|
Provider Communication Advisory Group Meeting
Medicare Services - Part "B"
| Meeting Date, Time & Place: |
Wednesday July 20, 2005 ~ 9:00 am – 11:00 am |
|
| |
Rhode Island Medical Society |
|
| |
Providence, RI 02908 |
|
| |
|
|
| Facilitator: |
Carol DeMelo |
|
| |
Provider Education & Training Representative |
|
| |
|
|
| Medicare Representative: |
Greg Hart, |
Senior Provider Education Representative, AR |
| |
Susana Astros, |
RI Medicare Services |
| |
Lori Langevin, |
RI Medicare Services |
| |
Cindy Cote, |
RI Medicare Services |
| |
|
|
| PCOM Advisory Group Members: |
Beth Oldham |
East Side Clinical Laboratory |
| |
Donna Gentes |
East Side Clinical Laboratory |
| |
|
|
| CMS Boston Regional Office: |
Rick Hoover |
Center for Medicare Services |
| |
|
|
| **Teleconference attendees: |
Mayo Gilson, MD |
Medical Director |
| |
|
|
Welcome and Introduction
Carol DeMelo called the meeting to order at 9:00 a.m. She thanked to everyone for taking the time out to participate in the 4th Quarter Provider Communication Advisory Group.
Review of April 20, 2005 meeting minutes
The minutes were approved as written. Members were informed that they can find previous meeting minutes on our web site, as well as, information about the upcoming meeting time. Please refer to following link:
www.rimedicare.com/provider/pcomag/default.htm
Old Business:
Mandatory Electronic Claim Filing ~ MedLearn Matters Number: MM3440
www.hipaadvisory.com/regs/mm3440.pdf
- Carol gave an update from the last meeting informing the audience that Medicare is prohibited by law from paying paper claims except for those from small providers and under certain other limited circumstances. Any provider that does meet the "small
provider" requirements or other requirements would have to submit their claims electronically in order to continue to receive Medicare reimbursement. Beginning in July, providers who submit paper claims will receive a letter asking them to show if they
meet an exception. At some point soon, if a provider doesn’t meet the exception or does not respond, their claims will not be accepted. We have published this on the website and in the newsletter; we will continue to emphasis it in workshops. No
additional recommendations for publicizing were received.
- MSP claims filed electronically - This information has been disseminated in our workshops and one of the leading concerns pointed out is related to "multiple payer claims". We do not have any provider submitting electronic MSP (Medicare Secondary
Payer) claims; but no-exception related to this topic is listed. Providers have tested and their claims have processed without any problem.
| Action Item # 1 |
MSP electronic claim submission & attachments |
| Rick Hoover |
Mr. Hoover offers to establish communication with the CMS department responsible and provide an accurate response to this topic. |
| Greg Hart |
Information is available in the EDI section of our website, www.rimedicare.com. One of the download documents is the X12 Companion Guides that outlines the requirements for including Primary Payer
information in the appropriate fields of an electronic claim. |
| Resolution: |
Carol DeMelo stat that our department is working with the EDI department in order to compile tips for electronic format, and then we will publish the information in the newsletters under the MSP section. Also, clarification and details
information will be addressed in the upcoming workshops and PCOM meeting. |
NPI Update - www.cms.hhs.gov/medlearn/matters/mmarticles/2005/SE0528.pdf
- Health care providers were able to begin applying for a NPI (National Provider Identifier) on May 23, 2005. The process has begun and it will be important to apply for your NPI before the compliance date of May 2007. You can apply for your NPI in one
of the following ways:
New Business:
Medicare Drugs Benefits-Update - Mr. Rick Hoover
- A handout was given that was related to the Medicare Drugs Benefits. The package included:
- Medicare Prescription Drug Coverage.
This information is designed to anybody who is interested basically in the state of Rhode Island. For those of you who do not know, SHIP is the organization essentially helps senior citizens figure what health
care means.
- Important Dates for people with Medicare for 2005 and 2006.
This calendar consists of the major implementation dates for the Medicare Drugs Benefits.
- Cost Sharing and Extra Help.
This is an explanation of the standard benefits, premiums, and co-payments.
- PowerPoint Presentation on the Drug Benefits Program.
This presentation gives a powerful idea about the benefits covered, dateline availability, low income help, retiree drug coverage, facts to make a choice, strategies considerations, bridge gap
and contact information for additional information.
This information can be reproduced and then display in the awaiting room, receptionist area or discharge room. People need to be aware that this may not be for them and it depends on whether they have other retirement benefits. But, this is for people
who truly are going to suffer catastrophic consequences for not having drug coverage. It is in fact, great for people who do not have coverage right now and for the low income category. Information about drug benefits sponsors and management care will be
released in September 2005. On another hand, it is entirely possible that some employer, especially smaller ones are struggling with health care benefits and how to cover retirees. Conversely, CMS is trying to encourage employers to keep these benefits by
actually providing a subsidiary plan. Also, Medicaid recipient are going to be automatically enrolled if they do not make a decision on time, because Medicaid Drug Benefits will go away. Lastly, we want to invite all providers to download valuable
information from CMS website and make available to their patients, family or friends.
Please refer to the following links:
- Carol asked the group if they had any questions.
Q.- Is this only eligible to our traditional Medicare?
It is only and you have to be enrolled in Part A and at least entitled to Part B.
Q. What if you have an HMO plan?
If it is managed by Medicare you are still entitled to receive it.
Q. Are there any drug restrictions?
Like any Health Insurance Program we do have drugs restrictions. Each plan has different drugs coverage, but you can choose the plan that best fit your needs. Also, generic and brand name medicine will be available by the MD’s recommendations.
Training tailored for Small Providers-Navigating the Medicare Website
- Carol informed the members that on July 19, 2005 we had our first "Navigating the Medicare Website" workshop and ten people registered, but only three showed up and their evaluations were very positive. During the seminar we had the opportunity to go
step by step on how to navigate our website and some of the CMS resources. Our upcoming workshop will be on August 24, 2005 at Westerly Hospital. Carol encourages the members to supply any feedback that helps to increase their interest or if they have any
particular topics that would like to be discussed in future seminars.
A representative from East Side Clinical Laboratory said: I think that it would be a good idea to have specialty workshops and small groups. Also, you need to be aware that in many MD’s offices they have only one person running the office;
therefore it is almost impossible for this person to attend a seminar.
Carol reported that we are planning to have in the near future a Denial Management Workshop, which includes topics on modifiers, bundling, medical necessity and duplicates. In addition, we are trying to publicize our workshops to increase attendance.
Our Provider Enrollment Department will add a workshop schedule in each provider enrollment package. A copy of our scheduled workshops has been submitted to the RI Medical Society. One of the big concerns is that many offices do not have internet access.
Carol emphasized the urgency to find out the most accurate way to advertise these workshops and asked the members for feedback. Members responded that these approaches were good. They also suggested using the message section of the Remittance Advice and
we will continue to investigate this avenue.
Data Analysis (FAQ’s and CSE’s)
- Carol reviewed the data analysis as a follow:
| Reason’s Code |
Number |
Comments |
| Duplicate |
64.035 |
Higher than previous quarter |
| Medical Necessity |
30.196 |
Higher than previous quarter |
| Patient cannot be identified |
8.616 |
Beneficiary information mismatch with information that we have |
- Greg informed the members that we are sending letters to providers that have a high volume of claims submission errors. Initially we were going to send this letter on a monthly basis, but are planning to send them on a quarterly basis. We will also be
using this data to develop seminars that help to minimize the error rate. We are looking at presenting these workshops to the medical community no later than January 2006.
Do you prefer to receive the information on a monthly or quarterly basis?
- A representative from East Side Clinical Laboratory said:
Since we are billing a high volume of claims it would be nice to receive this data information every month, because the sooner we can receive the information the better it is to look
for solutions
FY 2006 Workshop Schedule
- Carol stated that we are required to do six workshops for the next fiscal year to target small providers and right now we are looking at having four "Navigating the Medicare Website" Workshop and the other two being on Denial Management.
Q. Do you have any suggestions or something that you would like to have included in these workshops?
- It would be a good idea to include some information about "Medical Necessity Denial" in the Denial Management workshops.
- Carol informed the group that the next "Ask the Contractor" topic will be on MSP and a specialist will be available to answers your concerns. Carol asked the members if they have any questions or concern that they would like addressed during the MSP
Ask the Contractor Teleconference.
- A representative stated that we need to address Plan 65 as well as problems with pathology and psychology codes.
- Greg encourages the audience to submit their ideas or any concerns they would like to discussed in advance for future meetings. For anyone that need any information about the CERT Program we invite everyone to visit our website at:
www.rimedicare.com/provider/cert/default.asp
- Carol informed the group about the upcoming workshops as a follow:
| Upcoming Medicare Workshops |
| Fundamental of Medicare Part B |
Westerly Hospital
Nardone Conference Center, Room B
25 Well Street
Westerly, RI |
August 17, 2005
8:30 am – 3:00 pm
Cost: $30.00 per person |
| Navigating The Medicare Website Workshop (For Small Providers) |
Westerly Hospital
Nardone Conference Center, Room B
25 Well Street
Westerly, RI |
August 24, 2005
8:30 a.m. Registration
9:00 a.m. until 12:00 p.m.
Cost: Free |
| Part A – Ask the Contractor Teleconference |
Teleconference: (800) 949-2165 |
August 24, 2005
10:00 a.m. - 11:00 a.m.
Cost: Free |
| Fundamental of Medicare
Part B |
Rhode Island Health Care Association 57 Kilvert Street Suite 200
Warwick, RI 02886 |
September 14, 2005
8:30 am – 3:00 pm
Cost: $30.00 per person |
| Podiatry Requirements and Practical Applications |
Lady of Fatima Hospital
200 High Service Ave.
N. Providence, RI 02904 |
September 21, 2005
8:00 a.m. Registration
8:30 a.m. ~ 12:00 p.m.
Cost: Free |
Open Discussion
- Carol showed the group the pamphlets that new providers receive from enrollment and asked them to review them for ideas of anything else that should be included. Books will be provided to each member for their review and we will discuss at the next
meeting.
- Carol encouraged the audience to give any feedback, suggestions or any concern they may have.
- Membership: Members were asked how we might increase the participation level and membership of this advisory group. Some of the suggestions received and discussed included:
- Tell the CAC members at the Sept 20th meeting about this group and it’s purpose and solicit members from the specialty organizations or practices they represent.
- One member stated they had one or two potential members they would invite to discuss participation with Carol.
- We need to publize with existing members that teleconferencing capabilities now exist.
- We will explore the possibility of advertising the purpose of this group and asking interested parties to contact Carol.
- Dr Mayo Gilson invited the members to the upcoming CAC Meeting which will be held Tuesday, September 20, 2005.
The next meeting will be held on Wednesday, October 19, 2005. No further recommendations were received from the attendees. The facilitator thanked the members for being there and for their feedback. The meeting adjourned at 10:45 am.
|
