Highmark Medicare Services
Provider Outreach & Education (POE) Advisory Group
Pennsylvania
Meeting Minutes
August 15, 2008
9:30 AM – 11:00 AM 

Welcome and Introductions

Denise Church, manager 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.

Denise asked all attendees via telephone to email Vicki Kurland of their participation at today’s meeting at:  vicki.kurland@highmarkmedicareservices.com.

Quarter and Future Education Activities

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

August 2008

• FISS Basic                            8/19 (Pittsburgh) & 8/27 (Hunt Valley, MD)
• Webinar                                8/21 NJ Part A Intro to Website
• Teleconference                    8/25 Claim Errors

Sept 2008

• ACT                                       9/3
• Lunch and Learn 9/10 VC44
• Lunch and Learn 9/25 Physician’s Orders
• Workshop                             MSP (TBA)
• Workshop                             9/23 New Provider (Camp Hill)

The feedback provided by the Advisory Group to consider FISS Basic training in a webinar was reviewed.  POE will be offering its first FISS Basic Webinar on October 13, 2008.  Please watch our website for more details on how to register for the FISS Basic Webinar. 

For additional information on FISS, you may utilize our website to download the FISS Manual located here.  

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 September 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 Denise Church.  The claims sampled from 02/2007 – 01/2008 indicated that the Part A Pennsylvania Paid Claims Error Rate is .98%.  This represents a 2.5% increase from last month’s error rate of .96%. 

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

• Processing claims for Screening Pap Smears Q0091 - Claims suspended until FISS fix scheduled for 9/2/08
• Therapy Cap Exception Update - Exception extends to 12/1/2009
• July 2008 Update to the OPPS - MLN Matters Article MM6094
• Screening Pelvic Examinations - Clarification made to the IOM Pub. 100-04, Ch. 10, Sec. 40
• Annual Update to HCPCS Codes for SNF CB - CR6111 new codes for SNF CB enforcement
• New Hemophilia Clotting Factor & HCPCS Code Q4096 -  Provider instructions described in CR6006 to properly submit IP claims with HCPCS Code Q4096 for discharges on or after 4/1/08 through 1/5/09. No impact on OP hospital claims or SNF claims.
• Service Wide Edit for Infliximab for PA Providers - Provider bulletin published in June edition of the Part A Newsletter issued July 7, 2008. 

Provider Contact Center

Janine Fulginiti asked the Advisory group for any suggestions on training they felt the customer contact center representatives could benefit from during their Tuesday and Thursday training sessions. 

A member would like to see clarification on locum tenens for the CCC training session. 

EDI

An EDI update was provided by Patti Reidenbach regarding the following topics: 

• New! PC-ACE Pro32 Combined Institutional and Professional Version 1.94 Upgrade Available via Internet Download
• EDI Enrollment Forms
• Eliminating the Accept/RTP & Return to Provider Reports-POSTPONED

Note:  Additional information on these topics can be found in the August 2008 Part A Xchange  

If you would like to submit a question to EDI via our website, you may do so here.  

Questions and Comments

Q. Machelle Bucher questioned whether or not Highmark Medicare Services would be offering a large seminar/conference in the near future.

A. Denise Church replied that after all transitions are complete, we will look into a large conference for J12. 

Q. Jim Doheny commented on the search engine on the website.

A. A suggestion was made to refresh rather than use the back key. 

Note:  Mr. Doheny also mentioned several questions to the group which will be researched and responded to. 

Conclusion

Denise Church wrapped up the meeting by thanking the POE Advisory committee for attending the meeting and reminded November 12, 2008 at Highmark in Camp Hill, PA.