Highmark Medicare Services Premier Oncology Hematology Management Society Meeting Operations Report November
HMS CERT Scores 2010 CERT Error Rates National Goal: 9.5% National Average: 10.5% J12 Overall: 5.5% 2011 CERT Error Rates (Projected) National Goal: 8.5% National Average: TBD J12 Overall: 5.2% 2
2011 CERT Error Rates Percent of dollars in error 3 Claim TypePAJ12 E&M claims7.0%8.3% Non-E&M claims2.0%3.3% Part B overall3.8%4.9% Part A overall4.6%5.4% A&B overall5.2%
HMS CERT Scores Part B rate in PA is at a good spot Part A rate is high due to medically unnecessary inpatient admissions Even though these bills are submitted by facilities under Part A, individual physicians write the order to admit An inpatient admission must be substantiated by the patient’s: Severity of illness at the time of the order to admit and Intensity of treatments required 4
Provider Revalidation Project National Initiative -1.5 Million Providers J12 – 161,000 Providers Month Effort Process Overview Solicited Approach Web Revalidations Encouraged Dedicated Staff Deactivation for Non-Compliance Web sites (online revalidation) enrollment/index.html (reference site) enrollment/index.html 5
Consolidated Service Provides a single toll free number for General Inquiries, EDI, Enrollment and Reopenings (Parts A &B) Improved customer experience due to the extension of performance expectations to all inquiries not just General Inquiries Target Date – December 1, 2011 Tel. Number –
Provider Internet Portal Phase I Features Claim Submission via the Internet Eligibility Claim Status Mailbox for Outbound Mail (e.g. SPRs) Reopening Request Extensive Marketing & Outreach Target Date – April,
ICD -10CM Compliance Deadline:October 1, 2013 Suggestions: Identify current systems using ICD-9 codes Clinical Documentation Encounter Forms/Superbills Practice Management System Electronic Health Record System Contracts Public Health and Quality Reporting Protocols Talk with practice management system vendor about version 5010 and ICD-10 codes Discuss implementation plans with your clearinghouses, billing services, and payers to ensure a smooth transition Asses staff training needs Conduct test transactions using version 5010/ICD-10 codes with payers and clearinghouses Keep Up To Date: Visit the CMS website at 8
Website Satisfaction Contractors are rated on Medicare Contractor Website Customer Satisfaction Surveys will randomly appear when you are on our website Survey is nationally benchmarked and administered by ForeSee Results Your opinion matters to us! Comments should be contained to website content We have received valid complaints on surveys but not website related 9
Social Media We are moving forward with social media Our first social media will be Twitter We expect to implement Twitter by the end of calendar year 2011 We are currently exploring the use of Web Chat to assist providers in navigating the web site 10
Contact Information BENEFICIARY INQUIRIES: PA/MD/DC/NJ/DE: Beneficiary TTY*: (for the hearing impaired) *A TTY is required at both ends of the conversation in order to communicate. _________________________________________________________________________________________________ PROVIDER INQUIRIES: Medicare Part A Telephone:: Medicare Part B Telephone: : Enrollment: EDI: Mailing Address: Highmark Medicare Services 1800 Center Street P.O. Box Camp Hill, PA
Key Contacts Laura Minter J12 Project Manager (717) Fax David Vaughan Vice President, Operations (717) Fax Robert Muscalus, DO Vice President Contractor Medical Director (717) Fax 12