed

      • Rocco Bruno from RI Medicare Services explained the benefits to submitting the issues to the right address. He also advised that Audit & Reimbursement still exist in RI and plans to operate as they always have.
      • Greg Hart, Supervisor, Professional Services, from Arkansas Medicare Services encouraged the audience to express any suggestions, recommendations or issues that they may have.
      • Lori L reviewed the RI contact sheet included in the folder.
         
   6. Next meeting & agenda Items
      • Now scheduled for April 27, 2004, Warwick Public Library, 9-11 am
         
3. Action Items
   • Lori Langevin to find out how a copy of a missing paper remits can be requested.
     Arkansas has a protocol to request through Freedom of Information for duplicate copies of paper remits or missing remits.

   Freedom of Information
   Medicare Services
   P.O. Box 83310
   Baton Rouge, LA 70884-3310

   • Lori Langevin to create an issue log for FISS and transition issues.
     Issue log created and sent to Provider Communication Advisory Group members on 2/27/04. This log will be sent weekly with updates.
      
   • Lori Langevin to advise when claims will be released that are in a Jan04 reason code.
     Jan04 reason code claims should have all been released. Any provider with remaining claims in Jan04 reason code should contact customer service at 1-866-339-3714.
      
   • Lori Langevin to report ongoing CFW issues since June 2003 relating to consolidated billing and physical therapy caps.
     2/27/04, Lori Langevin discussed CWF issue with Medicare System Dept. and inquired when will CWF be making adjustments to Medicare take backs that were erroneous. The April release should correct all the current issues.
   • Lori Langevin to research why Plan 65 payments so low since transition.
     Arkansas Medicare was crossing over daily to RI Plan 65, however, RI Blue Cross was experiencing problems with crossovers. This was corrected and as of 3/3/04, the Plan 65 crossover payments were current.
   • Lori Langevin to research why IME claims are either rejecting from FISS erroneously or not getting into FISS.
     This was a system issue and the problem was corrected on 3/2/04. IME claims should be paying correct now.
   • Lori Langevin to find out protocol for MSP electronic billing
     For the Part A system FISS, providers can bill MSP claims electronically. The APASS system also allowed this.
     For the Part B system, MCS, this system does have the capability to accept MSP electronic claims. However, RI Medicare Services does not have this function set up yet.