J5 POE Advisory Group Minutes – Kansas/Missouri

November 8, 2011
10:00 AM - 11:00 AM
Teleconference

Members Present:

Tish Hollingsworth, Kansas Hospital Association
Eldon Schumacher, Great Plains Health Alliance
Mike Metro, Via Christi Health (H)
Wesla Arambulo, Skilled Healthcare, LLC (SNF)
Sandra Lindley, Ray County Memorial Hospital (CAH)
Joy Hohmann, Clinical Solutions
Tim Modglin, Ozark Dialysis Center
Sue Thomas, Kansas University Medical Center (H)
Jennifer Wormington, System Services, Inc
Sally Crawford, Salina Regional Health Center (H)

Meeting

The J5 Part A Provider Outreach and Education Advisory Group (POE AG) for Kansas and Missouri took place via teleconference on November 8, 2011. Aileen Sigler, Outreach Analyst, called the meeting to order at 10:00 a.m.

Aileen began by referencing the minutes from the last meeting which was held on August 12, 2011.

Suggested Education Topics

  • Inpatient Prospective Payment System
  • Outpatient Prospective Payment System
  • Self Administered Drugs

Suggested Seminar locations

No changes

Recommended Timeframes for Education

More teleconference over the lunch time period

Contractor Updates and Issues

  • Provider Revalidation - SE1126 introduced a different web address for providers to pay their enrollment fee for the new revalidation process. Providers are also reminded not to begin revalidation until notified by WPS.
  • 2012 Deductibles and Coinsurance Rates - CMS announced the new rates for 2012 in a press release on October 27, 2011. You may view that press release at: http://www.cms.gov/apps/media/press/factsheet.asp(external link)
  • Claims Hold - CMS has identified claims processing issues with some RHC and SNF claims.
    • CMS has identified a claim processing problem impacting Rural Health Clinic (RHC) claims where claims submitted with more than one preventive service results in double reimbursement. We are holding RHC claims, type of bill 71X, submitted with more than one of the preventative services noted in change request (CR) 7208 found at: http://www.CMS.gov/transmittals/downloads/R2122CP.pdfAdobe Portable Document Format. As soon as a system fix is in place and successfully tested, these claims will be released for processing.
    • The Centers for Medicare & Medicaid Services (CMS) has identified a claim processing problem impacting Skilled Nursing Facility (SNF) type of bills 18x and 21x containing Healthcare Common Procedure Coding System (HCPCS) code AAAxx and Revenue Code 0022. We are holding these claims. As soon as a system fix is in place and successfully tested, these claims will be released for processing.
  • EHR Incentive Program - Providers are encouraged to register for the Electronic Health Record Incentive Program. CMS has many resources for providers. For more information, see article on our website here.
  • New on the Web - We are excited to introduce a new feature to each introduction page. The "Question of the Week" is a survey question allowing you to provide information about your website usage, Medicare Program needs, and tasks as a Medicare provider. By completing the question, we will be able to gain a better understanding of you, so that we can better meet your needs and offer the best service possible.

Provider Education

Upcoming Seminars:

11/10/2011 - Critical Access Hospital (CAH) Billing Seminar in Sioux City, IA
11/16/2011 - Critical Access Hospital (CAH) Billing Seminar in Hays, KS
01/26/2012 - Critical Access Hospital (CAH) Billing Seminar in Grand Island, NE
02/22/2012 - Skilled Nursing Facility (SNF) Billing Seminar in St. Louis, MO
02/23/2012 - Medicare Secondary Payer (MSP) Seminar in St Louis, MO
03/21/2012 - Skilled Nursing Facility (SNF) Billing Seminar in Wichita, KS
03/22/2012 - Medicare Secondary Payer (MSP) Seminar in Wichita, KS

Upcoming Teleconferences:

11/10/2011 - EDI Ask-the-Contractor Teleconference regarding 5010 readiness
11/15/2011 - FY2012 SNF PPS Final Rule
11/30/2011 - CERT Website Changes and Navigating the WPS Medicare Website
11/30/2011 - Medically Unlikely Edits (MUEs)
12/07/2011 - Making the Call: Inpatient vs. Observation
12/08/2011 - Medicare Advantage (MA) HMO Billing for Hospitals
12/15/2011 - Avoiding Duplicate and Overlap Claims Submission Errors
12/20/2011 - CERT Appeal Rights
01/17/2012 - CERT 935 Demand Letters

Member Issues

  • CRNA - There has been no resolution yet on this issue.
  • Auto denying for GA modifier - This issue seems to have resurfaced recently. Call Customer Service with examples so it can be investigated.
  • Administration of Self Administered Drugs - Can an administration fee be charged for SAD? The WPS policy for SADs only applies to the drugs themselves, so if there is an administration charge associated with it, the regulations do not prohibit the provider from billing for it.

Next Meeting

The next meeting will be held via teleconference on March 21, 2012.

Submitted by: Aileen Sigler 11/21/2011

Page Last Updated: Wednesday, 07-Dec-2011 11:26:31 CST