Reimbursement Committee Minutes

March 18, 2015

9:30am

I.  Call to Order

  1. Introductions

Chris Kisell, Barry Cargill, Laurie Mones, Kerri Allen, Jan Wrzesinski, Kim Jenks, Mike Hall, Fred Lee, Amy Gil, Ashley Berger

  1. Acceptance of Minutes – No Comments
  2. Agenda Additions/Changes – None

1.  Barry and Dawn to work with BCBSM to facilitate detailed eligibility verification.

Amy will work with Barry.

2.  Chris to create a Benchmarking Questionnaire.

Completed and sent to members. Due back March 31.

3.  Tom R. to send Chris categories for P.D. Benchmarking.

Completed

4.  Laurie to contact Cindy to try and get a listing of Annual Conference Exhibitors distributed to agencies so that agencies can work on exhibitors not on the list for possible sponsorship.

Cindy sent out to group. Mary handed out copies at meeting.

5.  Amy to contact Tom Mann and Sheila regarding Private Duty benchmarking.

Chris Created form.

II.  Reports

  1. Executive Director Report – Barry Cargill

NAHC Legislative Day is March 23-25 in Washington. Barry is scheduling meeting. If you would like to go let him know so that he can schedule a meeting with your Rep.

Michigan Association for Home Care Annual Conference is May 13-16. Please check out the brochure. There is a big investment in this conference with a series of robust speakers.

There are 2 scholarships available and possibly 3. The application deadline for consideration is April 10th. It is free money for personnel that qualify and get chosen. Nominate today!

Michigan Association for Home Care is looking at Hospice Licensing. A survey every 3 years. Looking to get a break on the fees if an agency is accredited also.

There are possible changes in continuing education. The budgeted money is ahead of the legislation. Could be a 4 year license for Nurses.

HME competitive bidding is March 25.

Wholesale Manufacturers License now requires only a facility manager instead of a pharmacist on site but it is yet to be defined. This goes into effect on March 30. There is still the issue of no new agencies and those trying to renew because current regulations still state pharmacist. If you continue to have issues in this are please contact Barry to help get resolved.

  1. BCBSM Liaison Meeting – No new information – Reach out to contact your regional rep. first and then to the Association to get a solution.

Jan and Kerri are creating questions regarding issues of Out-of-State billing and payment along with P.D. not being able to get Weekend Authorizations.

If issues pile up then there will be a call for a Liaison meeting.

Questions should be submitted as they come in to .

  1. Billing Committee – Dawn Hyder, Amy Gil

No date set yet. Possibly in April. Kerri will get topics over to Amy.Looking for possible speakers. Lynn Hicks is a billing specialist for Medicaid. Kerri to send number.

Rick Hagan is writing an article on Medicaid expansion and is looking for a patient that had a positive experience. Please contact Barry if your agency has a recommendation.

  1. NGS/CMS – Chris Kisell –

MM 9027 – Preventing inappropriate Payments on Home Health LUPA Claims.

III.  Old Business

  1. Benchmarking Survey –

Cindy to send out to All members, Certified Committee and Reimbursement Committee.

  1. Private Duty Benchmarking –

Chris created the form and will revise based upon recommendations from the Private Duty Committee. When completed it will go out to the Private Duty and Reimbursment Committees. It will cover ALL of 2014 data.

  1. IACS – PS&R –

Make sure you check that you can get your PS&R form IACS as there is still no timeline for the transition.

IV.  New Business

  1. Medicare Plus Blue incorrect payments –

MPB is overpaying RAPS on crossover claims from 2014 to 2015. They are then rejecting the final and taking back the RAP. On those that are paid MPB is possibly overpaying on finals.

V.  General Business

  1. Payor Line Discussion
  2. Medicare –Crossover claims from 2014 to 2015 are incorrectly paying. Palmetto has unually long wait times for payments.
  3. Medicare Advantage – Humana still not paying. Kerri is going to resend contact information to Mike.
  4. Medicaid – Private Duty looking for Liaison meeting. There is a need for a rate increase. Molina is giving conflicting information regarding authorizations. Community Insurance Company out of Ohio has some issues for one of the agencies. No one else has heard of them.
  5. BCBSM – Nothing
  6. Other Payors – the V.A. is at leat 60 days behind paying P.D. claims. Looking to have V.A. at the Billing Committee. Amy will give Mike dates so that he can try and set up a speaker.

Agencies are giving up on Carecentrix. Bad reimbursement and are getting rejected for not submitting Admission Paperwork.

Meridian is rejecting claims if they are not on the RED U.B. form.

Aetna has issues as the rates are too low.

Health Plus is being looked at by the Department of Financial Services.

  1. Product Line Discussion
  2. Certified - Nothing
  3. Hospice - Nothing
  4. HME/Private Duty - Nothing

VI.  To Do Items

  1. Barry and Amy to work with BCBSM to facilitate detailed eligibility verification.
  2. Cindy to resend Benchmarking Questionnaire.
  3. Jan and Kerri to form questions regarding Blue Cross Issues and Submit.
  4. Kerri to send contact information for Lynn Hicks.
  5. Chris to revise Private Duty Benchmarking form and send to Committees for completion.
  6. Kerri to send Humana contact information to Mike.
  7. Amy to give Mike dates for Billing Committee so Mike can try and get V.A. Rep.

VII.  Next Meeting: April 15, 2015 Tele-Conference

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