Highmark Medicare Services
Provider Outreach & Education (POE) Advisory Group
Maryland/Washington DC
Meeting Minutes
May 16, 2007
10:00 AM – 12:00 PM
Welcome and Introductions
Kim Droboniku, Supervisor Outreach and Education, welcomed the group to the POE Advisory meeting, introductions were made of those that participated by phone and those that were present.
POE Advisory Group Guidelines/Membership
The primary function of the POE Advisory Group is to assist in the creation, implementation, and review of our provider education strategies and efforts. We ask that the POE Advisory Group provide input and feedback on our training topics, provider education materials, and dates and locations of provider education workshops and events. The group also identifies salient provider education issues, and recommends effective means of information dissemination to all appropriate providers and their staff. The POE Advisory Group should be used as a provider education consultant resource, and not as an approval or sanctioning authority.
The focus of the group meetings should remain centered on the development and implementation of effective provider communication materials and strategies.
Future Meetings: The final meeting of the POE Advisory is scheduled for August 1, 2007.
The Centers for Medicare and Medicaid Services (CMS)
Barbara Cerbone from CMS participated in the call via teleconference. Barbara was previously the contact person for the Maryland/DC area but was reassigned because of the Part D benefit program and Medicare Advantage. Highmark Medicare Services is pleased that we will once again be working with Barbara.
Physician Quality Reporting Imitative is a voluntary reporting process of 74 initiatives on the 1500 form for quality. epending on the results, physicians could be eligible for a bonus.
Ask the Contractor Teleconference
Topics were requested for the ACT scheduled for June 4th from 1-2 p.m. The following topics were suggested:
- Reason codes related to NPI errors and what the provider action will be.
- Systems issues- SMNCOV- and why claims are sitting in this status location. (This location was focused on by the claims department and the numbers are rapidly declining.). We also have a Claims Pending Release (CPR) page on our website; this will allow providers to receive an update on suspended claims and the action needed.
Other training suggestions included adding to the upcoming SNF workshop a section on documentation, to include what we are not seeing in documentation, and what we would like to see. Also some guidance on physician orders.
CERT
A CERT update was provided. The May report indicated that the Maryland/DC areas Paid Claims Error Rate is 2.6%, reduced from 3.1%. Insufficient documentation contributed to 32% of the errors. The insufficient documentation was mainly rehabilitation services, medication administration (J9201 & J2469) and infusion therapy. Incorrect coding contributed to 23% of the overall errors. The incorrect coding errors were comprised of RUG billing issues, duplicate submissions and rehabilitation services.
By bill type, the top errors were as follows:
- 21X
- RUG codes
- 13X
- 22X
- Blood Glucose- a draft Local Coverage Determination will be issued shortly
To verify your address is correct for your CERT requests, access the following link: www.certprovider.org. Also, if you have a question related to CERT you may call 717-302-4160 or via e-mail at questcert@highmarkmedicareservices.com
Discussion was held over how to best reach the SNFs that are receiving the CERT errors. A suggestion was made to contact the corporate offices. A problem was discussed over providers not getting ADRs timely; they felt that a delay occurred from the time a claim was placed in a SB6001 status location until a letter was sent. We were not aware of this issue and will work directly with the provider experiencing the problem. Also it was requested that providers should be able to print ADRs from FISS and submit the print screen as was allowed in past. The provider will be contacted directly to address this issue.
It was decided that the best mechanism to educate providers on proper RUG codes was to educate the MDS coordinators and the Rehabilitation Director, as they are entering the information into the system, which in turns generates the RUG score.
EDI
An EDI update was provided regarding the following topics:
- Front End Migration July 2007
- EDI Xchange http://www.highmarkmedicareservices.com/parta/pdf/newsletters/edi/edixchange_0507.pdf
Provider Enrollment Services
Provider Enrollment Service (PES) provided an update on the following topics:
- Part A applications
- Residents & Interns
The process of the 855A was discussed and it was requested that a web based training module. We will look into developing this module.
Medicare Updates
The calendar of events was discussed including upcoming workshops. The new Adjustment and Cancel Guide was also introduced, this is a guide to assist providers with the specifics of how and when to make an adjustment to a claim.
List Serv
The Advisory Committee was thanked for participating in the survey regarding the list serv; providers overwhelmingly responded that they were interested in receiving mailings specific to particular topics. We are currently sending out messages with more descriptive titles, and will also pursue having providers re-enroll for the list serv in the mail groups they are interested in receiving.
NPI
May 23, 2007 is just a few weeks away; providers are encouraged to submit their NPI on all claims. At the CMS Open Door Call for NPI, CMS instructed that they will be issuing details shortly on a crosswalk, similar to the UPIN directory and also instructions on self referred patients.
Provider Contact Center
The committee was asked to comment regarding the time and topics of the Customer
Contact Center Representative training. The committee had no concerns of the time of the training or suggestions regarding topics.
Roundtable Discussion
1- FISS user access codes are taking a long to resolve. Kim Droboniku advised that we are meeting with Core Services next week to discuss this issue. Follow Up-The result of the meeting is that Highmark Medicare Services has identified a solution that should be implemented within the next month. This should resolve this issue.
2- It was also discussed that when providers are speaking to nurse reviewers that they are indicating they don’t understand or know anything about the Maryland waiver, this is disturbing to providers. Follow Up- Medical review along with Outreach & Education has been having meetings with the HSCRC and the Maryland Hospital Association to get a better understanding of the Maryland waiver. The HSCRC has informed Highmark Medicare services that the Maryland waiver dictates what can be charged for a particular service, not how it should be billed. Medicare policies and guidelines would provide that instruction. Medical review will re-educate instructions on the Maryland waiver to the reviewers.
3- When an appeal or ADR is sent on an old date of service after May 23, 2007, which claim form should be submitted the UB-04 or the UB-92? Follow Up: The UB-04 would be required for the review, and possible subsequent adjustment to the claim.
4- We are experiencing long delays on the phone with the contact center. We are asked our name and provider number, are put on hold, then asked for HIC and date of service and again put on hold, we are experiencing tremendous hold times and are not receiving call backs when they are promised. Follow Up: The contact center is striving to provide the best service possible to providers; quality monitoring is also in place to make sure you are receiving the best service possible. Please provide examples, including date and time of the call so that we can investigate.