Last Modified: 3/28/2017 Location: FL, USVI Business: Part B
Florida and U.S. Virgin Islands Part B Provider Outreach and Education Advisory Group
Thursday, March 9, 2017
Angela Amey, Trident USA
Shelly Asbury, Advize Health
Joan Beauchamp, Tenet Healthcare Corporation
Lisa Burdue, Internal Medicine Specialists, Inc.
Pamela Butler, SMH Physician Services, Inc.
Philip Choung, Nature Coast Orthopaedics
Kim Corkins, Watson Clinic
Jennifer Erskin, Florida Medical Reimbursement Services
Nancy Farrington, Foundational Health Center
Michelle Flowers, Oncology Managers of Florida
Cindy Hambidge, Atlantic Orthopaedic Group
Lisa Hanley, Plessen Healthcare
Deborah Hogg, Navigant
Susan Hughes, Kidney & Hypertension Specialists of Miami, PA
Michelle Jennings, Medical Insurance Services Consultants, Inc.
Lisa Jones, CPC, 360 Practice Management Solutions
Nicole Jones, Ponte Vedra Plastic Surgery
Daniel Kapp, MD
Shirley Knoll, Therapy Management Corp. (TMC)
Najwa Liscombe, University of Florida Physicians
Holly Martin, Nature Coast EMS
Tom McNeil, Premier Dermatology LLC
Kim Norris, Family Care Partners
Lee Omalley, Act Corporation
Donna Osso, Celleration
Rikki Pirtle, Baptist Primary Care
Valarie Prusia, Prusia Medical Practice Consulting
Jeannie Randhan, Orlando Health Physician Partners
Eric Romanelli, Physical Therapy 4 U, Inc.
Joe Scaldione, Escambia Co EMS
Sarah Scott, CPC, St. Vincent's HealthCare
Samir Shah, ACCUMAX SYSTEMS INC
Donna Smith, Lorraine Molinari & Associates
Rona Traub, Florida Department of Health
Eveth Vialet, Dermatology & Wellness Center LLC
Allison Wakeland, Riverwalk Ambulatory Surgery Center
Linda Zane, PTPN of Florida, Inc.
Shari Bailey, Manager, Data Analysis and Compliance (DAC)
Christine Cubillan, Sr. Provider Relations Representative (PRR), DAC
Charles Johnson, PRR, Provider Outreach and Education (POE)
Kimberly Karnes, Manager, POE
Robert Lewis, PRR, POE
Cara Page, PRR, DAC
Stephanie Scott, PRR, POE
Terri Stanton, Sr. PRR, POE
Ursula Weaver, PRR, POE
Mark Willett, Manager, Medicare Websites and Provider Self-service Technologies
1. Welcome and introductions
2. Review of minutes and action items from prior meeting
3. First Coast’s self-service technologies
4. First Coast 2017 educational strategy update
§ Project teams focused on improper payments, inquiries
• Provider enrollment project
• Medical documentation project
• New! Evaluation & management (E/M) subgroup
§ Medicare Speaks
5. Education Action Team (EAT)
6. 2016 Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI) survey action plan
7. Collaboration with Medicare contractors
8. Upcoming events
• Events calendar
9. Open discussion and announcements
§ Social Security Number Removal Initiative
§ Updating the address for ADR letters
§ Telehealth services
10. Verify all action items and process out
§ Next meeting July 20
Welcome and introductions
Kim Karnes welcomed everyone to the meeting and completed the review of the agenda.
Review of minutes and action items from March 10 meeting
Kim reported that there were no outstanding action items to be reviewed.
First Coast’s self-service technologies
Mark Willett reported since the last November 2016 meeting that the remittance advice has been implemented on SPOT. Last week Part A providers requested 274 remit advices. Since implementation in November 2016, the total number of remits requested for both A/B providers was more than 18,000. Mark also encouraged users of First Coast’s provider website to complete the ForeSee survey. Our goal is to collect at least 300 surveys by April 6, 2017. Feedback from the survey helps ensure that the website meets the needs of the provider community. We carefully analyze customer feedback to implement enhancements to the provider site and improve provider satisfaction. Mark also announced the early stage of development of an enterprise-hosted version of Enterprise Identity Management (EIDM). The target date is before December 1, 2017. The move away from the current CMS-hosted solution will allow us to provide more specific user-friendly messaging and functionality as it pertains to registration and authentication.
First Coast 2017 educational strategy update
Kim introduced this topic and additional POE team members gave updates to multiple strategies.
Stephanie Scott provided an update on the provider enrollment project team. The POE-AG members were reminded that anyone interested in joining may notify Stephanie via email at Stephanie.Scott@fcso.com.
The project team will continue to focus on education regarding Internet-based PECOS. The option for requesting appointments is still available on our events calendar. So far this year, we received about 5 or 6 inquiries about scheduling a one-on-one session. Also, our provider enrollment POE AG subcommittee suggested a webcast on registering for the system, which is done via PECOS I&A, so we are looking at doing a webcast on this system and process this year.
We’ll continue to educate on revalidation, as necessary, and will communicate with the provider community on any issues trending with those applications.
Finally, we have the provider enrollment section on the First Coast provider website. We’ll continue to review and make enhancements as we receive feedback. Changes and enhancements have been made to the revalidation FAQs based on feedback received from the POE AG subcommittee.
Terri Stanton provided an update for the Medical Documentation project team.
Physical therapy services have been added back in to our strategy this year, specifically focusing on procedure code 97110 for therapeutic exercise. This is one of the two highest billed codes nationally as well as in our jurisdiction. Physical therapists in private practice are also on the Office of Inspector General (OIG) work plan for 2017. On March 22, 2017, we’ll deliver the “Ask-the-contractor webcast for physical therapy services (Part B)” where we’ll focus on CERT related errors and the medical policy requirements to reduce or eliminate those errors.
As a carry-over from last year, the clinical laboratory specialty specific to drug assays and substance abuse screening will be monitored. We’ll continue to market our webcast recording from last year and possibly hold another webcast later on this year. The drug screening is also on the OIG work plan this year.
A new topic to our strategy this year based on CERT errors and local data is chiropractic services. CMT, or chiropractic manipulative treatments, are on the OIG work plan this year and are also the subject of the Supplemental Medical Review Contractor post-payment reviews. At this time, we’re going to update the web-based training we have on First Coast University with examples of current CERT errors and promote the WBT and other related educational materials pertaining to CMT through our eNews.
For our ambulance services specialty, another carry-over from last year, we facilitated a face-to-face presentation earlier in the year to the Florida Ambulance Association. Our plan is to have this material converted into a webcast and schedule it for later this year. Members that attended the association presentation requested this presentation in other parts of the state. By doing a widespread webcast, we can reach all members of the association across our jurisdiction. Ambulance services are also on the OIG work plan for 2017.
For psychiatric/psychotherapy services, another carry-over from last year, a webcast was held in January 2017 and the recording is available through January 2018. For now, we plan to market the recording and send focused education letters to newly identified providers in our data analysis that may need additional education.
Finally, cardiology is another specialty that we’ve adopted this year on our project team due to errors that reflect medical policy education is needed, specifically for myocardial perfusion imaging procedures. POE facilitated a webcast last month on this topic and we will conduct a Spanish webcast in June 2017.
Relating to Part A topics, the team will continue to focus on outpatient hospital services billed on type of bill 13X, concentrating on the specific types of insufficient documentation errors identified for those services in CERT feedback files. These CERT errors are being evaluated for inclusion in First Coast’s Medicare Speaks Part A “Hospital Billing Challenges” class.
In relation to classes for the 2017 Medicare Speaks seminar, several classes will address topics that fall within the medical documentation project. One in particular will be a class covering the ADR process. First Coast’s ADR campaign will continue this year with addressing ways for providers to respond to an ADR effectively, efficiently, and timely. This project team also participates in the development of materials for the CERT A/B MAC POE taskforce. This includes items such as fast facts, fact sheets, resource guides, and scripts for video resources.
Evaluation and Management (E/M) subgroup
Kim Karnes announced formation of a new POE AG E/M subgroup as part of the First Coast E/M education strategy. This group will review and develop ideas relating to common E/M issues, to assist in providing guidance for providers while addressing proper E/M billing and coding. Those interested in participating with this team should email Robert Lewis at Robert.Lewis@fcso.com
Ursula Weaver provided a year in review of our signature face-to-face event Medicare Speaks. This year we are planning three locations for the face-to-face events: Miami May 17-18; Tampa July 26-27; and Jacksonville September 13-15. We are excited to collaborate again with Safeguard Services for fraud and abuse, Quality Improvement Organization on Quality Payment Program, and Cigna Government Services (CGS) Administrators on DME documentation. We will also continue the Part A and Part B forums this year in Tampa only. We will have advertising for these events coming soon on the website within the next couple of weeks. Ursula will be reaching out to the members to distribute the information to colleagues, providers, and staff.
Education Action Team (EAT)
Christine Cubillan gave an update regarding the EAT’s educational plans for 2017, explaining that the team will continue to deliver focused education to providers with a significant non-MR claim error rate, via mail and phone calls. The education will focus on promoting First Coast’s self-service tools on the provider website (such as FAQ’s), as well as what’s available on the SPOT. The EAT will continue to monitor data for the top non-MR claim errors and inquiries to determine if any new FAQs or educational articles should be posted to the provider website.
EAT has been collaborating with customer service and the web team to look at new ways to reduce written appeal inquiries that have been dismissed. Multiple common dismissals occur because providers:
• Have submitted a duplicate appeal
• Received a determination on the original appeal and should have sent it to the QIC as a reconsideration request
• Requested an appeal on a claim that was resubmitted and was either pending or already paid
• Appealed a claim that did not have appeal rights (like RUCs) OR for which the appeal rights had expired (didn’t use the initial claim determination date)
As a result, revisions have been made to several existing articles and FAQs on First Coast’s Appeals page, and eNews has been sent to promote First Coast’s free web tools and tips on what to do prior to submitting an appeal.
EAT is also providing focused education by reaching out to providers with a significantly large number of dismissed redeterminations. Based on this, we discovered that many have experienced a delay due to the time taken to process inquiries, and that many providers would have received payment sooner had they used one of First Coast’s web tools before sending a redetermination request. Because of this, education is focusing on going to the website: a vast majority of useful resources are located on the appeals page at https://medicare.fcso.com/Landing/271102.asp
To submit ideas regarding topics or suggestions on reducing related errors, please email Christine at Christine.Cubillan@fcso.com
2016 MAC Satisfaction Indicator (MSI) action plan
Kim shared that First Coast’s leadership implemented a company-wide action plan in January 2017 to address findings and survey comments. Some of the action plans included improving the accuracy and clarity of redetermination decisions and enhancing the performance of First Coast’s provider website.
Collaboration with Medicare contractors
Kim summarized First Coast’s recent and upcoming outreach partnerships with multiple external contractors:
§ Health Services Advisory Group, Palmetto Government Business Administrators, Cotiviti, CGS
She also referenced upcoming collaborations with separate medical associations:
§ Florida Medical Association, Oncology Managers of Florida
Open discussion and announcements
Social Security Number Removal Initiative
As mandated by the MACRA (Medicare Access & Children’s Health Insurance Program Reauthorization Act of 2015), SSNs will be removed from all Medicare cards by April 2019. Under the new system, a randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based HICN on the Medicare cards for Medicare transactions.
Currently, CMS uses a Social Security number (SSN)-based Health Insurance Claim Number (HICN) to identify people with Medicare and administer the program. CMS also uses the HICN with the following business partners:
• The Social Security Administration
• The United States Railroad Retirement Board
• State Medicaid Agencies
• Health care providers
• Health plans
The MBI will be clearly different than a beneficiary’s current number. It will be 11 characters in length, and consist of numbers and uppercase letters, and it will not contain any embedded intelligence or special characters.
Each person enrolled in Medicare will receive a new MBI Medicare card to replace their current Medicare card. CMS will start mailing the new MBI Medicare cards to beneficiaries in April 2018 with all new MBIs issued by April 2019. Beneficiaries may start using their new MBI Medicare cards as soon as they receive them.
During the transition period of April 1, 2018 through Dec. 31, 2019, providers and beneficiaries can use either the current Medicare card or the new MBI Medicare card for Medicare transactions. Also during the transition period, when providers submit a claim using the patient’s HICN, Medicare will return both the HICN and the MBI on the remittance advice. CMS will tell you in the message field on the eligibility transaction responses when they’ve mailed a new Medicare card to each person with Medicare. Your eligibility service provider can give you this information.
CMS source - SSNRI page: https://www.cms.gov/Medicare/SSNRI/Index.html
Provider page: https://www.cms.gov/medicare/ssnri/providers/providers.html
Updating the address for ADR letters
An article addressing the process for updating an address for ADR letters can be found on First Coast’s site at https://medicare.fcso.com/ADR/0368041.asp. (Terri Stanton addressed educational plans relating to the ADR process - see the above Medical documentation project team summary.)
Stephanie Scott summarized two recent change requests addressing telehealth services:
§ CR9726 – New Place of Service (POS) Code for Telehealth and Distant Site Payment Policy https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3586CP.pdf
§ CR9844 – Summary of Policies in the Calendar Year (CY) 2017 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3676CP.pdf
Follow up with Joe Scaldione to address prior inquiry submitted to Mark Willett regarding the possibility of submitting documents via SPOT in response to probe audits.
POE representatives to verify directives among other MACs regarding ADR address to be used when responding to ADR letters.
Verify all action items and process out
Kim concluded the meeting at 3:30 pm. The next Part B POE AG meeting is scheduled for July 20, 2017.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.