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INTRODUCTION AND ANNOUNCEMENTS Diane Weiss called the meeting to order at 10:05 a.m. Welcomed those attending and announced Shan McDaniel and Pam Kanawyer via teleconference. Everyone introduced themselves. OLD BUSINESS Review of January 20, 2005 minutes. Minutes will stand. Follow up of old business – Workshop Confirmation Notices. Michelle DeSoto distributed a copy of the postcard that other states use for workshop confirmation notices. Michelle asked the group for their input on the format of the postcard and asked if they think we should try sending out the postcards as our confirmation instead of the letter that we currently send out. Dr. Hickman asked which was least costly. Michelle indicated that the postcard is least costly. Shan McDaniel asked if the CMS logo really stood out on the postcard. The group recommended that we try the postcard confirmation notification. We will add to the registration that a confirmation postcard will be sent to the provider. NEW BUSINESS Recap of Ask the Contractor Teleconference & Future Dates – Diane Caldon gave an update about the ACT that we conducted on March 23, 2005. Diane Caldon indicated that Diane Weiss was the facilitator for the call. Louisiana had the most participants out of all six states. We had 178 participants on the call and 152 were providers. This included the number of people that were actually in the room for the call. We had our Director as well as representatives from our Medical Review, Education and Training, Claims, MSP, Financial, Appeals and Correspondence, Customer Service, EDI, and Provider Enrollment departments. We had quite a few questions after the call. We are developing a portion of our website that will be dedicated to the ACT. We will post future dates, previous dates and minutes, the recorded conference call; along with the powerpoint presentation. The questions that were asked during the call will be posted on the website also. We will also develop an email address that providers can email questions. The email address is not meant to circumvent customer service. They will be general in nature, not patient or claim specific. Diane Weiss asked the group if they had any comments from the teleconference, or if they had any suggestions or aspects that they would like to see in future teleconferences. Diane Weiss asked if the 15-minute update and then opening the lines for questions worked well. The group agreed that this was a good idea. Diane Weiss also asked if the lunch and learn concept was a good time for this teleconference. The group agreed that the noon hour was a good time. The next teleconference is scheduled for June 22, 2005 at 12:00 noon. It will follow the same format as the teleconference on March 23, 2005. The group was asked to submit "Hot Topics" for our call in June. Our September call will be specific to Medicare Secondary Payer, as suggested by our PCOM Advisory group. General Update Workshops – Group was given a handout that included the number of attendees for our recently completed General Update Workshops. We think that they well attended. Our last four workshops were repeat workshops for our larger cities. Diane Weiss asked the group if they thought that it was beneficial to repeat the workshops in our larger cities. They all agreed that this was a good idea. We feel that having the workshops in the same city twice gave the providers the option if needed. Diane Weiss commented that we received positive feedback from our providers. Fundamentals of Medicare Workshops – Group was given a handout that included the schedule for our upcoming Fundamentals of Medicare Workshop. Diane Weiss asked the group for feedback on an appropriate title for this workshop. We have changed it from Medicare Basics to Introduction to Medicare to Fundamentals of Medicare. Diane Weiss gave an overview of the workshop explaining that we try to take a provider through the entire process of Medicare billing. We are looking to see if the title captures the provider’s interest and if it addresses what the workshop is about. We would really appreciate the group’s suggestions on a title change. We will be scheduling more workshops later. Evaluation and Management Workshops – The group was given a handout that included a schedule of our upcoming E & M workshops. We have added consultation related services to our Spring workshops. These workshops are 3 hours long. The first 2 ½ hours are dedicated to E & M services and appropriate documentation. The last ½ hour is dedicated to general information and changes. There is no charge for these workshops. Registration is available on our website and a direct mailer was mailed to all providers. Navigating the Website Workshops – We are in the process of developing these workshops as the result of the provider community’s request as well as requirements from CMS. We will have dates and times posted as soon as possible. This will be a course designed specifically for providers to help them navigate our website. Comparative Billing Reports – We had a request to discuss and review the comparative billing report. The group was given a handout that included a sample of comparative billing reports that had been sanitized as well as a blank request for a comparative billing report and FAQ’s. Diane Weiss asked the group if they had taken advantage of requesting comparative billing reports for any of their physician staff. These reports are sent out for a six-month period. Shan McDaniel asked for clarification of some of the field titles. She suggested that the Denied Amount be renamed to the "Contractual Non-Allowed" amount. She also had concerns about the "Norm" column. We will clarify with appropriate staff. Shan McDaniel also suggested that we include an article in our newsletters concerning the clarification. Diane Weiss asked the group if they had any other issues regarding the comparative billing report. Diane Weiss asked if having the field definitions was helpful. Shan McDaniel asked that the verbiage at the bottom of the report be included in the field definitions. National Provider Identifier – Diane Weiss gave an update on the application process. She informed the group that we are not the enumerator for the application process that will begin May of 2005. We will post information on our website as it becomes available. Diane Weiss asked the group if they had any specific concerns about going through the application process. The group indicated that they were just ready to get the application process started. Shan McDaniel asked if we knew the length of the number. Diane Weiss indicated that it is supposed to be a 10-digit number. We do not know what the logic or format of the number will be. Charlene Breaux asked if we have seen any type of proposed application. We have not. Fix & File – Diane Weiss clarified that the implementation date will be July 5, 2005. After July 5, 2005, providers will not be able to fix a denial and send it back as a new claim. The provider will receive a duplicate non-paid denial. The provider will then need to request an appeal. Peggy Kelly asked why we changed this. Diane Weiss indicated that the Program Integrity Manual specifies that once we have already made a determination, the claim must go through the appeals process to be fixed. Diane Weiss asked for any comments or suggestions. The group does not want the fix and file process to go away. Shan McDaniel indicated that Mississippi carrier has been doing this for a while and it seems like its a lot more work for the providers. Shan McDaniel also expressed her concern that they are receiving medical necessity denials and the covered diagnosis is included in the policy. Diane Weiss will follow up on this. Shan McDaniel also asked about an edit diagnosis table being published. Diane Weiss clarified that we do have a diagnosis table in the specific policy. We included references in the handout where this information is published. Diane Weiss reminded everyone that unprocessable claims do need to be sent back as new claims. These do not fall under the "fix & file" guidelines. Web Based Training - Mark Ulmer gave an update on WBT. Our most recently released course is a course concerning national and local coverage determinations. It will eventually replace the LMRP course that is on our website right now. The LMRP course will probably be replaced by the end of this calendar year. The E & M guidelines course that covers the 97 guidelines is being released today. We have 1 course out for review currently which is E & M services. It is in review right now and should be released by the end of April. Within 2 weeks we will be releasing the Podiatry course for review. We have a skilled nursing facility Part A Billing and a MSP course in development. The MSP course is being developed based on input from the PCOM Advisory Group. Mark Ulmer also reminded everyone that if anyone is reviewing a course, we do not issue certificates for completed courses until they are finished, however if you take the test after the course is released, you will receive your certificate. Mark Ulmer also asked that everyone keep their email addresses updated. Mark Ulmer asked the group to suggest people who are knowledgeable in podiatry to review the podiatry course. We generally have about 20 people to review the courses. Diane Weiss asked the group if they had any suggestions or ideas for future Web Based Courses. Any suggestions should be sent to medicarewbt@arkbluecross.com. FAQ’s - The FAQ section is a very useful section of our website. The group was provided with a handout of a screen shot on our website where the FAQ’s are located. These questions will stay on our website for a year. We add FAQ’s on a quarterly basis. Diane Weiss asked the group if they had any questions to put on our FAQ section. She asked the group to consider sending us questions to include on our website. Other Business: Bobbie Smith of DMERC indicated that they will be conducting workshops in Baton Rouge and Shreveport beginning on April 27, 2005. The cost is $30.00 per person. Bobbie gave us a copy of their registration. We will try to provide a link from our website to the DMERC website for registration. Sharon Harless of Unisys updated everyone on the Medicaid + Choice program. Providers will have to actually download a coversheet and complete it for their claims. They are keying directly from the coversheet and the coversheets are not being completed correctly. They will have workshops in the Fall. Effective January, 2005 providers filing electronically no longer need to send in a certification form every time they file claims. They will start sending in the certification form annually. The forms will be sent to providers shortly. If Unisys does not receive the certification form by May15, 2005, their submitter ID will be discontinued. Shan McDaniel expressed concern about place of service codes for facilities. Diane Weiss directed to her to their intermediary, which is Tri Span, for clarification. Discussion of Future Meetings – Our next PCOMAG meeting will be June 2, 2005. We will also have one on September 22, 2005. Both will begin at 10:00 a.m. Our next meeting will be held in another building in this area. Diane Weiss asked the group to please submit any suggestions for topics of discussion for our future meetings. Meeting adjourned at 11:45 a.m. ATTENDEES: Advisory Group Members Medicare Services *Attended via teleconference |
