Wednesday July 28, 2004
9:00 am – 11:00 am
Meeting Minutes

1. Merle Francis, Manager Professional Services, LA,
2. Greg Hart, Senior Provider Education Representative, AR
3. Mayo Gilson, MD Medical Director, OK
4. Lori Langevin, Provider Education Representative, RI Medicare Services
5. Carol DeMelo, Provider Education Representative, RI Medicare Services
6. Susana Astros, Provider Education Specialist, RI Medicare Services
7. Andrea Zito, RN Medical Review Nurse, RI Medicare Services
8. Michele Paolino, University Medicine Foundation
9. Linda Geoghegan, University Medicine Foundation
10. Michelle Carello, A-Start Medical Billing
11. Michael S Noonan, RI Physical Therapy Association
12. Rick Hoover, CMS Boston Regional Office

The meeting was called to order at 9:00 am. Carol DeMelo invited the audience to introduce themselves, and then she welcomed the members. The minutes from the April 28, 2004 meeting were accepted with no changes. To remind existing members of the purpose of the PCOM Advisory Group, Carol explained that the group meets primarily to identify training topics for future workshops, publications and notices.

1. Chiropractic Billing of Active / Corrective Treatment and Maintenance Therapy (Medlearn Matters Number MM3063)
   Services rendered on or after October 1, 2004 must contain modifier (AT) to indicate that is medically necessary. We are in the process of identifying the contact person for the Chiropractic Association Advisory Group with hopes that they will have representation on the Advisory Group.
    
2. Medicare Incentive Payment for Physician Care in Underserved Areas (Medlearn Maters Number MM3108)
   Implementation of this change is effective for claims with dates of service on or after July 1, 2004. Physicians, including psychiatrist, are eligible to receive ten percent bonus payments if they furnish services in primary medical care Health Professional Shortage Areas (HPSAs). HIPSA designations are based on:
   • Areas with shortages of primary care physicians, dentists or psychiatrists, referred to as geographic based HPSAs; and
   • Underserved populations within an area, referred to as population based HPSAs.

   It is very important to emphasize that the bonus is paid for services in geographic HPSA areas only and only if those services are actually provided in the HPSA area.  For example, if the physician has an office in a HPSA area, but provides the service in the patient’s home, which is outside the service area, the bonus is not payable.

   Carol also noted that she had received several calls from providers who fall into the population based HPSAs and that these physicians believed that the 10 % incentive would apply to them.  Carol informed them that 10% incentive would only pertain to "geographic" HPSAs in areas such as Burriville, Foster, Gloucester, and certain areas in Woonsocket.  Article will be on the RI Website and in the Newsletter to clarify that Medicare only recognizes "Geographic" HPSAs for the incentive.

   The group agreed.
    

3. MMA Nurse Practitioners as Attending Physicians in the Medicare Hospice Benefit (Medlearn Matters Number MM3226)
   Nurse Practitioners are recognizing as the attending physicians in the Medicare Hospice benefits. Beginning December 8, 2003 Medicare pays for services, with the exception that a physician will be required to certify the terminal illness with a prognosis of 6 months or less. Also, for providers billing intermediaries, services rendered on or after June 28, 2004 must be used GV modifier.
    

This is a big concern for CMS. For the last couple months the number of duplicate claims has been increased. For example, between April through June 2004 we received 123,950 duplicate claims in contrast with 12,757 between January through March 2004. One of the most typical example is when Medical Review Unit requested additional information, providers instead to submit the missing paper work they submitted a new claim with the missing information. Therefore, the second claim submitted is a duplicate claim. Also, billing agencies re-submit unpaid claims every 30 day time frame.

3.- Claim Submission Errors/Frequently Asked Questions
Our Data Analysis Department created a list of the top duplicate submitter providers in order to outline a plan to offer more education by phone, office visit or letters in order to minimize this number. Therefore, if you have any suggestion will be happy to hear and join us to success in this plan.

4. Automated Response Unit (ARU) Reminder
Our customer services supervisor would like to remind all of you about our Automated Response Unit (ARU). This is a service that provides you with a simple method of obtaining Medicare information quickly. The Automated Response Unit will be able to provide you with information about your deductible status, the status of your most recent claims and general information about important Medicare issues.

Carol asked the group if they thought it would be necessary to publish the ARU instructions in the next newsletter. The group felt that was not necessary since we have them on our website. They thought a reminder to use the ARU and directing them to the our Website would be sufficient.

5. Local Medical Review Policies-Update – Andrea Zito, RN Medical Review
We encourage the audience to check our http://www.rimedicare.com website under Medical Review where you can be informed about the three new policies. The web-site has a new area for Medical Review. It will contain a list of the new probes with a link to the information to which it refers (NCD, Local Coverage Decision). It will also have the directions that will no longer be in the policies when they are converted from LMRPs to LCDs, Also, you can be informed about our new policies:

1. Physical Medicine and Rehabilitation AC-02-059 which is a draft and released for your comments.
2. Critical Care AC-01-007. This policy will be presented at the Contractor Advisory Meeting (CAC) meeting on September 14, 2004.
3. GI Endoscopy Anesthesia which is enforced since January 1, 2004

• Appeals:

Dr Mayo Gilson explained the procedures and purposes of CAC meeting, such as follow:

• All policies are posted in our website for comments prior to this meeting
• The Contractor Advisory Committee meeting occurs through a public and open process.
• The Contractor Medical Director will allow any interested parties, such physicians, providers, vendors, beneficiaries; to make presentation of information related to draft policies, also written comments are equal considerate at the meeting.

Carol reviewed the purpose of the Comprehensive Error Rate Testing (CERT) Program and the importance of responding to their medical records request in order to avoid the collection of dollars previously paid.

You will receive the request in this order:

1. First request letter. Randomly selected, attach you can find a copy of the initial letter submitted for AdvanceMed.
2. Second request letter, 20 days after the initial letter.
3. Third request letter, 30 days after the initial letter.
4. Final letter, 45 days after the initial letter.

It was noted that calls were made to the no responders by Susana Astros, Lori Langevin and Carol DeMelo to remind these providers to submit the medical records. It was noted that providers were very receptive to our phone calls.

Michelle Carello from A-Start Medical Billing was very concern in these issues:

• Missing check & EOB. Provider need to call Customer Services to notify this problem in order to us be able to follow the necessary steps, such avoid the check missed and re-issue a new one. In regard to EOB’ missing, we encourage the provider to verify if any address change had been occurred or requested. We will follow up in this issue.
• Wrong provider received payment. A payment was issued to a determined provider who did not render the services. Carol advised Michelle to fax examples to her attention so we can research.
• Medicare Number. Customer Services from RI Medicare Services do not give beneficiaries Medicare numbers by phone. Member informed us that Medicaid automated answer service release the information very easy, the only information required is the social security number and the system release the numbers for any insurance that this determined beneficiary has. Rick Hoover from CMS Boston Regional Office, offered to submit this issue to the Medicaid Department in order to get an answer on this matter.
• Credentialing. We have received some applications for incomplete information. Then, we re-submitted again with the requested information, but unfortunately these applications are returned again for missing information.

• Carol informed the group that we are planning Workshops for the latter part of September and she will be looking for suggestions from the group on topics we can add to the workshop that they feel will be beneficial to the providers.

• Rick Hoover is introduced and facilitated information to the members:

Rick Hoover from CMS Boston Regional Office has been very involved in the Medicare Modernization Act and all the future related to this Act, such the drug discount card. He motivated the member for any feedback about this Act and feels free to call him at 1-617-565-1258.

Therefore, informed that provider’s responsibility is to know where to send senior citizens to get the right information. The primary source is the phone number 1-800-MEDICARE, to Medicare website-www.medicare.org or CMS’s website-www.cms.hhs.gov; also motivated the audience to be aware about the many senior agencies located in Rhode Island that provide help without any cost. Finally, he encourage the audience to take time to read the brochures available in the Medicare website, which are very easy to understand, to follow and does not take a lot of time.

To be determined.

No further recommendations were received from the attending. Carol DeMelo thanks the members for being there and for their feedback. The meeting adjourned at 11:30 am.