February 2007 Medicare Bulletin - Tennessee Insert
Posted February 6, 2007
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Table of Contents
- 2007 Clinical Lab Fee Schedule - Tennessee
- Medicare Fee for Service (FFS) Implementation of the National Provider Identifier (NPI)
- Provider Outreach and Education Advisory Group (POE AG) Meeting
- Tennessee Health Professional Shortage Areas
- Tennessee Mental Health Professional Shortage Areas
TopProvider Outreach and Education Advisory Group (POE AG) Meeting
Minutes
December 6, 2006
Participants:
Via Teleconference
Shelly Asbury, Vanguard Health
George Dendrinos, Med-ARM, Inc.
Terri Durham, Dr. James H. Thomas
Pam Holt, Oak Ridge Surgeons, PC
Joyce Jones, AmSurg
Nancy Lasuer, Urology Associates
Sara Linton, The Frist Clinic, CCP, CPC
Norma Martin, Cookeville Primary Care Associates, PC
Sandra Mayfield, Urology Associates
Susan Merryman, Anesthesia Medical Group
Becky Morrissey, TN Medical Association
Sherry Preslar, Covington Internal Physicians, PC
Janice Simpson, Q-Source
Amy Walker, Gastrointestinal Associates, PC
CIGNA Government Services
Lynne Jordan, Provider Relations Representative
Michael McNeely, Provider Relations Representative
Tanya White, Provider Relations Representative
CIGNA Government Services conducted the quarterly Provider Outreach and Education (POE) Advisory Group meeting on December 6, 2006, with 14 members via teleconference. One participant reported technical difficulties in accessing the teleconference meeting. If others experienced technical problems, please let us know so that we may contact our vendor. We appreciate all feedback and participation in the call.
1. Calendar of Events- FY 2007
- Tanya talked about the plans CIGNA Government Services – Tennessee has confirmed for the next few months. There are six (6) full-day sessions of Medicare Basics (101) and Medicare Intermediate (102) workshops scheduled. We are considering contacting certain providers that we feel would benefit from this training in Medicare fundamentals. We will be calling a few providers who have had a high volume of claim submission errors (CO-16 rejections) in the last few months and let them know about the upcoming Basic and Intermediate Medicare Workshops. We asked for feedback from the Advisory Group to see how that would be received.
- The AG feels that this would be well received and that providers would welcome the ability to be invited to something that would benefit their practice. Since the Region IV Master Core Curriculum pilot project has now ended, we will use a slightly different format incorporating some interactive exercises. We asked if there were any suggestions as to what the Advisory
Group would want included in the Medicare 101 (Basic) and 102 (Intermediate) courses. - The AG did not have further comments but felt that interactive exercises would be of benefit. Lynne said that the remittance facsimile discussion which highlights both common claim submission errors and how to read the remittance would be added to the Core Curriculum modules. Later in the meeting Susan Merryman suggested that we spend more time on reopenings, refiles, inquiries, adjustments, and the forms and contact information for providers to use these processes appropriately.
CIGNA Government Services has posted registration links (http://www.cignagovernmentservices.com/wrkshp/tn/wrkshp_sem_TN.html) for the January workshops on the Web site. The dates are as follows:
Medicare Basics (101) Workshops schedule
| January 10 | Chattanooga Holiday Inn Choo Choo |
| January 17 | Nashville Airport Marriott |
| January 24 | Memphis Marriott |
Medicare Intermediate (102) Workshops schedule
| February 07 | Chattanooga Convention Center |
| February 21 | Nashville Airport Marriott |
| February 28 | Memphis Marriott |
Partner-sponsored meetings and seminars include discussion of Medicare updates and resources, NPI, CERT findings, and sponsor-requested topics such as MSP COB issues, and specialty-specific issues. Partner-sponsored events for 2007 include to date:
| March 07 | Johnson City | East Tennessee State University (AM and PM Sessions) |
| March 08 | Kingsport | Medical Group Managers Association |
| March - Date TBD | Knoxville | Medical Group Managers Association |
| May 10 | Murfressboro | Medical Group Managers Association |
In addition, we are committed to conducting at least twelve (12) Webinars/teleconferences this year targeting small providers, CERT errors and those groups in need of specialized training.
2. 2007 Spring Workshop (Contractor- sponsored)
CIGNA Government Services has followed many of the recommendations from the Advisory Group in the scheduling and planning of the Medicare A and B Workshop in partnership with Riverbend Government Benefits Administrator. The Advisory Group wanted to have the workshop pre-NPI full implementation and also wanted a date mid-month to accommodate practice administrative workloads at beginning/end of month. As a result, the workshop will be April 17th at the Cool Springs Marriott in Franklin, south of Nashville. The theme will be "All ABoard" with a focus on the AB partnership. We are planning for about 200 participants in an all day session covering various topics. We will be using the format discussed in the September meeting (General Session and simultaneous breakout sessions) and will notify you of confirmed topics based on their earlier recommendations after the 12/8 planning meeting with Riverbend.
Norma Martin brought to our attention that the TN MGMA will be meeting on April 18th in Gatlinburg and that this may adversely affect participation in our contractor sponsored workshop. We were not aware of their event date and since we are already in the process of finalizing the facility contract for April 17th, we hope that we will have participation and representation from other provider practice staff if the manager is going to be traveling to the MGMA meeting.
Joyce Jones mentioned that since ASC's have gone through so much change that maybe a breakout session should be dedicated to them. We agree that there has been a tremendous amount of change and are open to pursuing a Web-based training session to serve a more immediate need.
3. Revised Evaluation Form
As CIGNA Government Services constantly evaluates our performance and strives to increase the satisfaction rating, we often revisit our methods of gaining valuable feedback from the participants in our workshops. We are also trying to gain continuity in how that feedback is given, so our evaluation forms will be more consistent across all contracts. With the new standard evaluation form, there will be a database set up that will allow us to track the results. CIGNA Government Services will be able to establish a baseline, and track improvement against previous results.
4. Hot Topics NPI
There are only 168 more days until the National Provider Identifier (NPI) compliance date! The Advisory Group has reported that they have all enumerated. The current enumeration report (12/4)- TN= 24,057 Individual; 6,453 Organization; 30,510 Total. We reminded everyone that when providers apply for NPIs, CMS urges them to include their legacy identifiers, not only for Medicare but for all payers.
We are in Stage 2 of the NPI transition period of October 1, 2006, through May 22, 2007. Medicare will accept claims having only NPIs (as well as those having only legacy provider numbers); however in MLN Matters article MM 5378, CMS recommends that during this period you submit claims using:
- The provider's legacy number, such as a Provider Identification Number (PIN), NSC number, OSCAR number or UPIN; or
- Both the provider's NPI and legacy number.
Note: NPIs are not to be submitted on CMS-1500 forms until the revised CMS-1500 (08/05) begins to be accepted by Medicare on January 2, 2007.
5. MPFS
Lynne advised providers performing imaging procedures that they will need to check both the Physician Fee Schedule and 2007 OPPS Payment Cap Amounts for the TC and Global Portion of Imaging Services list to determine the appropriate allowed amount for those services. See
http://www.cignagovernmentservices.com/partb/fsch/index.html#2007updates .
6. Other Items
- Janice Simpson, Q-Source; QIO Contractor, mentioned that there are only 800 Physician Voluntary Reporting Program (PVRP) participants nationwide and wanted to encourage use of the program to our provider community. We are not aware of the number of TN participants in this program. She encouraged us to visit qualitynet.org for more information.
- Both Susan Merryman and Pam Holt mentioned that some emphasis will need to be placed on electronic MSP claim filing/billing. The POE team will work with these AG members to provide examples of the problems and collaborate with EDI to work toward resolution. If they are education issues, POE team will work toward a MSP Electronic Claim Webinar sequel course to address those educational issues.
- Susan Merryman recommended that the 101/102 workshops should include more detailed instructional of what constitutes a Claim Adjustment vs. an Appeal vs. initial processing. Our current Decision Tree will be used to facilitate this discussion.
Wednesday, March 28, 2007 will be our next POE AG meeting 9:30am-11:00am CST.
Medicare Fee for Service (FFS) Implementation of the National Provider Identifier (NPI)
CMS has been working toward full implementation of the NPI in Medicare transactions. In coordination with CMS, CIGNA Government Services will be expanding testing efforts beginning February 12, 2007. As of this date you may experience increased suspense/reject/unprocessable claim notices. To assure that the impact on your practice is minimized, please do the following:
- Ensure claims submitted, electronically AND on paper, contain a valid NPI
- Ensure that all of your information in the National Plan and Provider EnumerationSystem (NPPES) is correct, such as date of birth and social security number, and
that your Medicare legacy identifier(s) are present
and that they are associated with the correct NPI. You may view/correct your NPPES information by
accessing the following Web address to the National
Plan and Provider Enumeration System (NPPES) is https://nppes.cms.hhs.gov. - If your NPPES information is correct and you have
included all Medicare legacy identifiers in NPPES,
but you are experiencing problems with your claims that contain a valid NPI, you may need to submit a Medicare enrollment application (i.e., the CMS-855).
Please contact your contractor prior to submitting a CMS-855. If your contractor determines that a CMS-855 is needed to ensure that payments are made correctly, please make sure to complete the Medicare enrollment application fully and submit all supporting documentation, including a copy of your NPI noticed received fromNPPES. It is also important to note that all providers and suppliers are required to receive payments through electronic funds transfer. Accordingly, if you will be receiving Medicare payments directly, you are also required
to submit the Electronic Funds Authorization Agreement (i.e., CMS-588).
2007 Clinical Lab Fee Schedule - Tennessee
2007 Clinical Lab Fee Schedule - Tennessee
Tennessee Mental Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
Tennessee Health Professional Shortage Areas (HPSAs)
Designated Geographic Areas
|
1 Classified as a HPSA, effective March 1, 2002.
2 No longer classified as a HPSA, effective March 1, 2002.
3 Classified as a HPSA, effective June 1, 2002.
4 Classified as a HPSA, effective February 1, 2004.
5
No longer classified as a HPSA, effective February 1, 2005
6Classified as a HPSA, effective September 12, 2006
7Classified as a HPSA, Effective August 8, 2006
8No longer classified as a HPSA. effective August 8, 2006
