Present: Charlene Beaux, LMGMA; Amy Brunet, Baton Rouge Clinic; Diane Caldon, ABCBS; Merle Francis, ABCBS; Kim Gassie, ABCBS; Diane Groh, ALC & Acadian Ambulance; Dr. Lynn Hickman; Peggy Kelly, Acadiana Computer Systems; Sheila Plummer, ABCBS; Sylvia Doggette, ABCBS;

Teleconference: Jack Olden, PRO and Shan McDaniel, Med Data Services

Total Attendees: 12. Attendance decreased by 5 during this PCOM Advisory meeting from 17 attendees at our last meeting due to scheduling conflicts. This may also be due to changes in some member’s email address that have not been updated.

The meeting began at 10:00 AM with self-introductions and the introduction of the individuals that were not able to travel to the meeting but took advantage of the teleconferencing option. Teleconferencing will continue to be made available to anyone that is not able to attend the meeting in person due to scheduling conflicts that do not allow the member to travel. We do ask that each member of the PCOM Advisory Group to attend at least one meeting in person per calendar year.

1. Contractor Participation in Establishing New or Modified Reason and Remark Codes used in Remittance Advice

Mrs. Francis gave an overview of a Joint Signature Memorandum received from the CMS Provider Communication Group (PCG) on July 21, 2003. The memorandum seeks participation from the Medicare contractors in the pursuit to improve the reason and remark codes in two ways. First, they are asking us to examine the remittance advice reason and remark codes that are generating inquiries from providers and suppliers to determine if the language for these codes may need to be modified or possibly new codes need to be created. This would allow us to better communicate the reason for not paying the original amount billed. Second they are asking us to ask for input form our Provider Communications Advisory Group.

Mrs. Francis stated that CMS has provided us the opportunity to let them know what corrections, additions and/or deletions need to be made to make the codes on the Remittance Advice more understandable to the provider and the beneficiary. She asked the group in looking at Remittance Advice (RA’s) is there additional codes that we can give to CMS to that will achieve a better understanding.

Mrs. Doggette stated that when a claim is denied for PR 31- beneficiary eligibility, the code does not clarify as to why the beneficiary is not eligible.

Mrs. Palmer explained that there are three (3) denial messages depending on the type of denial.

Mrs. Gassie agreed that if Mrs. Palmer will let her know what those codes are she would write an article that will be published on our website that will explain the reason codes and their differences.

Mrs. Palmer stated that her department has been receiving many inquiries from providers that receive an "Oscar number". This is in reference to zip codes. Some clarification could be provided in the reason code to explain the reason for the "Oscar number".

The group then discussed Code CO-16 and it’s associated reason codes 408, 405 and 915. They feel that it lacks definition and more explanation could be provided about whether the duplicate is against a pending claim or a processed claim. The group agreed that this would eliminate many phone calls.

There are three different types of duplicate claims but from a provider stand point all you see is the denial for duplicate.

644 Denial-

They also discussed Code CO-17 and it’s associated reason code 644 – "lacking the global modifier (78 or 19 modifier) suggesting that CMS add a remark code to stipulate global modifiers. The denial code just states that there is missing information. There is no remark code that tells what information is needed.

Mrs. Palmer stated that she has not yet seen the new list for modifiers bit she will get a copy of the list and review for more suggestions. The group will also send more suggestions if they think of them after the meeting.

Any suggestions should be emailed to Diane Caldon at dbcaldon@arkbluecross.com by September 20th so that they can be included on the master list that will be submitted to CMS. Suggestions should include the following information.

1. Code: Indicate whether the code is a reason or remark code.
2. Associated Reason Code: If requesting a remark code, indicate which reason code(s) this remark code supports. If requesting a reason code, leave this block blank.
3. New Code or Modification Requested: If requesting a change to an existing reason or remark code, indicate the existing code. If requesting a new code, enter N.
4. Code Language: Indicate exactly how the code should read.
5. Justification for Request: Indicate the business justification for your code request. The approval of our request is based on the detail of your justification.
6. Code Utilization: Give details of when this code would be used, and if there is an existing PM supporting the use.
7. Contact: In case CMS has questions, please provide the name, phone numbers and the email address of a person we can contact.

2. MPFSDB is now loaded to our Website
The Medicare Physicians Fees Schedule Database is now loaded to the website. Mrs. Francis thanked Shan McDaniel for letting us know that portions of the fee schedule were missing. All parts are now there and are accessible at http://www.lamedicare/provider/disclosure/default.asp

3. Elimination of Paper Bulletins
The group discussed the fact that we have requested that CMS allow us to move to providing the newsletter for free only on the website and to individuals that do not have access to the website for a nominal fee.

As of July 2003, paper bulletins will not be mailed unless a provider contacts us to report their inability to receive electronic bulletins. We ask that providers please join our listserv to receive notification of updated information.

Providers with the inability to receive electronic bulletins who wish to continue receiving paper bulletins may do so for an annual fee of $100.00 per bulletin type. Please indicate bulletin preference, "Part B" Newsletters & Policy Notices or "Part A" Newsletters & Policy Notices and the reason you have chosen to receive paper rather than utilizing the website. Please make checks payable to Medicare Services and submit to Medicare Communications, Attn: Theresa Baxley, P.O. Box 1418, Little Rock, AR 72203.

Amy Brunet at the Baton Rouge Clinic used to receive extra copies of the newsletter but stated that she no longer needs them since the majority of the people that need it now have access to the internet and the lamedicare.com website.

Mrs. Francis is concerned that providers with out access to the Internet will not know when the bulletin has been posted. The newsletters should come out on a monthly basis rather than quarterly beginning in October 2003 which will allow providers with the internet free access to important information more quickly than paper subscribers who will still receive their newsletter on a quarterly basis and have to pay for it.

More and more providers are gaining access to the Internet within their offices. We need to encourage every provider to do the same to ensure they receive important information timely.

Providers with Internet access will also be able to sign up to listservs that will sort information by specialty and allow subscribers to receive only updates pertinent to their specialty. All subscribers will receive the general information in addition to their specialty information.

4. New Dedicated Customer Service Line
   Beginning in September 2003, the current customer service line will be available for providers to call and just verify their claims status. An additional line will be added for providers that wish to speak to a customer service representative. This requires the caller to make the decision before they call, if they would like to check the status of their claim or speak to a representative.

   The group agreed that this would help to eliminate some of the time that callers are placed on hold because everyone is currently calling the same line whether they are just calling to check on their status or they need to speak to a representative.
    

5. Additional Provider Enrollment Line
   An additional line has been to our provider enrollment department to assist the call volume from Missouri providers and also allow more callers to speak to an enrollment specialist rather than receiving a message or being placed on hold.
    
6. LA Board of Nursing- Approved high level codes for NP’s – We Will Follow
   Dr. Hickman explained to the group that as soon as we get confirmation from the Louisiana Bard of Nursing we will immediately add the high level codes for Nurse Practitioners. The codes will be 99223, 99233, 99245 and 99263. We will not publish this because the LA Board of Nursing has already published this in mid-summer of this year. The effective date for the codes will be July 1, 2003.
    
7. Pneumococcal Vaccine Payment Increase Effective October 1, 2003
   Reference: Joint Signature Memorandum CI-2076, 08-20-03,
   Merle reminded the members that effective October 1, 2003, the Medicare Part B payment for the pneumococcal vaccine will be increased to the lower of the charge billed to Medicare or $18.62. Annual Part B deductible and coinsurance amounts do not apply. All physicians, non-physician practitioners, and suppliers who administer the pneumococcal vaccination must take assignment on the claim for the vaccine.

   For additional information about immunizations, refer to the Immunizations Quick Reference Guide at http://www.cms.hhs.gov/medlearn/refimmu.asp.

   Jack Olden of OPR stated that his colleagues are very happy with this.

   The numbers for Flu have not been released yet.
    

8. Workshop Updates
   This fiscal year ends on September 30^th. The last workshops we have scheduled involve IDTFs. They will be held on September 18^th in Alexandria and on the 23^rd at the East Jefferson Hospital in New Orleans Invitations have already been sent out for these.

   There is also one more Introduction to Medicare workshop that will be conducted on September 9^th for anyone that may have a new employee and would like to familiarize him or her with Medicare billing.

   Mrs. Francis will be participating in the LA HIPAA conference on October 27-28^th at the Radisson Hotel here in Baton Rouge, LA. She will be speaking on the afternoon of the 28th. We will have a booth at the conference and will be available to answer questions about Medicare.

   The PowerPoint presentations that were used in the Workshops this fiscal year are now available to view on our web page at

   http://www.lamedicare/provider/Events/default.asp#pmg

   For the new fiscal year beginning on October 1 we have developed a strategy with Medical Review and Post pay to determine the areas where the educational need is the greatest. During the first quarter of FY04 we will conduct workshops on Chiropractic and critical care services. The second quarter will cover general updates to include the new fee schedule.

   Quarter three will involve Wound Care. We have seen a large amount of providers billing for services that they are not actually providing. Dr. Hickman feels that this is not a result of intentional fraud but actually incorrect coding and warrants additional education of the providers.

   The last quarter in FY04 will be devoted to Ambulance providers since this will be near the time that the new Ambulance fee schedule will be released. This will allow ambulance providers the opportunity to ask and have their questions answered about the fee schedule.
    

9. Education Strategy Update
   We have received new directions form CMS requiring us to tae Medical Review data analysis to drive our educational efforts. As a result, our workshops will be conducted a little differently in the next fiscal year. The workshops will be divided into two sessions with a break in between. The first session will be LPET driven and will contain results from the data analysis showing providers where the problems lie. The second session will be generally driven and will explain to the providers exactly what to do about the problems addressed in the first session.

   A handout was provided showing the Louisiana 2002 data covering the allowed charges of general provider type, surgical MD specialty, and the medical MD specialty breakdowns. This information can be found at

   http://www.lamedicare/provider/datanaly/default.htm#utildata.

   Dr. Hickman presented this data at the State Medical Society meeting. The data shows as of July 2002 dates of service. This will change for 2003 but the trend will remain basically the same.
    

10. Medicare Update Notification Survey
    Each member was provided a copy of a Medicare Update Notification Survey. This survey will be attached to each LA Medicare Part B Update that is sent to our PCOM Advisory Group Members, Ambulance Liaison Committee Members and our Top 100 list. The survey asks the recipient whether or not the information sent is useful to them or their organization and/or if it would be helpful to anyone they know outside their organization and how useful the information is to them. It also asks if they will forward the information to any of their colleagues either by email, web site or in their next regularly scheduled bulletin.

    The survey was created to allow us to track how many other providers we are able to contact through the use of emailing our members. This will also give us an idea as to how useful the information is to the providers. We would also like to determine if it is a worthwhile effort to continue sending the LA Medicare Part B Updates.

    Mrs. Francis asked the members to please return this survey to Diane Caldon via email when they receive an "LA Medicare Part B Updates". We will continue to send the surveys out until further notice.
     

11. Referral vs. Consult
    Charlene Breaux of the LMGMA asked for clarification of the difference between a referral and a consult.

    Dr. Hickman explained that a referral is a transfer of care form one doctor to another.

    A consultation is when one physician seeks an opinion from another physician without transferring the patient to his or her complete care. A consultation does not have to be written. If the consulting physician writes somewhere in the patients plan of care that they were "asked by___ to see the patient" this would qualify as a consult.

    An explanation was posted to our web site once before. Dr. Hickman will write another explanation and post this to our web site in the near future.
     

12. LMRPs

    Mrs. Francis asked Mrs. Palmer if there were any questions from her area. Mrs. Palmer stated that they have noticed a high volume of providers that have not read the material. Mrs. Francis encouraged the group to remind their providers to review their LMRPs on the website prior to requesting an appeal.

    As of January 1, 2004, a message will be added to notices that their denials are based on a certain LMRP or NCD which may help. CMS has just released several NCDs with brief descriptions. This is the third update to the NCDs.

    A suggestion was made to post a notice on the website that denials are based on LMRPs and NCDs.

    Dr. Hickman explained that NCDs are the bible for CMS and they are what are used in Medical Review to determine denials or coverage. Transmittals are published with what has been added along with their effective date.

    The Louisiana LMRP is scheduled to be reviewed next Wednesday and about 100 policies will be retired. These policies will be posted in December.

    There is a section of the website on LMRPs that are in draft and final. Providers have the option to comment on them when they are in draft. The next comment period ends September 15, 2003. Dr. Hickman encourages everyone to take advantage of the comment period. This section can be found at:

    http://www.lamedicare/provider/medpol/Drafts/default.asp

    Shan McDaniel of Med Data Services suggested that this information be passed on. An "LA Medicare Part B Update" will be sent out along with the new survey.
     

13. HIPAA Update- fewer than 70 days remain! We are moving forward.

    October 16, 2003 remains the deadline for HIPAA compliance. Although there ahs not been a large success with the amount of providers in the testing phase the EDI Department is working forward to compliance.

    MCE Software Release Update
    The addenda version of MCE, the MEDB replacement software, will be released to providers soon. Version 4010 of the HIPAA standard format was upgraded to version 4010A1; this upgrade is commonly referred to as the "Addenda changes". Version 4010A1 will be the only accepted format used to submit health care claims to Medicare Services effective October 16, 2003. Obtain full details at:

    http://www.lamedicare/provider/edi/latest.htm

    Guidance on Compliance with HIPAA Transactions and Code Sets after the October 16, 2003, Implementation Deadline is available now on our website:

    http://www.cms.hhs.gov/hipaa/hipaa2

14. 99 Codes- Additional Documentation Required
     

Any claims with the "99 – unlisted procedure" codes go directly to Medical Review. Additional documentation is required on claims with 99 codes to prevent a delay in the review process caused when the reviewer has to request the information from the submitter. Documentation should be sent with the claim to explain the procedure used.

The same can be said for J3490- Drug codes. If documentation is sent with the claim the reviewer will know what you administered and why and this will prevent a delay.

Mrs. Francis mentioned that scheduled to add a link to our website to the Single Drug Pricer (SDP) reimbursement amounts. This is not something that we maintain on our website so we will provide a link to it. Providers should watch for this on their lamedicare.com website updates.

15. Conclusion:
With no further issues to discuss the meeting adjourned at 11:45 P.M. and our next scheduled meeting will be on November 20, 2003 at 10:00 a.m. The location will be the in the same PR conference room on the second floor. Any changes will be determined no later than two weeks prior to the next meeting and the members will be notified via email.

:DBC