Highmark Medicare Services
POE Advisory Group
Meeting Minutes
May 17, 2006
Timonium POE Meeting Group Attendees:
Kim Droboniku (Highmark)
Cami DiGiacomo (Highmark)
Cathy Mackenzie (Highmark)
Ruth Rivera-Wilkins (Highmark)
Kristi Pederson (Fundamental HealthCare)
Traci Phillips (Maryland Hospital Association.
Teleconference Attendees:
Kathleen Richardson (Anne Arundel Medical Center)
Trish Wright (Good Samaritan ESRD)
Lorry Toomey (HCR Manor Care)
Michelle Thureson (HCR Manor Care)
Vicki Choka (HCR Manor Care)
Shelley Railing (EDI/Highmark)
Georgia Rackley (CERT/Highmark).
Kim Droboniku, (Supervisor) of the Highmark Medicare Services Provider Outreach and Educational Specialist team in Timonium, Maryland began the meeting with an introduction of the Maryland/DC Provider Outreach & Education staff.
Action Items/ Kim Droboniku:
- The revised Quick Reference Guide is posted to Highmark Medicare Services Website. Two different versions are available: Print version for downloading and an Online version for viewing.
- Web Base Training is also available on our website for Inpatient Rehabilitation Facility and Skilled Nursing Facility.
Education/Present
- F.I.S.S Basic Workshop, teaches you how to maneuver through the system. We also provide a F.I.S.S manual for $25.00, and teach you how to get through this manual, where it can ultimately become a great tool for your staff.
- Hospital 101 workshop will be held on 5/23, 6/15, and 6/16.
- Ask The Contractor (ACT) will be on 5/25.
- F.I.S.S Basics will be taught again on 6/7.
- Outpatient Physical Therapy (OPT)/ Comprehensive Outpatient Rehabilitation Facility (CORF) will be taught on 6/19 at National Rehabilitation Hospital.
- You can register for a class on Highmark Medicare website through Outreach/Education.
- Reminder: The F.I.S.S workshops are limited to 5-6 people. This creates an environment where providers can feel comfortable to ask questions.
Future
- CERT Teleconference on 5/31: This teleconference will provide an update on CERT errors, as well as the reasons claims have been returned to the provider.
- CERT Workshops: will be held in July and August of this year. They will focus on CERT errors and how to prevent claims from being returned or rejected.
Top 10 Provider Inquiries for April
- Overlaps
- Part A Entitlement
- Suspended Claims
- Billing/ Filing Instructions
- Part B Entitlement
- RTP Request
- Beneficiary Demographic Information
- Claim Information Change
- Simple Eligibility
- Payment Explanation
Interactive Voice Recognition System (IVR) is coming in early September to Maryland providers. This will be extremely helpful for all providers when they need to retrieve eligibility for their patients. At this time our Return to Provider report indicates that half of the top 10 inquiries are for not understanding or utilizing HIQA.
Kim Droboniku asked:
How can we educate providers on HIQA?
- Teleconferences
- Workshops
- Web Base Training
Needs Assessment:CMS is concerned about the lack of attendance in our current workshops.
- How can we get Maryland providers to participate in our workshops?
- Are we marketing properly?
- How can we develop ways to educate providers better?
- How do we get the word out to our provider community?
- Maryland billing staff has low turnover rate
- Monthly updates of upcoming training via email.
- Facility focused training.
Georgia Rackley(CERT)
- May 2006 Error Report just came out showing Maryland at 3.4%.
- The reports will be available on our website.
- Georgia will investigate why Kristi Pederson received a CERT letter on a no-pay claim.
EDI (Shelley Railing) There are no updates at the present time.
Provider Contact Center: There is nothing to submit at this time.
Lori & Michelle (HCR Manor care):
Shared a best practice: Business Office Support System (B.O.S.S).
- Their staff is set up to answer questions for individual offices on an 800 line.
- Most frequently asked questions involve:
- Consolidated Billing, Fee schedule questions.
- MSP- How to bill? Hospitals in MD had concerns on what they were allowed to bill.
- They also made available an 800 number where they can assist their patients with HIQA issues.
Kathleen Richardson (Anne Arundel Medical Center)
- Suggested that offering workshops throughout the year would be better than offering workshops on one topic per quarter.
- Suggested training on Consolidating Billing- Determining who is responsible for what.
Kristi Pederson (Fundamental Health Care)
- Suggested Documentation Training- What Medical Review really needs?
- Minutes in look back period (MDS)
- Kim suggested a teleconference on issues pertaining to medical review and documentation.
The next Provider Communication (PCOM) Meeting will be held August 16, 2006.