Wednesday October 27, 2004
9:00 am – 11:00 am
Meeting Minutes

Attendees:
Pat Grover, Gateway Health
Terri Beagan, University Medical Group
Linda Geoghegan, University Medicine Foundation
Greg Hart, Senior Provider Education Representative, AR
Amanda Goodwin, Centers for Medicare Services- CMS Dallas Regional Office
Donna Gentes, East Side Clinical lab
Beth Oldham, East Side Clinical
Rick Hoover, Center for Medicare Services-CMS Boston Regional Office
Christopher J. Gould DC, Chiropractic Society of RI
Robert A. L’Europa DC, RPT, Chiropractic Society of RI
Mayo Gilson, MD, Medical Director, OK & acting Medical Director for RI
Cindy Cote, RN, Senior RN of Prepay Medical Review, RI Medicare Services
Carol DeMelo, Provider Education Representative, RI Medicare Services

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 July 28, 2004 meeting were accepted with no changes. To remind existing members of the purpose of the PCOM Advisory Group, Carol explained that the primary purpose of the PCOM is to provide the contractor with suggestions and guidance on how to better educate the provider community through workshops, website, newsletters etc. Carol also explained that we will address individual provider problems however we do not want individual problems to dominate the meeting.

We are also looking to the specialty Association members to help us distribute information through their websites and meetings.

Greg informed the group that as part of the Medicare Modernization Act effective January 1 contractors will be restructuring their Provider Customer service areas in an effort to provide better customer service. Greg noted that this would be a major change. The customer service areas will be structured into tiers, the first tier will handle very general question…the 2^nd tier will handle more specific calls and 3^rd tier will handle very complex questions that may need research. Greg also mentioned that another aspect of Provider Education will be to target small providers. Greg asked the group to think about ways that we can identify "small providers."

We will be looking at what types of denials small providers receive and are also looking to the group as how to best approach this issue. Another provision calls for "Ask the Contractor" teleconferences. The group discussed how best to implement these types of calls. It was felt that the scope should be specific to a type of provider or program and have a published agenda with some topics for discussion but allow time for open discussion as well. Members were asked to forward any further ideas for these educational initiatives to Carol.

Greg also added that providers will be directed to the IVR (Interactive Voice Response)) for status on a claim. More info to be posted in our newsletter.

Amanda Goodwin from CMS reminded the group of the Open Door Forums sponsored by CMS One member said they had participated in this Forum . Amanda provided the group with the CMS website for the forum (www.cms.gov/openforums).

Carol provided the group with the new allowances for the flu and pneumococcal vaccines which are effective 9/1/04. However it was noted that the new fees were recently updated in the system so providers that submitted claims with dos 9/1 and after prior to the end of September may have received the old allowance. It was noted that these claims will be adjusted to pay the new allowance.

Carol informed the group that effective Jan 1 2005 Medicare will pay an additional 5% to physicians who rendered services in area designated as Physician Scarcity areas. The following website will have information as to what areas (by zip code ) will qualify for the PSA bonus. We were not aware of any areas to date in RI that would qualify.

In addition physicians rendering services in geographic HPSA areas will also be able to go this website to see if they qualify for the 10 % HSPA bonus. Depending on the area they may or may not have to use the modifier to receive payment. This information has been disseminated to the provider community through our newsletter and on our Website. Members agreed that this method of communication is adequate.

The members were reminded that as of Jan. 1, 2005 providers must be filing the 2005 HCPC codes. There will be no 90 grace period as in previous years. Providers have been notified of this change at the workshops, in our newsletter and on our website. Our members indicated that many times the CPT or ICD.9 books are not received until sometime after January, therefore the providers may not have access to the changes/updates. Carol referred the group to the CMS website which provides the updated codes. This website address has also been published on our website and given out at our workshops.

-2005 Medicare Participation Enrollment Fee Schedule (CD-ROM)

Effective November the Medicare Fee Schedule will be mailed to providers on CD-ROM.

For providers who are not able to access the CD-ROM, they can request a paper copy for a minimal fee.

The group expressed a concern that many times the fee scheduled is mailed out to a billing address instead of a provider’s address and the physician or office staff does not always receive the information.

Greg asked the members if they thought it would be a good idea to send notification through the list serv that provider has been mailed a copy and to what address. The members agreed that this would be very helpful and would alert the physician and his staff to look for this in the mail. Greg took this time to remind the group of the benefits of subscribing to our list serv. Providers also have the option of selecting the type of information they wish to receive according to specialty Dr. L’ Europa and Dr Gould have offered to share this information with their members at their next Chiropractic Society meeting.

-HIPAA 835 (4010A1) ERN

The members were reminded that providers receiving Electronic Remittance Advices must be HIPAA compliant. Providers are to call our EDI department for information.

Carol presented data from the last quarter (July through September) on top ten claim submission errors and frequently asked questions.

As in the previous quarter duplicate denials accounted for the highest number. However recent data indicated a significant decrease . Greg informed the group that as an effort to reduce this number letters were mailed (late September) to the top 10 providers filing duplicate claims. Carol noted that this information is given to providers at workshops along with methods to reduce these errors. Greg referred the members to a handout that is being developed which identifies the error and gives tips on how to resolve them. He asked the members if they thought this would be helpful to the providers. The group agreed it would be useful to the providers.

4. Workshops

Carol informed the group of the upcoming workshops in December for Evaluation & Management coding and Provider Enrollment . We have scheduled the E & M Workshop for four sessions, two in Providence and two sessions in South County area. We are also planning Update Workshops for the second quarter of FY 2005. We plan on holding these in various parts of the state in order to accommodate more providers. We will also be working with the Chiropractic and Podiatric Societies to schedule a workshop for each of those specialties.

We are also looking into a specialty workshop for Ambulance suppliers sometime in the future. The workshop schedule will be posted on the website.

The members were given a copy of our Web page that lists the Web based courses that we offer. We have recently added a course for "Reading the Remittance Advice".

Carol asked the group if they have taken our courses. Some stated they had and found them to be a very good education resource. Some members said they would use them as training for their new employees.

Carol reminded the group that these courses are eligible for CEU credits.

Cindy Cote, RN, gave an overview of the new Medical Review section of the RI Medicare Website. This section when completed would provide documentation guidelines for complex reviews being reviewed by the carrier.

One member asked if they can get a provider specific report that will show if a provider is aberrant in a specific service or services.

Greg referred them to the Comparative Billing Reports which can be requested by the provider.

Cindy explained the Local Carrier Transition and informed the group that there were 13 Draft Eye Policies that had been presented at the Open CAC meeting on Oct. 13. These policies will be presented at the formal CAC meeting this evening with a 30 day comment period to follow. She explained the process of submitting a comment and how to access the Draft policies on the RI Medicare website.

Dr. Gilson informed the group that we will be having "specialty specific" Carrier Advisory Committee meetings to accelerate the process of consolidating RI’s policies to the Arkansas Consortium policies. An Open CAC meeting, which marks the start of the comment period for Draft policies being presented, is scheduled 2 weeks prior to the formal evening CAC meeting.

Carol asked the group if there were any further questions or recommendations.

No further recommendations were received from the attending.

Next meeting is scheduled for Tuesday, January 18, 2005

Carol DeMelo thanks the members for being there and for their feedback.