Last Modified: 2/3/2018 Location: FL, USVI Business: Part A
Florida and U.S. Virgin Islands Part A Provider Outreach and Education Advisory Group (POE AG)
Tuesday, November 7, 2017
Cyndra Alderman, Orlando Health
Lisa Almodovar, Martin Health System
Shelly Asbury, Advize Health
Victoria Bolton, Jupiter Medical Center
Evie Brown, Lee Health
Melissa Burns, Memorial HealthCare System
Stacey Chevious, Baptist Health Care Pensacola
Christine Davenport, Brooks Rehab
Andrea Eklund, Tallahassee Memorial Healthcare, Inc.
Dale Gibson, HMA Naples
Dana Kulvin, Miami Jewish Health Systems
Felice Landry, Reingruber & Company
Assunti Love, Promise Hospital of Florida at the Villages
Sharon Miles, Baptist Hospital of Miami
Ana Navarrete, Baptist Health South Florida
Debra Pizzulo, Palm Healthcare Management, LLC
Pamela Reed, Kindred Hospital Melbourne
Pamela Schulman, Halifax Health
Rita Sturm, Shands Jacksonville
Verono Teal, Promise Hospital of Florida at the Villages/Promise Healthcare
Terri Tierney, Sacred Heart Hospital
Leslie Brinson, Supervisor, Provider Contact Center (PCC), Customer Service Operations
Mary Carrazana, Provider Relations Representative (PRR), Data Analysis and Compliance (DAC)
Christine Cubillan, Sr. PRR, DAC
Charles Johnson, PRR, Provider Outreach and Education (POE)
Kimberly Karnes, Manager, POE
Cara Page, PRR, DAC
Stephanie Scott, PRR, POE
Terri Stanton, Sr. PRR, POE
Robert Stroud, eCurricula Development Specialist, Learning Solutions Center
Ursula Weaver, PRR, POE
Mark Willett, Sr. Manager, Medicare Websites and Provider Self-service Technologies
1. Welcome and introductions
• Review of goals and responsibilities of POE AG members
2. Results from campaign to increase POE AG Part A membership
3. Review of minutes/action items from prior meeting
4. Hurricanes Harvey, Irma and Maria and administrative relief efforts
5. First Coast's self-service technologies
6. Education Action Team (EAT) update
• Overview of EAT
• Top errors/inquiries, including Medicare secondary payer
7. Customer Service update
• Qualified Medicare Beneficiary (QMB) program
• Tips on calling customer service
8. 2017 Medicare Administrative Contractor Satisfaction Indicator (MSI)
9. Provider outreach and education strategy
• Year in review for improper payment reduction, provider enrollment, and Part A focused classes
10. Open discussion and announcements
• New Medicare card project
• Targeted probe and educate process
• Upcoming educational events
11. Verify all action items and process out
Welcome and introductions
Kim Karnes welcomed everyone to the meeting. All participants and staff present within the room and on the teleconference introduced themselves. Kim thanked all the new members for joining us. Kim reviewed the roles and responsibilities of being a member of POE AG as follows:
• Reviews new and existing Medicare education programs
• Offers your comments and suggestions regarding potential program enhancements. To ensure you are prepared to discuss, we try to send out questions in advance to think about and come prepare to discuss.
• Serves as an important communications liaison to the provider community
• Shares widespread provider issues and concerns with First Coast educational staff (individual issues should be worked with Customer Service)
• Attends POE-AG meetings (three a year) and shares information with the organizations they represent. Our goal is to make this as interactive as possible.
Campaign results to increase POE AG Part A membership
Kim reported that as a result of campaign to increase Part A membership in the POE AG, 33 new members have joined.
Review of minutes and action items from July 18 meeting
There was a live demonstration showing the pathway to the minutes from previous POE AG meetings on the First Coast's provider website. Kim reported out on the completed action items from the last meeting.
• Update to a frequently asked question (FAQ) for obtaining beneficiary eligibility and claim status to include the timeframes for SPOT and interactive voice response (IVR). The secure provider online tool (SPOT) provides up to 12 months from the date of the inquiry; IVR can provide up to 27 months from the date of inquiry.
• Suggestion to consider updating SPOT with the ability to submit the credit balance report. This functionality is under consideration.
Hurricanes Harvey, Irma, and Maria and administrative relief efforts
Kim provided an update on hurricane administrative relief efforts. Since our jurisdiction is often at risk for natural disaster, she shared how CMS and First Coast responds. CMS issued directives and special edition articles allowing certain waivers and administrative relief such as:
• Waiving the three-day prior hospitalization for coverage of a SNF
• Waiving the requirements that critical access hospitals limit the number of beds to 25
• And allowing the housing of acute care patients in excluded distinct part units
Subsequently, First Coast published several articles outlining some of the administrative relief efforts that can be located on the Disaster information page of the First Coast provider website.
First Coast educated the provider community on these relief efforts by including this topic in our quarterly webcast series Medicare Changes and Regulations held on September 26 and 27. Topics included the CMS special edition articles, website resources, and First Coast articles. This information was also published in the fall edition of the quarterly congressional newsletter, including an article and a special message from our CEO.
The relief efforts were also presented at the monthly meeting of the Florida Rural Hospital 2017 HomeTown Health Webinar Series on September 27, 2017, the Medicare Executive Circle (MEC) Part A and B meetings at the Florida Hospital Association in Orlando, FL on October 5, 2017, and the Florida Medical Association Health Insurance Summit on October 5, 2017.
First Coast's self-service technologies
Mark Willett reported on the First Coast website and self-service technologies.
Mark provided a demonstration of the new LCD search features available on the English and Spanish provider websites.
Mark also reported that beginning in January, First Coast will be scheduling interactive, face-to-face presentations delivered onsite at providers’ offices that have an interest in getting their staff members signed up for SPOT. The presentation will detail the advantages of using SPOT to reduce administrative costs through efficiencies. Additionally, First Coast facilitators will assist office staff through the registration process as needed. These sessions will be conducted with both Part A and Part B providers.
Mark added that beginning April 1, 2018, the Medicare ID field label will replace HICN. Whatever value that is used on the claim submission, HICN or MBI, will be displayed under this heading on all claims-associated displays on SPOT.
In addition, starting on April 16, 2018, users will be able to track and see the status of their additional documentation requests (ADR) that are associated with medical review. This additional functionality is being implemented to support the Target, Probe and Educate (TPE) approach to address billing inconsistencies that was introduced October 1, 2017.
Finally, beginning June 1, 2018, an MBI/HICN lookup will be available on SPOT. Users will be able to submit a beneficiary's HICN and have the associated MBI returned to them.
Christine Cubillan reported out on this year’s progress for the EAT.
Christine explained that the EAT is one component of First Coast’s data driven educational strategy with the goal of developing and implementing education in an effort to reduce billing errors and provider inquiries. The EAT analyzes current data trends, to identify root causes for the top 10 non-medical review (non-MR) claim submission errors and telephone/written inquiries.
Christine reported that this year they have seen over half a million non-MR claim submission errors from January to September 2017. Based on an analysis of the data, they develop FAQs on the top 10 rejected and return to provider (RTP) claims. Christine provided a live demonstration on the provider website showing members where to locate RTP reason code FAQs and reject reason code FAQs. Christine asked members to feel free to email her at Christine.Cubillan@fcso.com with feedback or suggestions on how they can enhance educational material in the future.
Christine added that the EAT also provides focused education and reaches out to providers with a significant claims submission error rate, and duplicates for education. They do this with letters or telephone calls on a monthly basis and provide tips on how to identify and avoid common errors, as well as provide information on the free online self-service resources that reside on the First Coast provider website. Year-to-date EAT has sent over 350 letters and completed numerous provider educational calls for Part A.
In addition, Christine reported that First Coast has received over 60,000 inquiries for the same reporting, clarifying that this number does not represent all inquiries received by the Contact Center. It excludes general entitlement, claim status inquiries, and few others. The top inquiries were found to be related to claim overlaps, and general Medicare secondary payer (MSP) filing billing instructions. Based on the findings, the EAT developed an overlapping claims FAQ page that include several scenarios and questions. Christine’s team will also be providing wide spread education on MSP for intuitional providers via webcast on December 6, 2017. Christine solicited advance questions to the members prior to the webcast as follows:
• What are the biggest challenges you face with billing Medicare Secondary Payer (MSP) claims?
• What are some common questions/concerns that you or your peers have with Ongoing Responsibility for Medicals (ORM) under auto/no-fault, worker’s compensation, and liability insurance plans?
Christine reminded members that they can email her at Christine.Cubillan@fcso.com.
Leslie Brinson presented on the Qualified Medicare Beneficiary (QMB) addressing the following issues to reduce inquiries.
• CMS has issued two MLN Matters Article SE1128 and MM9911. MM9911 implemented a change in the remits for QMBs.
• Providers cannot bill QMB patients for deductible nor coinsurance (regardless of whether Medicaid pays or not).
• OA 209 will print on remits instead of patient responsibility.
• Make sure billing companies/clearinghouses/vendors are aware of this change to the remits.
• The ESRD Network Support Adjustment (CO 118) that stopped printing on remits with the implementation of CR9911 will be corrected next month.
• The IVR has been updated to not release deductible information for QMBs.
• A concern that a couple providers brought up was QMBs that also have a supplemental insurer. The provider has to manually calculate the patient’s deductible and coinsurance so the supplemental insurer will process the claim. This concern has been brought to CMS’ attention.
2017 Medicare Administrative Contractor Satisfaction Indicator (MSI)
Kim reported that First Coast had a greater percentage of Part A respondents this year which we are very pleased about. (2015: 15 percent A, 85 percent B, 2016: 11 percent A, 89 percent B, 2017: 21 percent A, 79 percent B). Kim also shared that First Coast was rated the highest in satisfaction for Provider Outreach and Education in the 2017 MSI. Finally, the team is evaluating trend results from the survey to identify improvement opportunities.
Provider outreach and education strategy
Kim introduced this topic and POE team members provided updates to multiple strategies.
Terri Stanton provided an update for the medical documentation project team.
Terri advised that since the medical documentation project team has focused on specialties based on the strategy this year that have a high error rate nationally, as well as within our jurisdiction, and contribute most to the CERT error rate. Most of the errors are due to insufficient documentation.
The team continues its focus on the specialty clinical laboratory, in particular for drug assays and substance abuse screening. Stephanie held a webcast on September 6 that focused specific drug screening codes with high errors and the LCD requirements for controlled substance monitoring and drugs of abuse testing. The event was marketed publically; however 150+ invitational letters were mailed to the top ordering or referring providers of the drug monitoring codes recommending they attend the webcast. The recording of the event is posted to First Coast University for those that were unable to attend the live event.
For the ambulance services specialty, our educators in Puerto Rico hosted an Ambulance services webcast in Spanish on Sept. 15. The webcast addressed the documentation requirements for non-emergency ambulance services, specifically the additional documentation request (ADR) process, the local coverage determinations (LCD) sections for indications and coverage guidelines, medical review data for PR providers, and an overview of the emergency services requirements. Invitational letters were mailed to the ambulance suppliers in Puerto Rico requesting they attend the event.
The project team also continues to monitor the outpatient hospital services billed on type of bill 13X; concentrating on the specific types of insufficient documentation errors identified in the CERT feedback files. Examples of these CERT errors are included in the Medicare Speaks Part A - Tackling the Complexities of Institutional Medical Documentation class which was held in Jacksonville, Oct. 17-18 and facilitated by Ursula.
Also with a Part A focus, one of the outlier topics of the project team is Inpatient Rehabilitation Facilities or IRF. Ursula facilitated a webcast on October 4 and focused on the medical documentation IRFs must obtain and sustain in the patient’s medical record, such as the preadmission screening, post-admission physician evaluation, overall plan of care, admission order, and the IRF patient assessment instrument.
Other topics for our project team that were covered at Medicare Speaks in Jacksonville included Safeguarding the Integrity of Electronic Health Records (A/B). Topics of the class included OIG report findings on vulnerabilities in EHR, benefits and features of EHR, amendments, corrections and industry suggestions to managing audit trails, as well as recommendations for maintaining integrity of medical records. A CMS case study was also included in the class discussion to relate inappropriate access to PHI back to the key elements of the presentation.
The ADR campaign still continues with education on ways for providers to respond to an ADR effectively, efficiently, and timely. In addition to including material about responding to an ADR in our events, we also included a class on Responding to Requests for Medical Records (A/B) at our Medicare Speaks in October. Topics of the class included an overview of Medicare improper payments (CERT), Medicare review contractors (CERT, RA, SMRC, MAC MR, ZPICs), methods and timeframes for responding to ADRs, how to be proactive in their practice or facility in the event of a review, and additional helpful online resources.
And lastly, the project team’s efforts are continuing to show progress with most specialties showing an error rate reduction. The project team is on target to exceed error rate projections overall for our jurisdiction. The final CERT 2017 report should be out soon.
Stephanie Scott provided an update on the provider enrollment project team. The POE AG members were reminded that anyone interested in joining the provider enrollment subcommittee may notify Stephanie via email at Stephanie.Scott@fcso.com.
As for the internal Provider Enrollment Project team here at First Coast, Stephanie explained that they continue to focus on education regarding Internet-based PECOS as well as the Identity & Access (I&A) system. First Coast is marketing one-on-one training via appointment and registration is available on the event calendar. Stephanie also facilitated a webcast on October 25 that focused on getting started with PECOS and registering in I&A. She reported that it went very well and she received good questions from the participants. The recording of the webcast is currently available on our website.
Stephanie reported that education continues on provider enrollment revalidation, as necessary, and will continue to do so as trends are identified with the applications received.
Stephanie discussed the Provider Enrollment section of the First Coast provider website that continues to be enhanced as we receive feedback and suggestions, or CMS releases updates.
Open discussion and announcements
New Medicare card project
Terri reported that this is the third of three POE AG meetings this year that the new Medicare card topic has been discussed. In previous meetings an overview of the initiative was covered, including the timeframes for transition, the look and design of the new Medicare number, and what providers can be doing now to prepare. Terri stated that on October 2, First Coast as well as other contractors mailed out the provider notification letters along with a brochure about the new Medicare cards. In a September press release, CMS unveiled the first view of the new Medicare card in which no longer contains the gender or the signature line of the recipient. Members were encouraged the upcoming webcast on November 14, 2017, from 11:30 to 12:30, the new Medicare card is coming: Will you be ready?
Terri reported that POE has been educating on this topic since the fall of 2016 and has included information on the new Medicare cards in 38 events thus far, with nine more events scheduled through to the end of the year.
CMS is also ramping up its beneficiary outreach which began with the ‘Guard your card’ campaign that members may have seen on television, as well as announcing the new Medicare cards inside the front cover of the new Medicare & You handbook for 2018. CMS has published materials for providers to order and hand-out to their Medicare patients.
Targeted probe and educate process
Kim provided an overview of the TPE initiative and the goal to reduce provider burden. Kim asked members what they are hearing from the community. One member asked a question (First Coast will be contacting facilities and who will they be using as their point of contact).
Kim explained that the TPE review and education process includes a review of 20-40 claims followed by one-on-one, provider-specific, education to address any errors with in the provider’s reviewed claims. Providers with moderate and high error rates in the first round of reviews, will continue on to a second round of 20-40 reviews, followed by additional, provider specific, one-on-one education. Providers with high error rates after round two will continue to a third and final round of probe reviews and education.
Providers with continued high error rates after three rounds of TPE may be referred to CMS for additional action. Providers may be removed from the review process after any of the three rounds of probe review, if they demonstrate low error rates or sufficient improvement in error rates, as determined by CMS.
Upcoming educational events
Ursula reported on upcoming events through the remainder of the year by reviewing our events calendar.
On November 14, Terri will be facilitating a webcast on the new Medicare cards making sure you are ready for the transition. On November 15, Stephanie will be providing information on “How to register for PECOS I&A system”. On December 6, POE is collaborating with KEPRO, the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) to facilitate a webcast to help you better help our Medicare beneficiaries. On December 6, POE has a webcast on MSP for institutional providers. On December 12, POE will have the quarterly Medicare Changes and Regulations Part A webcast. And lastly, December 14, Stephanie is facilitating a webcast on the Targeted Probe and Educate (TPE) strategy. All of these events are free of charge but you must register to attend.
Verify all action items and process out
POE AG member Brenda Tuohey submitted a question via email prior to the meeting.
Question: Many of our seniors do not carry their Medicare insurance card with them. Will providers be able to access and verify coverage in DDE with the patient SSN?
Answer: Yes, the MBI (if one has been issued) and eligibility will be available with the April 2018 release for DDE.
The following action items were captured during the meeting:
• In follow-up to our meeting, here are links to the two CMS communications regarding QMB:
• Obtain example of remit regarding QMB issue from member -- Completed
Kim concluded the meeting at 3:32 pm.
The next meeting will be March 6, 2018.
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.