Highmark Medicare Services
Provider Outreach & Education (POE) Advisory Group
Maryland/Washington DC
Meeting Minutes
August 1, 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 first meeting for next fiscal year will be November 14, 2007.
The Centers for Medicare and Medicaid Services (CMS)
Barbara Cerbone from CMS participated in the call via teleconference. NPI is important, please enroll and submit claims using your NPI.
Medicare Administrative Contractors (MAC) awards will be awarded shortly, jurisdiction J12 (PA, MD, DE, and NJ). The MAC award will be seamless to providers; there will minimal disruption to providers. Once a decision is made it is final, unless it is appealed. The implementation will be delayed if appeals are submitted.
Ask the Contractor Teleconference
Topics were requested for the ACT scheduled for September 06 from 1-2 p.m. No topics were offered for this call.
Lunch and Learn topics-
- Wound Care Billing
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%. Nationally, the FI error rate is 1.4 %.; the MD/DC region is 29th out of 31 FIs. Maryland/DC is contributing to 1/9th of all errors nationally, CMS/OIG and Highmark Medicare Services is looking to lower the error rate. Inpatient SNFs account for 45% of the errors, outpatient hospitals account for 29% of the errors.
Insufficient documentation contributed to 33% of the errors. Incorrect coding contributed to 29% of the overall errors.
Discussion was held over how to best reach the SNFs that are receiving the CERT errors, comments from the chain providers included:
- SNF only teleconferences
- Making sure we get the message directly to the corporate offices, so that they can get the word out to their homes.
- Additional web based training
- Timing- the last week and first week of the months are not good for SNFs to take time away from their daily tasks.
- SNF workbooks training over teleconference.
- Load workbooks and answer keys on the website as resources
- It was also recommended that we supply additional reference materials on our website
- E-Learning
- Web based training modules
- Visible to facilities
- Incorporate into required training
- Train the trainer
EDI
An EDI update was provided regarding the following topics:
Special Edition July 2007 Xchange
http://www.highmarkmedicareservices.com/parta/pdf/newsletters/edi/edixchange_0707.pdf
Join our EDI Website
http://www.highmarkmedicareservices.com/mailinglists.html
On August 31, 2007 all providers need to be on the Stratus platform. Letters were sent in early July, if you didn’t get the letter, contact the EDI help line. A small batch of claims needs to be submitted to make sure we are able to correctly process claims.
Log-on IDs, CMS is merging the data centers into 4 nationally, the data center we will be processing through is called Enterprise Data Center (EDC). All log-on IDs will be reassigned through the EDC. An on-line form needs to be completed for each user, so that they will continue to have access to FISS.
Discussion:
When we complete the RACF form, how long will it take to get our log-on ID? All forms need to be submitted by 8/10, a response will be sent around 8/20-via e-mail. Effective 9/1/07 new passwords are needed for DDE.
A provider suggested that it would be helpful to get a confirmation when you submit the on-line form.
Provider Enrollment Services
Provider Enrollment Service (PES) discussed the Authorized or Delegated Official bulletin.
Medicare Updates
The calendar of events was discussed including upcoming workshops. Transplant facilities are required to re-register their facilities by December 26, 2007. Details were provided.
Change request 5583 will fix the problem of 210 bills overlapping with 22X bills, a 74 span code needs to be placed on the 210 TOB, effective 10/1/06, implemented 8/27/07.
NPI
CMS is hosting a NPI roundtable today to discuss common billing issues; SE 0725 should be viewed prior to the call. Data dissemination is coming soon, please check the NPI website to make sure that all of your information is correct and look at the optional fields in case there is information that you don’t want disclosed.
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.
Training for customer service representatives will be on Monday’s until 9:30 a.m.
Concerns for the contact center:
- CR about 95% of clean claims within 30 days, it seems like a high number of claims are being held for excessive time frames. Also, an increased number of claims are being held for FI use only. If claims are suspended and you do not understand the reason code associated on the claim, please call the contact center and ask.
- It was requested that the website be updated to show status/locations that are sitting for extended periods, and when providers can expect resolution.
Roundtable Discussion
1- Develop a web based training module on MSP
2-A teleconference for LTCHs on lifetime reserve days, outlier bills and interrupted stays.
3- A question was asked as to whether we have any trending on questions asked through the contact center. Yes, we do and these questions are posted under the FAQ section of the website.