Highmark Medicare Services
Provider Outreach & Education (POE) Advisory Group
Pennsylvania
Meeting Minutes
May  7, 2008
9:30 AM – 11:00 AM 

Welcome and Introductions

Kim Droboniku, Supervisor Outreach and Education, welcomed the group to the PA POE Advisory meeting, introductions were made of those that participated by phone and those that were in attendance at the meeting. 

Current Quarter and Future Education Activities

Kim Droboniku, Supervisor Outreach and Education, advised the committee of the upcoming educational events, (see schedule below) or visit our website for more details.   

May 2008

• Webinar SNF Rehab 5/14
• Teleconferences Claim Errors 5/21
• Billing Diagnostic Services 5/22

June 2008

• ACT                                       6/3
• Webinar                                CORF/CR5898 6/17
• FISS Basic                            6/10 Camp Hill & 6/11 Pittsburgh
• CAC                                       6/12       
• Workshops                           Hospital 6/20 & 6/27

July 2008

• Teleconference - Medicare Updates 7/30
• Workshops  - Hospital 7/10, 7/15, 7/22, 7/24 & 7/29 

However, moving forward POE is considering a webinar for the FISS Basic classes in addition to the classroom style offered at Camp Hill, Pittsburgh and Timonium, MD.

For additional information on FISS, you may visit our website to download the FISS Manual located here.  Feedback was requested on the direction of FISS Basic, suggestions indicated to continue with the quarterly classes and include instructions via webinar so that staff could participate without leaving the office.  

At this time, POE will be cutting back on FISS Advance classes do to low attendance. 

Suggestions for Lunch and Learns were solicited, however no suggestions were provided at today’s meeting. If you think of a topic or have a suggestion, please notify Kim Droboniku at: kim.droboniku@highmarkmedicareservices.com.

As a reminder, the ACT is scheduled for June 3, 2008 from 1-2:30 p.m.  If you have any topics you would liked discussed, please email Kim at:  kim.droboniku@highmarkmedicareservices.com 

CERT

A CERT update was provided by Kim Droboniku.  The claims sampled from 10/2006 – 9/2007 indicated that the Part A Pennsylvania Paid Claims Error Rate is .90%.  This represents a 15% decrease from last month’s error rate of 1.06%. 

Reminders: 

• Respond to CERT Requests in a timely manner.

• Review documentation prior to sending the records to the CDC to verify that the documentation submitted substantiates the service billed on the claim.

• If a billing error is identified for a claim sampled by CERT, submit a letter to the CDC outlining the error.
• The leading cause of CERT errors is insufficient documentation and incorrect coding. 

 Medicare Updates

The following Change Requests (CR) were discussed:

• CR 5984 Percutaneous Transluminal Angioplasty (PTA)
• CR 5999 April 2008 Update of the OPPS
• CR 5971 Signature Requirements Clarification
• CR 5923 Processing Drug with the JW Modifier
• CR 5916 Adjusting when Medicare did not pay for the original transplant
• CR 5874 New Automated Test for AMCC Panel Payment Algorithm
• CR 5898 CORF Billing Requirement Updates for Fiscal Year 2008

Provider Contact Center

Effective July 1, 2008, the telephone lines will be closed every Tuesday and Thursday from 8:00a.m. - 9:00a.m. to conduct training for customer service representatives. Topics for internal trainings were solicited, no suggestions were offered. 

EDI

An EDI update was provided by Jenn Baran regarding the following topics: 

• New NPI Edits for Secondary Providers
• Rejection of Electronic Claim Status Requests that Lack National Provider Identifiers (NPIs)
• PC-ACE Pro32 Version 1.91 Upgrade Available via Internet Download
• Clinical Trial Policy Number Requested
• Shared Systems Participation in Claim Adjustment Reason Code and Remittance Advice Remark Code Maintenance 

Note:  For more information on these topics please visit our website for the May 2008 Part A Xchange 

Provider Enrollment 

Judy Andidora from Provider Enrollment Service (PES) discussed the following: 

New version of the CMS-855 Forms Published 2/08

The Office of Management and Budget recently approved changes to the Medicare Enrollment Applications (CMS-855).  The Centers for Medicare & Medicaid Services (CMS) has placed the revised enrollment applications on their website.  You may access these forms via Highmark Medicare Services’ website. 

With the exception of specialty hospitals who are required to use the revised application immediately, Highmark Medicare Services will accept the 2006 version of the CMS-855 for all providers and suppliers through June 2008.  However, we encourage you to submit the revised version of the application.  Please review MLN Matters Number SE0810 for more details on the new forms. 

Register for IACS-PC now to be ready to use PECOS Web Applications

SE0747  (first in the series)

SE0753  (second in the series)

SE0754  (third in the series)  

When to submit a CMS-855 Form to Provider Enrollment

http://www.highmarkmedicareservices.com/partb/enrollment/forms.html

Questions and Comments

Nancy Esterly submitted two questions prior to the meeting and they were addressed as follows: 

Q. IACS-PC - a CP575 form is required.  We no longer have a copy of the CP-575 but we do have a letter from the Department of Treasury showing our Tax ID #.  This is the form that we submitted with our 855 application in January.  Will this letter suffice?  I read somewhere that you cannot get a copy of the CP-575 from the government. 

A. Provider Enrollment accepts a letter from the IRS in lieu of a CPC575 if it cannot be found.  We cannot guarantee that the IACS PC contractor will accept this, but I would suggest trying with a letter explaining the situation attached. 

Q. Zostavax (90736) claims - we have many claims that are in the RTP file with reason code W7062.  When we check the CPT codes in the FSS system, the code is valid: eff dt = 010106 TRM dt is blank so the claims should process.  We need a denial from Medicare in order to bill the claims to the secondary carriers.  We are told to F9 them back.  Some of the claims are approaching the other carriers timely filing limits.  Is there a resolution in sight?  I understand that these will always edit and RTP - can't they just have the processing department override the edit and process as a denial? 

We have been trying to get these resolved for over a year.  Can someone please help?  If this is not the appropriate forum for this issue, should we be taking our concern to CMS? 

A. We have requested clarification from CMS.  It appears the service may be considered a statutory exclusion, which would change the way this service is billed.  More information will be provided as soon as it becomes available.

J12 MAC

Ed Sanchez, Director of Provider Outreach & Education provided an update regarding the J12 MAC. You can find more information regarding the J12 MAC 

Conclusion

Kim Droboniku wrapped up the meeting by thanking the POE Advisory committee for attending the meeting and reminded everyone that the next meeting of the PA POE Advisory Group will be held on August 15, 2008 at Highmark in Camp Hill, PA.