Provider Advisory Groups

Welcome and Introduction
The meeting facilitator began the meeting by thanking everyone for taking the time to participate in the second quarter meeting. It was emphasized that the goal of this meeting is to provide timely, useful and relevant educational opportunities to our providers. For that reason, we distributed a communication/comments sheet where the members can address any concerns, needs or ideas for future educational seminars and other initiatives. The members were also reminded that this meeting is the provider’s designated time to provide the Fiscal Intermediary with input on what areas that they need more education and efforts so that they are fully knowledgeable on the Medicare rules and regulations. Also, we provided membership forms for attendees that want to become a member of this committee and for existing members so that we can update our records.

Old Business ~ Review of October 29, 2004 meeting minutes
The prior meeting minutes were noted and the minutes were accepted as written. The members were informed that they can find previous meeting minutes on our website, as well as information regarding upcoming meetings including the date and time. Please refer to following link for this information: http://www.rimedicare.com/provider/pcomag/default.htm

• Provider Education for claims submission (110 bill type)
  Some hospitals are still experiencing difficulty getting cost inlier claims through FISS as well as admission denial no pay claims (110 bill type). Are there any plans to provide the hospitals with refresher workshops? We have then planned for May 2005.

• Consolidated billing issue
  This relates to SNF patients that are admitted to the Emergency Room and stay over the midnight hour. Due to consolidated billing, hospitals were instructed per CMS to file all services related to the ER visit for the same date of service. The hospitals asked that CMS put this in writing for audit purposes. This issue is currently with CMS and we will provide feedback once we hear from CMS.

• Mass adjustments
  Consolidated billing mass adjustment were suppose to take place in July 2004. Some hospitals are reporting that they still have numerous claims that had payments taken back in error and were suppose to be corrected with a mass adjustment. Is this complete? Should I be submitting these claims to someone for manual adjustment? The answer is that the mass adjustment process takes many steps and testing is involved in each step. Yes, mass adjustments are still ongoing for consolidated billing. The process is almost complete. Hospital may compile a list of outstanding claims that need adjustments and Lori Langevin advised that she will forward these lists to the Claim’s Manager.

• Upcoming Hospital Workshops
  March 10, 2005 ~ IRF PPS Holiday Inn, Providence RI
  This workshop will have a medical review section as well as a general billing update section for Inpatient Rehabilitation Facilities relating to the Prospective Payment System. Please keep this date open and refer to our website and newsletters for an invitation and registration.

What’s New:
IPFPPS ~ Inpatient Psychiatric Facility Prospective Payment System
Lori Langevin to attend a CMS training conference in Baltimore the week of January 24, 2005.
We will keep you posted when Medicare will provide this training.

We had also planned to have workshops pertaining to fundamentals and billing updates for this March 2005. However, due to education efforts for the hospitals for IRF PPS and Part B providers this has been rescheduled until May 2005.

For Hospitals that also do Medicare Part B billing (1500 form or electronic) we have these workshops scheduled:

General Update Workshops. These are half day workshops and include new changes for 2005 and general billing information, but does not include any specialty specific information. We have scheduled two sessions –morning & afternoon- on March 08, 2005 at Memorial Hospital and one session on March 09, 2005 at the Holiday Inn located in South Kingstown.

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. We have also scheduled one for April 14, 2005 at the Warwick Public Library and another one for June 08, 2005 at the Holiday Inn Providence Downtown.

• "Ask the Contractor"
  Medicare contractors will offer quarterly teleconferences through a toll free number, which will be called "Ask the Contractor". These calls will give you the opportunity to interact directly with representatives from various departments within the Medicare organization. These teleconference sessions will serve to identify problems in timely manner with no cost for participation. The first teleconference will be on February 23, 2005. We will communicate the time of this call as soon as we schedule it. If you have any ideas or suggestions that will help this call flow better, please feel free to share with us.

• Holding of Outpatient Claims
  The members were advised that as of January 17^th that all holding claims for January 2005 have been released. If you have any further questions regarding these claims to contact our customer services at (866) 339-3714. Lori asked the members if there were any suggestions on future updates and how else to get the word out to the providers. All agreed that an email was the quickest and best way. Lori reminded group to also refer to our website for timely updates too.
   
• Fraud Alert
  Lori wanted to make sure that members did receive the information regarding a recent Fraud Alert concerning an organized group, who is representing themselves as a Medicare employee and is calling physician’s office requesting information that they will use to take advantage of physicians and Medicare. This information was sent out by e-mail, mail and an alert was posted on our website, please refer to the following link: http://www.rimedicare.com/provider/viewarticle.aspx?articleid=1334

  Lori asked for suggestions on how else Medicare can communicate this type of information to providers. All agreed that the above methods were enough.

• FISS-Top 10 Reason Codes / Top 10 Claim Submission Errors
  Lori reviewed the top 10 reason codes for claim submission errors. The number one reason for claims being returned to providers continues to be "patient name not matching beneficiary record". Lori reminded members to make sure the name and number that you are entering on your claims matches the beneficiary’s Medicare card. Lori reminded the members to check the remarks screen (page 4 on FISS DDE) and read the comments or reason about why the claim was denied. Lori discussed in detail the reason codes and encouraged the members to bring up any questions, concerns or suggestions that would help providers to avoid claims being returned to them. Members can also fax or mail samples that reflect their problems. Our fax number is (401) 276-5719.

  Greg Hart emphasized that as part of the analysis on claim submission errors, we plan to contact the top providers that receive these top reason codes. The first contact would be by phone or letter, and then if this provider continues into this category, we will visit them in order to reduce the claims submission errors for the providers as well for us. No comments or suggestions were received from our members.

• Cert
  As a reminder, AdvanceMed is the contractor for CMS to perform CERT (Comprehensive Error Rate Testing). AdvanceMed selects a random sample of claims from each contractor for medical review. It is very important that you respond to the medical records request in a timely manner to avoid being a non-responder or subsequently your payment being affected. For more information on CERT, visit their website.  http://www.cms.hhs.gov/CERT/

  Lori inquired if the hospitals are getting these request and how the process is working. Most agreed that the medical records request process could be improved by sending the request to someone’s attention. Lori suggested that the hospitals should send this request to CERT.

Medical Review ~ Cindy Cote, Senior RN ~ cmcote@arkbluecross.com
Cindy reviewed the current policies on the Medicare website and advised the members that the Part A website section will soon mirror the part B section for medical policies. This is a work in process.

Many members raised their concerns about medical records request that get lost or routed to the wrong departments in the hospital.

Q. Is there a way Medicare can address to someone’s attention.
A. Currently our Medical Review Dept. is working with our System Dept. to try to enhance this process to allow for an attention line when requesting medical records. We will keep you posted on the progress of this enhancement.

Open Discussion
1.) Godiva Laliberte from Eleanor Slater Hospital inquired if the PRO Reviews would also request medical records or feedback to a specific person in the hospital.

Gail Mihalakos, RN, CPUR, Director of Case Management for Qualidigm (who handles PRO Reviews) responded to this inquiry. Gail advised that they do have a form that they send out once per year for this information. Lori Langevin suggested that Gail forward this form to her and she would pass along to PCOM members. (This form was forwarded to members on 1/28/05)

2.) Pat Moran, HARI advised that the new UB04 comment period is until Feb 1, 2005.

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

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