In Person: Bobby Smith, Palmetto GBA; Sheila Plummer, ABCBS; Merle Francis, ABCBS; Kim Gassie, ABCBS; Diane Groh, AASI; Amy Brunet, Baton Rouge Clinic; Diane Weiss, ABCBS; Dr. Lynn E. Hickman, ABCBS
Teleconference: Shan McDaniel, Med Data Services; Susan Taylor, LMGMA,
Minutes Taker: Diane Caldon, ABCBS
Role Call
- The meeting began with introductions. The members that called in to the meeting and the members in attendance identified themselves.
Business Updates for Arkansas Blue Cross & Blue Shield
Rhode Island Contract- ABCBS was recently awarded the Part A contract for Rhode Island Medicare. Beginning February 1, 2004, this Baton Rouge office will take over the Enrollment Department for Rhode Island Medicare. ABCBS will also move much of
the other workload involved to Louisiana and Arkansas. The Carrier Medical Director (CMD), Dr. Staples has agreed to stay onboard to work with the other CMDs. Rhode Island has 13 hospitals and 92 Skilled Nursing Facilities. Merle will be there often
over the next few months to help ensure the transition goes smoothly.
Novation- we are working to become a separate company from our parent company. We have appointed a CEO, Dennis Robertson. Merle is now responsible for all of the Provider enrollment and education for all five states under the ABCBS contract and
will have Rhode Island after February 1, 2004. We have appointed a new District Manager for this Baton Rouge Office. The appointee has not been formally announced as of yet.
David Couvillon, our Claims Department Manager has safely returned from his tour of duty in Iraq. He will resume his position and we are happy to have him back.
HIPAA Contingency Plan Implementation
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The HIPAA deadline has come and gone. Susan D’Antoni stated that they are doing fine at her office. Claims are flowing well through the system and they claims are being paid.
Shan McDaniel stated that there are a few stragglers and they are working towards gaining compliance.
Diane Groh of Acadian Ambulance Service stated that they are doing okay. They are finding that they the program allows them to use some fields differently, depending on the Carrier or Contractor that they are using. There is a difference between
the Louisiana and Mississippi. However, this has not slowed down the billing process or the incoming revenue.
Contingency Plan- we have not received any word as to how long the contingency plan will be in place. CMS is using the number of providers in compliance with the number of providers that are actively testing to gage the length of time.
Comparative Billing Reports (CBR)-
continue to be available. Amy Brunet of the Baton Rouge Clinic has found them to be very useful. She feels that it is a good tool to see how Medicare billers compare to their peers.
ABCBS provided a handout to the members in attendance, and emailed to the members on the telephone, which included an order form. To receive this report it must be requested it in writing. The physician or practitioner must sign each request.
Medical Review will not accept the request from an office manger or staff member. Mail the request to Medicare MR Data Analysis, PO Box 1418, Little Rock AR 72203-1418, to the attention of Lisa Moore, 10UCC.
Shan McDaniel of Med Data Services has received some CBRs. At first, she found them a bit difficult to interpret. She called the help line provided and they were very helpful in explaining the reports.
The reports are most current with a six-month lag. If you request the reports now, you would get the January thru June of 2003. The is a two month lag in the creation of the reports which means you will be able to get the July thru December 2003
reports by February 2004.
Fee Schedule
- Right now there is a scheduled decrease for physician services. The president has not signed the Fee Schedule yet. After instructions from CMS, there will be a 1.4-% increase. We have mailed the Fee Schedule out in paper form
because we did not receive any direction from CMS telling us to wait. Like last year, providers will have to rely on the website for the correct fee schedule information. Merle will check the IES inflationary index. As of today, President Bush still
needs to sign it and CMS still needs to implement it.
Tom Scully Is Resigning
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By December 15, CMS will appoint an interim to take his place.
ICD-10
Merle stated that it would be intuitive of specialty societies to become involved. She recommends that there should be action from the Physicians and Specialty societies that they do not want the ICD-10 because this would introduce a whole new
coding system.
Susan stated that her societies are lobbying against this on Capitol Hill. Software vendors are also lobbying against the ICD-10.
Merle suggested that we take a poll of all the Advisory Committees of all five states. If they all agree, then we should draft a letter, to voice the feelings of all members, to Capital Hill as well.
Dr. Hickman stated that he would bring this up at the CAC meetings as well.
Susan will email her information about the ICD-10 either to Merle or to Diane Caldon.
Diane Weiss, of ABCBS, stated they intend to bring the ICD-10 issue up during the General update workshops. The Oklahoma PCOMAG has already agreed that this is a good idea.
Practice Administration Information Worksheet
We provided a handout to attending members and emailed to members that teleconferenced in to the meeting. The handout is a printed version of a web page on the CMS web site. CMS intends this page to "provide up-to-date information and tools as
they relate to Administrators, Coders, Billing Personnel and others outside the traditional provider role." This web page can be found at
Information is available such as Payment/Billing, Education, MSP, Coding, Medicare Coverage, Enrollment, participation, HIPAA, Compliance/Medical Review, Manuals, Specialty Specific Resources, Grants/Demonstrations, Rural/Urban and Contacts.
Optical Character Reading
We provided a handout to attending members and emailed to members that teleconferenced in to the meeting. The handout was a copy of the Optical Character Recognition Scanning Newsletter published in November 2003. (MCB 2003-05.SB)
We have postponed OCR one month. This sets it back to February. This only affects paper claims. We are trying to educate providers on awareness of paper claims.
Merle asked the PCOMAG if they felt the newsletter and posting this to the web site was enough to reach providers.
Kim Gassie noted that this would also be mentioned in the General Update workshops in February 2004.
Electronic Newsletters
Merle asked the PCOMAG if they had any complaints from providers about the fact that we have switched to strictly electronic newsletters.
Dr. Hickman stated that he has received some complaints form attorneys that this is an inadequate way to educate providers.
The PCOMAG discussed the fact that paper newsletters are available to providers, without access to the Internet, for a yearly subscription fee of $100. Paper copies are available for a fee to anyone that requests a subscription.
Fee Schedule
The 2004 Physician’s Fee Schedule went out in paper form on November 15, 2003. Changes to the fee schedule are expected however, we received no directive from CMS not to mail out the paper copies.
Just like last year, the correct version will be available online only and after the bill is signed. We must first receive instructions to make it available.
Online CMS Manual System
We provided a handout to attending members and emailed to members that teleconferenced in to the meeting. The handout was a copy of a brochure printed from the CMS web site. This brochure provides a "how-to" explanation about the Online CMS Manual
System.
ABCBS informed members that a PowerPoint presentation, that they can use to train their employees and providers about the Online Manual System, is available. This PowerPoint and brochure are found at
PECOS – Provider Enrollment Change Ownership System
The process of enrolling providers is taking much longer than usual. CMS has implemented the PECOS system as of November 1, 2003.
There was not ample training time for the specialist to become familiar with the system before CMS instructed them to begin using it.
The system is on a national server that which means that every contractor in the country is using it. This causes cumbersome delays in application processing.
For example, if we receive a reassignment and we have not yet keyed the group into PECOS then the specialist must first key in the group and then the individual.
We completed about 500 applications in October, In November, only 100 applications were processed.
Specialists also face the responsibility of keying the Railroad Enrollment as well. RR has provided us with 100’s of Railroad backlog. CMS is addressing this issue because carriers across the country are getting backlog everyday.
We will place something in the newsletter to make providers aware of the delay.
CMS is monitoring our progress and they are concerned about the escalating workload.
Merle recommended that providers that know that they will be taking on additional providers should begin the enrollment process as soon as possible.
National Coordination of Benefits (COB) Contractor
CMS is looking at on national COB to process all of the country’s crossover claims.
What this means is that if BCBS of LA wants to receive payer information from ABCBS, they would have to enter into a payer agreement to receive the information.
This is a good- new process- This means that only one Trading Partner Agreement (TPA) would be necessary with only one COB Contractor. This will allow them to receive all he information for all contractors as necessary.
Concerns- there are some concerns because we are getting call about claims not crossing over or crossing over incorrectly. This will be frustrating from a customer service standpoint.
Starting in January the COBC will have a 1-800 number. Providers will have to coordinate with the COBC to get the claims processed.
This transition should be seamless to the provider. States would be exempt to TPA.
Susan D’Antoni asked if there would be a time penalty on the COBC for timely processing. Kim Gassie stated that we did not see any instructions to the COBC on a period of time. CMS will give us more information soon.
The PCOMAG members questioned when they would know when to follow up. How will they know at what point to take additional action?
Merle stated the she felt this would be something that the new COBC would provide on their website. Merle will ask the following questions of CMS:
What are the periods that a COBC will have to crossover claims?
How will providers know if the COBC has signed up the payers?
A Remittance Advice (RA) message will indicate that we forwarded the claim to the COBC.
What information will the COB send to the providers?
How will they know which claims have been crossed over?
Whom does a provider contact about these issues?
QIP- Appeals
CMS has put out an RFP for all appeals and ALJ workload. ABCBS will of course be bidding on the workload
New Web Based Training (WBT) Course Available
A new Web Based Training Course is available and ready for use. This course is on Modifiers. Several members of staff that have taken the course feel that it is very broad. Unless you were in a specialty, you would not know some of the answers.
They feel that it should be broken down into parts. It is not as easy as the first course. There are more modifiers than each person realized.
We are close to releasing the "Intro to Medicare Course. This course could be to train new staff or as a refresher course for people that just need to know the A to Z of Medicare. This course would be a compliment to the Intro to Medicare
workshop.
The next WBT course we are working on is a Critical Care Course. IT should be out in February and be a compliment to the Critical Care workshops that we will be conducting this year.
Everyone is encouraged to take the course. The PCOMAG members also encourage publishing the availability of WBT as much as possible. In their newsletters, on their websites and in conversations with providers.
Cheryl Green has moved from the position of Field Representative to the Technical Writer for the WBT program. Cuts in the education budget eliminated her position. With Cheryl’s background in Medicare, we were able to move her to WBT and she is
doing very well in her new position. Sylvia Doggette and Diane Weiss are the only two remaining Training Representatives in the state of Louisiana. They are sharing the responsibilities of covering the entire state with their skills in provider
education.
Bobby Smith of Palmetto, GBA feels that the first WBT course was easy. The second course was too long and difficult, even for someone that has been in Medicare for many years.
The PCOMAG discussed and agreed that the Modifier Course contains too much information and should be broken down. The learned that modifiers exist that they will never use, unless they change their specialty. There was no desire to retain the
information that they learned.
The PCOMAG group was encouraged to provide opinions about the courses to Mary Kay and Cheryl Green. The comments is very helpful is designing the courses to make them more useful and compatible to the provider community.
The PCOMAG agreed that it good to be able to book mark the courses. This allows them to come back to it and not complete it all at once. They are able to do a little each and fit it into their busy schedule.
Future courses scheduled for release are as follows:
Critical Care in the Spring
Wound Care in the Summer
Ambulance in the Fall
Workshop Schedule
General Updates will begin in February. We will do direct mailing this year. Last year the attendance was low because we did not do a direct mailing. This year we included direct mailing in the budget to increase attendance. The Direct mail flyers
will go out within the next few weeks.
The PCOMAG requested that we include the room names on the registration form.
We provided a handout to attending members and emailed to members that teleconferenced in to the meeting. The handout was a copy of the 2004 General Update Workshop Schedule. A change was noted that the workshop scheduled in Monroe might be moved
to the 18th. We will email a change to the PCOMAG if this does change.
General Update workshops include information that came out in the past few months, upcoming information and any current problems in Medicare.
We have not scheduled "Introductions to Medicare" workshops yet. They will probably be two all day sessions. We will try to provide lunch depending on the location and the availability of food.
Provider’s can view the list of 2004’s workshops on our web site under provider information.
New Guidance on Policy Publishing
Policies seem to get to the billing office and die there. Dr. Hickman recently spoke to the CAC about this and they agreed that we do not want this to happen.
Moving from Local Medical Review Policies (LMRP) to National Coverage Determinations (NCD). This new format for LMRPs removes parts from the policy to allow it to fit into the database. This comes just after we finally got policies that made
providers happy.
This means we will not look at Claims on the front end. We will pay them and then Post pay will look at them.
A national conference call is scheduled next week to include this issue.
DMERC Issues
Dr. Mieske, DMERC Medical Director, has retired. He now works for the scooter store.
Fraud & Abuse – CMS is trying to put an end to abuse of the Medicare program by the power-wheelchair industry over the past five years.
Open Discussion-
LA Medicare Part B has scheduled Ambulance workshops in September because we map out to CMS what we will do one year ahead of time. We have scheduled the WBT course release near the workshops. This is also near the time of the release of the
Ambulance Fee schedule. This gives ambulance providers time to ask any questions they may have, about the fee schedule or WBT, during or near the time of the workshops.
Conclusion –
With no further items to discuss the PCOMAG meeting concluded at 11:30 am.
We have scheduled our next meeting for March 25, 2004. Diane Caldon will notify members of any changes to this date via email.
