Highmark Medicare Services
Provider Outreach & Education (POE) Advisory Group
Pennsylvania
Meeting Minutes
August 9, 2007
9:00 AM – 11:00 AM
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.
The next meeting will be held on November 16, 2007 from 9-11 AM.
Highmark Medicare Services would like to thank Patty Johnson from Quality Insights on conducting the Important Message for Medicare Beneficiaries teleconference. A follow up call will take place on August 22, 28 and 29th. Denials can be found on both Quality Insights and the Highmark Medicare Services website.
Ask the Contractor Teleconference
Topics were requested for the ACT scheduled for September 6th from 1-2 p.m. Topics suggested was a description of the crossover process and guidance on notification letters required by SNFs. The letters for SNFs are being discussed in the SNF workshops.
Provider Enrollment
Provider Enrollment Service (PES) discussed the Authorized or Delegated Official bulletin.
The provider enrollment frequently asked questions have been reviewed and additional questions have been added to the website.
CERT
A CERT update was provided. The May report indicated that the Pennsylvania Paid Claims Error Rate is 1.2%. Pennsylvania’s error rate is 11th in the nation out of 31 FIs nationally.
Errors are concentrated in the following areas:
- Blood glucose monitoring
- Injection of medications
- Colonoscopy coding
- Physical therapy services
Incorrect coding is the primary driver of the errors in Pennsylvania Medicare Part A. Data analysis indicates that incorrect coding errors resulted in down coding, up coding or changing of units on the services listed above. Outpatient hospital errors accounted for nearly half of the total dollars in error. Blood glucose billing errors account for 21.7% of all dollars in error, and inpatient SNFs account for 16.8% of all errors.
Discussion was held over how to best reach providers, suggestions provided:
Special training related to specific errors
- A webinar further training on understanding an LCD
- Specific instruction on tips to better assign the correct RUG rate
- Send correspondence to both the CFO and Compliance officer to make sure the message is getting to all vested parties.
EDI
An EDI update was provided regarding the following topics:
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. If you don’t migrate to a secure vendor, providers will not have access to DDE/HIQA.
Log-on IDs, CMS is merging the data centers into four 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. A RACF form needs to be completed by September 7, 2007. A new log-on will be set via secure e-mail.
A provider expressed frustration over the amounts of changes that are being asked for by Highmark Medicare Services. The Front End Migration was already in process and deadlines were set prior to the EDC log-on transition. The timing has not worked out well, and we empathize with providers, however the deadlines must be met in order to avoid disruption in a providers business.
As requested by a POE Advisory Group member, we currently have 427 PCACE Pro32 submitters.
A request was also made for instructions to set up hyperteminal software to download a Medicare A remittance advice. Instructions can be found on the link below: http://www.highmarkmedicareservices.com/parta/edi/toenroll-era.html
NPI
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.
Feedback for the contact center:
Inconsistent answers-the contact center is receiving additional training to make sure accurate consistent answers are provided. If you receive an inconsistent answer, please ask for a supervisor so that the issue can be clarified, and education can occur for the customer service representative.
Advise staff that it is okay to get back to a provider, providers feel that the CSRs feel the need to provide an answer during the call, the providers felt that the would rather wait then to receive an answer that has not been thoroughly researched.
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.
August is National Immunization month; please educate beneficiaries that “Immunizations are not just for kids”.
Roundtable Discussion
1- Reason code 32104 is being received because of NPI issues; we will work directly with the provider to resolve this issue.
2- Has Highmark Medicare Services received any additional information on the post acute demonstration project? No additional materials were received other than the change request.
3- We have a high volume of claims that were denied incorrectly because of a Super-op error. Janine Fulginiti will work directly with the provider to make sure the claims are corrected.
4- Will a CMS representative participate in the call in the future, as they had in the past? CMS is invited to all calls, however due to schedule conflicts they are not always able to attend. It was requested to include the CMS contact with the minutes - Patrick Hamilton (Patrick.hamilton@cms.hhs.gov).
5- It was suggested to include “Important, Revised or Urgent” at the beginning of list servs, so that providers can identify which messages contain corrections or items that providers need to take note of. Highmark Medicare Services will look into revising our current process.
The next meeting of the POE Advisory Group will be held on November 16, 2007.