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