|
Medicare Part B Provider Communication Advisory Group
Pinnacle Medicare Services
Rhode Island Medical Society
235 Promenade Street, Suite 500
Providence, RI 02908
| Meeting Date, Time & Place: |
Wednesday, November 9, 2005 – 9:00 -11:00 |
| |
Rhode Island Medical Society |
| |
235 Promenade Street, Suite 500 |
| |
Providence, RI 02908 |
| |
|
| Facilitator: |
Carol DeMelo, Provider Education & Training |
| Representative |
|
| |
|
| Medicare Representative: |
Greg Hart, Professional Service Coordinator, (teleconference) |
| |
Linda Myers, Provider Education Specialist, (teleconference) |
| |
Cindy Cote, RN Medical Review |
| |
|
| PCOM Advisory Group Members: |
Lori Lazouras, University Medical Foundation |
| |
Julie Sylvester, Comprehensive Practice Management Inc. |
| |
Lynn Silva, East Side Clinical Lab |
| |
Beth A. Oldham, East Side Clinical |
Welcome and Introduction:
The meeting was called to order at 9:05 a.m. Carol welcomed everyone and introductions followed.
Old Business:
The floor was opened for comments and corrections to the July 20, 2005 minutes. No corrections or comments were received. The minutes were approved as written. Members were informed they could access copies of the previous minutes as
well as the future meeting dates and times on our website at http://www.rimedicare.com/provider/pcomag/default.htm.
New Business:
Comprehensive Error Rate Testing (CERT):
Cindy Cote RN provided an overview and update on CERT
- CERT continues to be a hot topic in all of our meetings. The non-responder is not the primary issue any longer. Errors are also resulting from insufficient documentation. Providers need to be sure to provide all the documentation requested by the CERT
contractor.
- Many times the documentation only supports one of the dates of service causing the entire claim to be denied or down-coded.
- The overall error rate, including non-responders, for Rhode Island is 9.7%. Our goal is to achieve less than 4.7%.
The group requested information about our education efforts to the physician community. Cindy informed the group that we receive a targeted list of providers with the identified errors. Providers are contacted by telephone or via face to face meetings
to discuss the error. At all our workshops, we provide an overview of the CERT program and explain why it is important to respond to CERT requests for medical record documentation. Carol explained that we present examples of CERT letters at our workshops,
so the providers can identify a CERT request if they should receive one.
The group asked if the CERT record requests are going to a specific contact person and if not, how a provider can have requests made to a specific individual.
- Cindy presented the group with the CERT website address (www.certprovider.org) where this information can be added. This address is also provided at our workshops.
Claim Submission Errors and Frequently Asked Questions (FAQ)
Carol conducted an overview of our efforts to reduce the claim submission error rates. One effort utilized to reduce claim submission errors is to mail letters to the providers with the highest number of denials. Letters are mailed (quarterly) to the
top five providers for each of the top ten denial reason codes.
- Initially a letter is sent, followed up with a telephone call if they remain among the top five providers identified. If necessary, an educational visit is scheduled with the provider to determine methods of reducing these errors.
The denial data does not include procedures submitted with the GY modifier.
One member asked how these figures compare to the national average.
National data is available for claim submission errors as well as claim submission data for all of our six states. Carol noted the number of claims denied as duplicates have decreased considerably. We have also seen a decrease in medical necessity
denials however, bundling errors still remain an issue. Greg added that we will be scheduling Focus Group meetings with providers that have high claims submission error rates.Influenza Vaccine Reimbursement
Carol advised the group the flu shot and pnuemoccoccal vaccine allowances were increased effective September 1, 2005. This information will be included in our educational materials, posted on our website, and in our newsletters.
One member asked if we will conduct retroactive adjustments for flu shots rendered after 9/1/2005 which were paid at the old rate. Carol stated she will research this request and provide a response to the group.
National Provider Identifier (NPI)
We are reminding all providers if they have not applied for NPI to please do so. The following bullets summarize pertinent information.
- Fox System, Inc. is the contractor to perform support operation for the NPI project.
- The effective date for all health plans and clearinghouses must accept NPIs standard transaction by May 23, 2007. Small health plans have until May 23, 2008.
- All Health care providers including individuals such as physicians, dentists, and pharmacists, and organizations such as hospital nursing homes, pharmacies, and group practices are eligible to apply for and receive an NPI.
- For more information please visit: https://nppes.cms.hhs.gov
One of our members suggested that a checklist be offered to providers to assist with the application process. This information will expedite the process.
Pinnacle Business Solutions, Inc
Arkansas Blue Cross and Blue Shield have established a new corporation for the administration of our public program contracts and new business endeavors. The headquarters is located at 515 West Pershing Blvd in North Little Rock, AR, with
satellite offices in AR, LA, OK, NM, MO, RI, FL, and MD. Medicare beneficiaries and providers who are currently being serviced by Arkansas Blue Cross and Blue Shield have been notified of the formation of the corporation and new name.
Workshop Overview
An overview was provided to the group regarding our educational efforts for the upcoming year:
We are in the process of scheduling Navigating the Web, General Updates, and Welcome to Medicare workshops. The "Welcome to Medicare" workshop is new this year and is geared toward providers new to Medicare program.
Greg informed the group the workshop schedule is expected to be mailed to providers the week of Thanksgiving.
The members asked if we have made a decision to include the workshop schedule with the Remittance Advice. The members felt this would be a great way to advertise our workshops and bring it to the attention of the billing staff. Greg indicated that we
are still considering this as an alternative, however no decision has been made to date.
A draft of the Welcome to Medicare and the last General Updates workshop presentation material were distributed to the members for their review and suggestions. Members were also asked to complete a survey form identifying topics they think would be
of interest to the provider community for inclusion in our General Updates presentation materials for 2006.
One member suggested we include information on NPI in our Welcome to Medicare presentation. Carol agreed that NPI should be included in all workshops and will have this information will be incorporated in the Welcome to Medicare workshop as well.
Ask the Contractor Teleconference (ACT)
- Greg Hart is the facilitator of the ACT calls. The last ACT discussed the topic of MSP and was held in September. Representatives from MSP were in attendance. The material is located on the website along with a recording of the call and an evaluation
for all participants.
- The next call is in December 14, 2005 and is scheduled for an hour and a half. All six states will be included in this call. To attend, please call 1-800 260-6066 and ask the operator to connect you to the "Ask the Contractor Teleconference."
- The time and agenda will be posted in the newsletter, on the website and announced at workshops.
- Greg encouraged the members to suggest topics for future Ask the Contractor Teleconferences.
Medical Review: Cindy Cote, Senior RN
- Cindy distributed the Critical Care article she had written and was published in the October 2005 Part B Providers’ Newsletter:
- The Critical Care audit that had been in place since January 2005 was inactivated in October 2005. Provider Specific Probes will begin in November 2005. Providers are selected based on Data Analysis ranking. Two providers per month will be selected,
each having 30 claims reviewed. Individualized education will be conducted with each provider based on the results of the probe review.
Open Discussion:
- The Provider Participation and Enrollment packet is being mailed this year on a CD-ROM without the fee schedules. One member stated that in prior years they have extended provider enrollment dates, will they again this year? Greg was not aware of any
extension, however will verify this information and share this information with all members.
- A member voiced concerned about the age of their provider enrollment application. They currently have some applications over 120 days old. In addition, they also stated that Provider Enrollment is not supplying out provider numbers via the phone. Greg
stated that we can provide an update for the group as well as contact the provider concerning the aging applications.
Next Meeting and Adjournment
The meeting was adjourned at 11:00 am. The next meeting is scheduled for February 10, 2006, at 9:00 am.
|
