Louisiana Medicare Services: PCOMAG Meeting October 04, 2005

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Resources > PCOMAG > October 04, 2005 Meeting

PCOM Advisory Group

Provider Communications Advisory Group (PCOMAG)

Date:	October 4, 2005
Time:	10:00 a.m.
Location:	Louisiana Medicare Office
	8687 United Plaza Blvd.
	Baton Rouge, LA 70884

ATTENDEES:

Advisory Group Members Medicare Services

Michelle Venable, Med Data Service* Diane Weiss

Nita Katz, Northlake Pulmonary Associates* Kim Gassie

Diane Groh, Acadian Ambulance Michelle DeSoto

Bobby Smith, Palmetto GBA Diane Lencse

Tricia Canella, Louisiana Healthcare Review Gina Waild

Judy Cain, Louisiana Medicaid

Sharon Harless, Unisys

Mary Raby, Unisys

*Attended via teleconference

Meeting Minutes:

INTRODUCTION AND ANNOUNCEMENTS
Diane Weiss called the meeting to order at 10:00 a.m. She welcomed those in attendance and announced Michelle Venable as well as Nita Katz were in attendance via teleconference.

OLD BUSINESS

Review Minutes: Minutes dated June 14, 2005 approved and will stand.

NEW BUSINESS

Review of LA PCOM Advisory Group Action Items: This form was designed to record and document action items recommended by the committee members. Diane Weiss reviewed the most current action items at hand. The first item mentioned concerned the CERT Checklist. The second item noted was a suggestion that Medicare Secondary Payor (MSP) would be the topic of one our "Ask the Contractor" Teleconferences. Diane stated Medicare Services offered a MSP ACT on September 29, 2005.

CERT Checklist: Per a suggestion by the PCOMAG, Medicare Services developed a checklist for responding to CERT requests distributed to the provider community. Our CERT contractor informed us that they are not receiving all of the necessary documentation regarding consultations. We have included consultations as part of the checklist criteria. Kim Gassie mentioned that when documentation is reviewed for consults, the CERT contractor is seeking information pertaining to the requestor and the reason for the consult. In addition, Kim indicated that the CERT contractor is also verifying if the findings and recommendations were returned to the referring physician. These recommendations as well will be incorporated as part of the checklist criteria.

Kim requested the group members to share this form with their co-workers and obtain their input. Gina Waild indicated all suggestions should be forwarded to Michelle DeSoto by the end of October. We will distribute the checklist to our internal CERT team to review by November 15, 2005.

Diane Weiss reminded the group that the CERT newsletter is available monthly and on our website at www.lamedicare.com/provider/cert.

Part B Premiums and Deductibles for 2006: A fact sheet from CMS was provided to the committee members. Diane Weiss stated the Part B deductible will increase to $124. Also, there is an increase in the Part B premium to $88.50. This information will be published through all of our usual channels such as our website, workshops, and newsletters. It is also available in the "2006 Medicare and You" handbook that is distributed to all Medicare beneficiaries. Diane mentioned to the group that this fact sheet included some background information on what determined the increases in premiums and deductibles. Diane asked the group if they had any suggestions as to how this information could be distributed in addition to our current methods. Gina Waild also reminded the group that our goal is to obtain the group’s feedback on how we can better serve our provider community.

CD –ROM Fee Schedule: Information about the CD-ROM fee schedule was provided to the committee members. Additional resources will also be included on the CD-ROM, such as MPFS disclosure reports, par agreements, ABN’s, provider enrollment instructions, HIPAA instructions, EDI instructions, Indicators/Global Surgery percentages/Endoscopies for 2006, Health Professional Shortage Area Information, and other Medicare related billing information. Diane Weiss asked the group if they had any recommendations on the format of the CD-ROM. Gina Waild asked the group if the CD-ROM seemed to be user friendly. Members did report that this format has been very helpful and easy to utilize.

Judy Cain asked if the "Medicare and You" booklet was mailed to all beneficiaries. Diane stated that it should be mailed to every eligible beneficiary. Judy Cain asked if the Department of Insurance still assisted with distributing these booklets. Diane indicated, we will verify this information with the Department of Insurance. Kim Gassie stated that we distribute these booklets to our providers that attend our General Update workshops. We explain to the physicians how to order these reference materials for their offices. Providers have expressed these booklets are helpful with managing the day to day operations of their practices.

Disaster Recovery & Relief Programs: A copy of the Louisiana Provider Enrollment Disaster Recovery Emergency Update Form was distributed to the committee members. This form allows a physician to change their practice or payment address location. Medicare Services has received positive feedback from the provider community regarding this information. A completed form should be faxed to our Enrollment Department in order for us to expedite these requests. Once the pay to address is updated, the remittance advices’and checks will be mailed to the new location. Currently, we are holding the remittance advices and checks for the affected zip codes identified by the United States Postal Service. As the United States Postal Service releases zip codes for mail delivery, Medicare Services will follow suit.

An Electronic Funds Transfer agreement and applicable instructions were supplied to the committee members. Diane Groh expressed concern that some of the banks had to relocate and wanted to know if the providers still needed to complete the form as a result of this change. Diane Weiss stated that the financial institutions have instituted provisions to address this change. Kim Gassie stated that the providers should only complete the EFT request, if they changed banks, but not the location of the bank. Kim Gassie expressed the fact that the physicians are changing their addresses with the United States Post Office, however they are not changing their address with Medicare Services. She indicated we have a "do not forward" policy in place, therefore providers will not receive their mail in these instances. Kim recommended to the group to place a reminder again on our website and also distribute a notice to our Top 100 providers and PCOMAG members regarding the importance of changing their address directly with our office.

Gina Waild asked if the providers are able to retreive their remittance advices online. Diane Weiss stated that this capability is availabe provided they have an electronic remittance advice in place with Medicare Services. A committee member noted not all providers have access to the internet to retreive their remittance advices electronically.

Michelle Venable asked if the processing of claims was ever delayed as a result of the hurricanes. Diane Weiss stated that there was no delay in claims processing. In addition, there was no customer service issues either. Our customer service calls were routed to another state due to accessibility issues in Louisiana and this was a "seamless" change as far as the providers were concerned.

Kim Gassie stated that Medicare Services has been conducting " Ask the Contractor" teleconferences for our Disaster Recovery Relief efforts. We created a powerpoint presentation that highlights notable changes as a result of the hurricanes. This information is located on our website for providers to review. Kim noted one of the key changes included was related to the introduction of a new condition code "DR"(Disaster Related) and modifier "CR" (Catastrophe/Disaster Related) . The new condition code and modifier is for use by providers submitting claims for beneficiaries who are Katrina disaster patients in any part of the country with effective dates of service on or after August 21, 2004. This modifier will be effective until further notice. Kim agreed to touch base with CMS regarding a final deadline.

Kim recommened the group should visit the "Hurricane Katrina Information" section located on the CMS website. Also, there is a Q&A section that provides valuable informaton as well. As a convenience, Medicare Services has provided a link to their website from our website for review.

An Advance Payment Request form was distributed to all committee members. The completed form can be faxed to the Medicare Services Accounting Department for processing purposes.The advance payment is reimbursed to Medicare 61 days after it is issued until the entire outstanding balance is completely satisfied. Repayment can also be reimbursed as a lump sum, if the provider chooses to do so. Tricia Cavella asked if there was a cap on the amount that the provider can request? The limit of the request is equal to the average amount that was paid to the provider over the past 3 months.

Kim Gassie asked the group if they knew if there were any other avenues available to disseminate this information to the provider community, especially since some of these folks are now in a postion to establish a new location or reopen their current practices. Diane Groh expressed concern that some displaced providers did not have an opportunity previously to participate in our "Ask the Contractor" teleconferences. Diane Weiss stated that she had received a recommendation from a provider that had relocated to continue our "Ask the Contractor" teleconferences. Kim Gassie asked the group if they thought it would be a good idea to continue to offer the ACT’s. The group agreed that the teleconferences should continue due to the fact most providers are just now coming back on line. Tricia Cavella stated that it will be months before telephone and internet service would be restored in some of the storm areas. Diane Groh stated that the 800 number circuit centers were very busy, therefore some providers may not have been able to call in the the ACT’s. She suggested that we definitely continue these calls. Kim then asked the group if they had any suggestions on a particular day of the week or time that might be better for the calls. The group stated that the noon hour worked best for their staff members, however Wednesday would be preferred over Monday, which was the day previous calls were conducted. Moving forward, the ACT calls would be conducted at the noon hour on Wedneday.

Gina Waild pointed out the education team has provided additional outreach to the provider community. Medicare Services visited evacuee centers to share with providers key informaton related to effectively servicing our beneficiaries during this difficult time. In addition, Gina Waild noted public service announcements were distributed to all major broadcasting affliates.

Gina Waild asked the group if there was anything else that we could add to our program at this time to support our provider community. Diane Groh stated that most providers are starting to relocate and receive their mail. Gina stated that a suggestion had been relayed to her that the Provider Enrollment Disaster Recovery Emergency Update forms be provided at the U.S. Post Offices. Tricia Cavella suggested that we utilize the state societies to include a reminder in their newsletters about the address change forms.

Medicaid Updates: Sharon Harless from Unisys provided a few updates on Medicaid issues. She stated that there are many providers that will not accept Medicaid because of the Medicaid beneficiary increase. Effective, September 1^st, Medicaid has expanded the "J" codes to allow reimbursement in a clinical setting. In addition, Medicaid is expediting the PA process for the providers who provided DME services.

Diane Groh asked about modifier codes for ambulance. She asked how they would determine what origin code or destination code they would use when they would take a patient from a shelter or temporary residence. Kim Gassie stated that our claims department is asking CMS for their recommendations. Once we receive clarification from CMS, we will place that information on our website and distribute this information via our Ambulance Liaison Committee. Michelle Venable asked if Medicaid was also recognizing the "CR" modifier. Sharon Harless from Unisys indicated that they were going to have to let their systems staff know about the modifier for crossovers. Sharon asked what "CR" stands for. Diane Weiss stated that it stands for Castrophe/Disaster related. This "CR" modifier is for Part B only.

Schedule for Workshops: The group was provided a tentative schedule of workshops that will be offered in the near future. Kim Gassie noted Medicare Services is in the process of confirming final dates and locations. Based on recommendations that the PCOMAG members provided to us in 2005, Medicare Services followed the same format in targeting the major metropolitan areas at the beginning of our workshop schedule and repeating the workshops in these areas again per the conclusion of our workshop sessions. We plan to distribute a finalized schedule by month end.

Medicare Services has developed a "Welcome to Medicare" workshop. In our "Welcome to Medicare" workshop, we intend to provide an overview of the program and available resources offered to new or newly staffed providers in our community. In addition, the name of our "Fundamentals of Medicare" workshop has been changed to "Medicare Advanced." This workshop offers information for the experienced provider enrolled in our program. This change was implemented based on recommendations received from our committee members during our last meeting. Medicare Services will be conducting a "Welcome to Medicare" workshop in Alexandria around mid November.

We have received positive feedback regarding our "Navigating the Medicare Website" sessions. This workshop has been very well received by the provider community. Diane Weiss asked if any of the PCOMAG members had ever attended this workshop. They stated to date, that they had not attended this particular session. Diane Weiss note Medicare Services is planning a "Navigating the Medicare Website" workshop in Alexandria around mid-November.

Gina Waild stated that we are also developing "focus groups" where we will target providers that are having issues with denial management. We will also offer additional "Ask the Contractor" teleconferences on an "as need" basis. Gina polled the group regarding suggestions for future topics for these teleconferences.

Provider Satisfaction Survey: The group was provided a copy of the fact sheet for the Medicare Contractor Provider Satisfaction Survey. The Medicare Contractor Provider Satisfaction Survey (MCPSS) is designed to measure provider satisfaction about the services provided by Medicare Contractors. CMS will implement this survey on a nationwide basis beginning in 2006. Approximately 30,000 providers will be targeted to participate in this survey. Judy Cain asked how many providers participate in the Medicare Program in the Louisiana region? Diane Weiss stated that we have about 20,000 active Medicare Part B providers in Louisiana. Diane then noted if you are contacted to participate in the survey, we want to encourage our providers to give CMS feedback. Providers will be able to submit their responses via a secured internet website. The information with the survey would also instruct providers on how to submit their responses to the survey in a paper format via fax or mail. Gina Waild noted provider satisfaction is a top priority for our organization and we are looking forward to continuing to improve our service levels to our provider community. She asked the group to please share with us any suggestions for increasing satisfaction.

"Ask the Contractor" Teleconferences: Diane Weiss asked for the group’s input regarding our ACT’s. Our first teleconference was held in March 2005. It was general in nature. The format for our teleconferences is a 15-20 minute update of information then we open the telephone lines for questions from the provider community. The PCOMAG members recommended conducting teleconferences of a general nature and some topic specific. In June, we had a CERT specific teleconference and in September, we held a MSP teleconference. We are planning to conduct ACT’s on a quarterly basis throughout 2006. Diane asked the group if they would recommend the same format for 2006. She asked what topics they would like for Medicare Services to address. A suggestion from the group was to conduct a call related to the appeals process. Gina Waild suggested that our last teleconference for 2006 focus on the Provider Satisfaction Survey results. Kim Gassie stated that she had a recommendation for us to provide a "General Update" ACT for this quarter. Gina Waild also suggested that we include a CERT follow-up ACT.

Kim Gassie stated that once we conclude the teleconferences, the audio of the call is posted to the ACT specific section of our website. Providers access our website and listen to the call. Diane Weiss asked the group if they had any other suggestions or recommendations on our "Ask the Contractor" Teleconferences. The final consensus was: October thru December: General "Hot" Topics; January thru March: Appeals Process; April thru June: CERT; and July thru September: MCPSS results. They did not have any further comments.

Flu and Pneumonia Update: The group was provided a handout that included the updated allowables for the flu and pneumococcal vaccines.

Pinnacle Business Solutions: Effective October 1, 2005, we have officially changed our name to Pinnacle Business Solutions, Incorporated. Providers will begin to notice our new name on all remittance advices, the website, letterhead, etc. Diane Weiss assured the group that the same quality staff is involved in providing education and training. This is a move that we have made to strengthen our position as a Medicare Contractor. We are still a wholly owned subsidiary of Arkansas Blue Cross Blue Shield and will continue to provide the same quality service that has been offered in the past. Diane asked the group if they had any questions or concerns about the name change. They did not have any questions.

Closing Comments: Diane asked the group if they had any recommendations for future educational activities. She also asked if the group had any suggestions for improvements on our meeting forum. No suggestions were provided at this meeting, but members were reminded that this was an "on-going" process and should feel free to bring suggestions of this nature to group at any time.

Future dates for PCOMAG meetings: The group was provided a schedule of all of the upcoming dates for our meetings. Diane Weiss asked the group if they had any major conflicts with the schedule. No major conflicts were noted at this time. Our next meeting is scheduled for December 1, 2005.

Gina Waild stated that she was looking forward to working with all of our PCOMAG members.

Meeting adjourned at 11:30 a.m.