**National Business Office Committee**

**Nashville Area Office**

**Nashville, TN**

**[In attendance:]{.underline}**

Carl Harper, Acting Director, ORAP

Joe Hathcoat, Phoenix Area

Kurt Priessman, Tucson Area Finance representative

Deborah Burkybile, Nashville Area BOC

Leah Tom, Portland Area BOC

Roland Todacheenie, Navajo Area BOC

Lu Rae Erickson, Alaska Area BOC

Cynthia Larsen, Billings Area BOC

John Rael, Albuquerque Area BOC

Sandra Lahi, OIT, National Programs

Mary Beaver, Oklahoma Area BOC

Mary Lingruen, Tucson Area BOC

Sharon Sorrell, Navajo Area, BOM, GIMC

Elmer Brewster, HQE

Toni Johnson, California Area BOC

No attendees from Aberdeen and Bemidji Area.

**[Invited Guests]{.underline}**: Ron Grinnell, Oklahoma Executive
Officer, Sandra Winfrey, Albuquerque Executive Officer, Sherry Varner,
TB Part B, Denise Mohling, TB Part B, Cheryl Cowan-Sweetin, TB Part A,
Pam Bellows, TB Part A

**[Tuesday, November 16, 2004]{.underline}**

**Welcome and Introductions**. Richie Grinnell, Acting Area Director,
Nashville, TN

**Agenda Overview.** Elmer Brewster

**Review and approval of Minutes from Albuquerque**. A motion was made
to approve the minutes and seconded by the workgroup.

**Documentation of minutes for Nashville meeting.** Documentation of
final minutes of NBOC meetings should be made available timely.

**ACTION:**

-   Sandra Lahi will have draft of minutes by Monday to NBOC members for
    review.

-   Group will finalize Nashville minutes by first conference call,
    December 1, 2004

-   Sandra will post final minutes and work-plan on Business Office
    website soon after for national view.

[Election of Co-Chair]{.underline}. Leah Tom, Portland Area Office, will
be the lead Chair for FY 2005. Nominations made and a vote was
completed. Roland Todacheenie, Navajo Area BOC will be the Co-chair for
FY 2005 and the lead Chair for 2006.

**[Headquarters Report -- Elmer Brewster]{.underline}**

**[TOPIC: Cost Reports/Rate update.]{.underline}** Elmer Brewster

**DISCUSSION**: Cost reports are a little behind schedule. Lower 48
initial cost reports complete with a few outstanding. IHS has met with
CMS. IHS to continue using Method E cost reports and plan to continue
with awarding a 4-5 year contract.

There is a possible 3% increase. IHS Should have final rates by end of
November for Alaska. After IHS finalizes rates with CMS, they will meet
with the department. The department will contact OMB. A meeting will be
scheduled with OMB the first part of January. Overall, rates are
starting to stabilize for inpatient.

All BOCs agree that they support the continuation of the OMB Rate.
Except a few FQHCs have lower rates. Moving to the APC rate would only
benefit the Medical Center reimbursements and those facilities that
provide ambulatory surgery type services.

**ACTION:**

Elmer will try to get new OMB rates available as soon as possible.
Current All Inclusive rate type billing is a regulation and will not
change in the near future to OPPS. Need to consider all Inclusive rate
fee-for-service as well as the cost of providing services. There are
some state Medicaid plans that are considering paying at the OPPS rate
and not the all inclusive rate. BOCs to monitor these issues.

**[TOPIC: Partnership Activities]{.underline}**. Elmer Brewster

**DISCUSSION**: Working with HRSA over three primary areas: Health
professions (including Community Health Centers), HIV, Health
disparities ie. development of Community Health Centers (encouraging
tribes to see all patients and utilize sliding scales). The tribes are
encouraged to market the CHCs as a resource to the community.
Headquarters staff toured Deering facilities in Billings Area. There are
barriers to access 330 funding and applying fees. Barriers have been
addressed. The view is to see these as separate authorities. 330
authority is the CHC HRSA funding, technical assistance for
infrastructure and governance. IHS authorities would be separate.

Headquarters is also working with the VA on IT, Clinical, Outreach,
sharing services/payments and VSN. Headquarters is also continuously in
partnership with the TTAG addressing MMA issues, Medicare Payments,
Section 506, Part B, 630, undocumented payments, 1011, DDC and Part D.
Other items of discussion are the TTAG Organization and/Budget.

**[TOPIC: Section 506, Part D Issues]{.underline}**. Elmer Brewster

**DISCUSSION:** Regulations are finalized now and being published this
month. To provide guidelines on hospital like rates for Dual Eligible
patients (full Medicaid vs QMBs), PDP payments under Medicare revenue
impact, contracts with I/T/U, TROOP costs and formulary. This will apply
if you are a Medicare provider and must accept the OMB rate as payment.
Part D is part of Trailblazer training. Home Health Care is not covered
under Part B for IHS. Currently under Part A, includes hospital, home
health, SNFs and Nursing Homes. IHS cannot bill for Part A. Under
Section 80, efforts need to be made to change the law.

**ACTION/RECOMMENDATION**: IHS needs to pursue payment for free standing
clinic facility charges under the above law. Trailblazers stated this is
available.

**[TOPIC: MMA is being worked on to allow for reimbursements for illegal
aliens as Medicare like rates.]{.underline}**

**DISCUSSION:** Final regulations are not out but will be sent out
final. IHS is in the legislation to get reimbursement.

**ACTION:** IHS is pursuing to get this on a fast track to get it
approved by mid spring. Plan to get review process and hopefully
implement by second quarter.

**[TOPIC: IHS will be required to change billing for Commissioned
Officers/Dependents from BMP to Tri-care]{.underline}**

**DISCUSSION:** The initiative is for IHS to bill through Tri-care and
to balance bill through HQE. Alaska will be an issue. For remote
locations, there will be no change but will still be required to bill
Tri-care first. For remote sites, there is a list available that was
issued by Champus/Tricare on how remote is defined. For non remote
locations that have access to their MTFs (Military Treatment
Facilities), the officer will have to go to their MTF for their
treatment. If they chose to go to IHS, IHS will not be able to get
reimbursed

**RECOMMENDATION/ACTION:**

-   Tri-care Prime Remote defines where the officer and dependents live
    and this needs to be provided to the BOCs for review.

-   Elmer to pursue a letter from BMP defining the new regulations

-   Need to minimize facilities process of applying to become a provider
    within the network.

-   There is still a question to who will be the contractor or whether
    it will be regional type of billing.

-   Headquarters will need to request BMP to continue to receive payment
    for non-remote locations.

-   Headquarters will need to request that claims paid that exceeded the
    all inclusive rate will be considered paid in full.

-   For RPMS, we need to define how to send the claims based on the
    requirements.

-   IHS can bill up to a certain amount. Will we have to refund down to
    \$216?

-   Headquarters will need to define a date of implementation.
    Currently, Elmer thinks it will not be effective by January 1, 2005.

-   NBOCs need to start sharing with CEOs and Service Units that this
    funding will have an impact on Area and Service Unit budgets.

**[TOPIC: Headquarters East Reorganization -- ORAP]{.underline}.** Carl
Harper

**DISCUSSION:** HQ reorganization went into effect August 23, 2004.
Chart was distributed entitled "Organizational Placement of Executive
Vacancies" and "Where We Are in the Process."

Review of Office of the Directors office was completed. Focus discussion
was made on the Office of Resource Access and Partnerships. Draft copy
of the ORAP reorganization chart was distributed. ORAP consisted of
Division of BO Enhancements to include Field Operations staff (2
positions), Reports Coordination Staff, Internal Control/Review Staff
and a Legal Policy/Guidance position (assigned to ORAP).

**[1. Division of Business Office Enhancement.]{.underline}** Kurt
stated that Dan Medrano from Finance also has an audit/review division.
How will this fit in? This kind of feedback needs to be addressed. How
is Business Office involved with Cost Reports. Need to add Internal
Control/Review and the word "Audit" to title. Need to include compliance
and coding audits and how accounts receivable leads to Finance audits.
Finance needs to have a cross team defined to include Finance and
Business Office. The Director will be Elmer. The Internal Audit group
should have access to contracts to assist with auditing and being
proactive with OIG work plans and getting sites prepared. The Field
Operations staff will consist of two positions. One of the positions
will be in Rockville and one will be Balerma's position. There is the
possibility of establishing another position in the field. A reports
coordination staff will gather data, analyze trends, benchmarking and
possibly be involved with cost reports.

**ACTION:** NBOC needs to be involved in the written discussion of this
reorganization.

-   Leah will take the lead to get recommendations from the BOCs on what
    duties these offices will consist of. The areas include Legal and
    Policy guidance, Director of BOE, Field Operations staff, Reports
    Coordination staff and Internal Control/Review staff.

**[2. Division of Contract Care]{.underline}**. If there are comments on
CHS, the BOC should send emails to Car Harper for any other items that
might be included. It was recommended that CHS also needs an Internal
Controls and Audit review section.

-   The CHS policy should be re-reviewed to see if it should be updated.

-   The time limit for providers to submit bills to IHS has been changed
    from seven years to five years.

**[3. Division of Partnerships]{.underline}**. Office will be
responsible for Headquarters agreements and cascading performance plans.
The office will also be responsible for Internal and External Advocacy,
dealing with tribes and other agencies. The office may need to be
responsible for defining a major webpage for grants processing, and
having a liaison with other NIHS, FDAs and HRSAs programs to enhance
access to services.

Question: Will there be any type of partnership established with Human
Resources to be able to work closely with Classifications to get
positions upgraded? Headquarters thinks this is an opportune time to
work with Human Resources.

Question: Should there be an additional box for IT? Where does the IT
development fit in? The group needs to add comments on the requirement.

Question: Should there be another box for planning for future
initiatives. Phase I: List everything you want to get done by existing
boxes to Leah Tom by November 30, 2004. Leah will compile the comments
and send to Carl Harper by December 1, 2004.

Question: Where is Medical Records in this reorganization? It is under
the Office of Clinical & Preventive Services. IHS needs a national
direction to get PCC Data Entry current. With the new HIM Lead, Pat
Gowan, direction can be provided to get Data Entry current and other
third party billing issues related to HIM.

There may be a workgroup established to further define the role of these
positions in BOE.

**[TOPIC: Four Objectives to be cascaded down for IHS Directors contract
FY 2005]{.underline}.** Elmer Brewster

**DISCUSSION:** By 3^rd^ 4^th^ qtr, PAMS beta test to be completed.
Final AR III to be completed by 2^nd^ qtr. Revenue Operations Manual to
be completed by 4^th^ qtr. By end of FY, 3% increase in revenue.

**[TOPIC: CAH Ancillary Study]{.underline}**. Elmer Brewster

**DISCUSSION:** CAH will be required to do an Ancillary study between
now and the middle of February because cost reports are due by the end
of February. Billings, Navajo, Phoenix, Alaska Area will be affected.
Headquarters need individual ancillary percentages to establish a CAH
rates.

**ACTION:** Elmer to schedule a conference call with CAHs to review the
requirements. These reports are due to Headquarters by end of February.

**[TOPIC: Management Implication reports and review of Pharmacy payments
with Aberdeen Area. SD Medicaid pays the all Inclusive
rate.]{.underline}** Elmer Brewster

**DISCUSSION:** Issues were raised on how each state were reimbursing
for Pharmacy rates. OIG was currently reviewing a specific SU.

**ACTION:** HQE is reporting on that and meeting on this issue. For
Information only.

**[TOPIC: DME Billing]{.underline}**. Elmer Brewster

**DISCUSSION:** How are we going to track those payments. IHS does take
DME out of cost reports now. FS clinics can bill. For hospitals, it will
be different due to reporting on cost reports. Suggestion to take out
revenue out of cost report next year if we get paid by a certain amount
this year. We'll pull ou the revenue, not the cost. Peggy Sheets is
looking at the impact on the OMB rate for future negotiations. For FS
Clinics, we do have some instructions and to do this now.

**ACTION:** No further follow-up.

**[TOPIC: HPSA (Health Professional Shortage Areas)
billing]{.underline}.** Elmer Brewster

**ACTION:** There are a lot of sites (over 200) that are on the list.
Sites who bill this way use the QB modifier.

-   Elmer to check on status of new remote location policy that IHS is
    rewriting. Also look at remote location designation and how IHS is
    redefining this.

-   Cynthia reported that this may affect the Non-Beneficiary billing
    process.

**[TOPIC: PT and OT billing]{.underline}**. Elmer Brewster

**DISCUSSION:** Medicare Part B will pay for hospital services provided
for these providers. Place of Service 11 and 22 would be applicable.

IHS will be sent a notice that hospitals can bill for this service.
These costs will be pulled out of the cost report next year.

**ACTION:** Trailblazers Part B provided guidance on this guideline
during the session. BOCs are to implement if applicable.

**[TOPIC: RTC payment issue from North Carolina Medicaid]{.underline}**.
Elmer Brewster

**DISCUSSION:** This affects RTC services in states and border states,
specifically NC. Deborah Burkybile has shown North Carolina that there
is legislation that Native American people are exempt from the managed
care process. There is a gate keeping function if there is a
certification of need, and the request goes through a huge process
before the site can get paid for services. NC has \$330,000 owed to a
site based on these requirements. The inpatient rate is very low and
negotiations with

**ACTION**: The alcohol branch in Rockville has been having conference
call with CMS and to approach with an OMB rate established in the
Federal Register. Deborah has been taking the lead as an active
participant and will be attending a meeting on this issue on Thursday to
further pursue this issue.

**[TOPIC: Diabetes Billing]{.underline}**. Elmer Brewster

**DISCUSSION**: A couple of sites are billing for this now.

**ACTION**: Continue to support sites in billing for Diabetes Services.

**\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-\--**

**[Area Business Office Coordinator Reports]{.underline}**

**[Billings, California and Aberdeen Area]{.underline} -** Not available
to provide reports

**[Oklahoma Area:]{.underline}** Mary Beaver.

Tahlequah, Haskell and Lawton were on Corrective Action Plans for 120
days and older AR accounts. They are working to resolve this issue.
Medicare collections, Medicaid and PI are significantly high compared to
other areas. Medicare is higher. The population must be higher. Medicare
billing with HIPAA was higher because WW Hastings bought Claredi
software to assist with billing the 837 format. Sue Rollice did provide
on site services for coding inpatient records to both WW Hastings and
Lawton to deal with backlogs.

**[Tucson Area]{.underline}:** Kurt Priessman and Mary Lingruen

Brand new SUD, Priscilla Whitehorn, at Sells SU. HIPAA is being
addressed. ASells still having problems with split billing bills.
Collections goal was 15.3. Actual was 15.8. Sells is also working to
clean up Pt Reg database for v7.1. 75% of bills are current. Area is
very aggressive on A/R and aging accounts. Medicare Part B is beginning
to age due to provider \# applications becoming a problem. PNC bank EINs
were also assigned for each SUs. Paperwork is still being worked
through.

**[Phoenix Area]{.underline}**: Joe Hathcoat

PNC Bank Tax ID's are set up for each site. Payers are still sending
checks to each site. It was recommended by the group that PAO design a
cover letter to be attached to all of the claims to notify the payers to
send the checks to PNC.

PAO has hired an outside company to do a business process assessment.
The contractor finished last week with PIMC. The Area has plans on doing
this in preparation for PAMS. Sites are continuing to prepare for PAMS.
The Area is working on the OIG issue that came out about compliance less
than a year ago. They are also reviewing the risk areas that came out in
the federal register. Continue to work on these issues for the Area
Office.

**[Navajo Area]{.underline}**: Roland Todacheenie/Sharon Sorrell

NAO utilizing Insurenet browser through Quovadx for the 270 and still
testing for 271. Additional enhancements are still going through
procurement. Working with Quovadx for 837 processing. Standardizing
Patient Registration entries because of denials in 837 claims.

ASM amounts are somewhat large. This item was addressed at the last
BOMgrs meeting. Collections increased by 6.9% for 2004.

PAMS process changes were reviewed at the Navajo Area BO Mgrs meeting. A
future approach will be to focus the training with all Business Office
Mgrs only.

GIMC had completed applications with AHCCCs to move towards electronic
ACH. Kayenta also signed up. When this happened, GIMC started receiving
GIMC and Kayenta's information in one file. The routine number was the
issue. They are now working on setting up with AHCCCs for all sites to
have an individual routing number set up. PNC bank should set up this
process. Now the sites are able to view it by provider number.

**[Alaska Area]{.underline}**: Lue Rae Erickson

ANTHC is moving to a new building. Administration staff from the Medical
Center will also be there. The Area has been providing CHIP education
and training. Training was also attended by the Division of Public
Assistance. Also have statewide coalition with Robert Wood Johnson.
Intent is to keep enrollment and applications going after the date is
completed and to do a lot of networking. There was a BOMgrs training
held the week of Nov 12. MMA will not help the provider base sites in
Alaska. Had Art Votek come up to provide coding and PI billing training
which also ncluded the Medicare Drug card training and transitional
assistance training for that entire week. HFMA session was also the same
time.

Lue Rae has been trying to work with those sites to get geared up for
PAMS. Many of the sites were using COTs and are now very unhappy with it
and want to use PAMS. Kotzebue will be a beta site for PAMS.

**[Billings Area]{.underline}**: Cynthia Larsen

Billings Area increased collections in between 8 and 9%. EHR is at Crow
and Wind River. EHR is also being implemented at Poplar and Browning.
Wind River is 100% EHR. Sharon and Sandra to come out to Wind River SU
who will be a PAMS beta site to train on Pt Registration 7.1, process
changes and checklist for installing PAMS.

MR and BO committed to doing an internal audit at all SUs. It was a full
time job. Based on OIG guidelines, the review included an audit of 10
documents for each provider per site. Browning had about 600 copies.
This year, Area BO will be doing a very intense detailed Accounts
Receivable audit to include follow-up activities. A/R is the highest
priority this year. Still around 30% in over 120 days category. Trying
to put some training tools together to explain what A/R is. SUs are
required to put a plan in place on action items for A/R. Many sites will
be contracting out.

[Critical Access Hospitals]{.underline}. For three years, Ft Belknap has
had to pay back funds. Cost reports are not being reported accurately.
Elmer and Carl should possibly review the possibility of getting paid at
95% to allow for the cushion. The remaining money can be negotiated
during the final settlement. Crow came on October 1^st^. Ambulance at Ft
Belknap, one of three IHS owned ambulances, so they will be working on
the billing for MMA.

There is a plan to do an in-depth study on current collection rates and
how to do future projections for increases.

[Clearinghouse]{.underline}. BC/BS of MT is being used as clearinghouse
for one facility. The BC/BS (45% of PI) are sent free of charge. Area
contract is in place for Infinity. Contracting is now saying that they
cannot use BC/BS anymore so there is an issue.

Area Staff will be hired out this year to assist with backlogs. There is
a proposal to bill the SUs for the Area Office staff's salary.

[Ambulance billing for Tribal to Medicaid]{.underline}. There was an
in-depth discussion between Tucson and Billings Area on this topic.

**RECOMMENDATION/ACTION:** Need to address on a national initiative to
assist sites with billing and reimbursement issues for ambulance
services. Elmer to talk to CHR program director to see if they want to
take on from their viewpoint.

**[Albuquerque Area:]{.underline}**-- John Rael

There is a new CEO at ACLSU with two vacancies. Jicarilla SU will be
opening their joint venture project 12-5-2004. The facility will have
the ability for electronic note pads in all rooms. The Area completed an
audit of charts for Diabetes program looking at documentation and coding
and billing. Tomorrow presentation is being done by two BOMgrs to
Presbyterian to provide IHS billing procedures. Pueblo of San Felipe is
638ing and will affect SFSU FY 2005 collections. Taos and ACL are using
Datatrak to deal with backlogs.

SFSU sponsored a Certified Coding course. At SFSU, 80% of billing and
70% of DE staff are certified coders. Albuquerque Service Unit
collections are low and may be decreasing services in the near future.

A copy of the ASM will be sent out showing aging accounts via email.

HIPAA 837 issues. Here was a problem with the signature not on file.
Most did get paid. Working through AMPMED to submit claims for free
service. NM Medicaid has not loaded 2005 codes yet and having
rejections. Problems with CERTs being sent out with tax ID numbers are
being sent out and they are floating around until it gets to the sites.

Training plans for next six months. Training for UNMH hospital with
provider rep for Native Americans. Training for State Aging Department
for Benefits Coordinators. External Payer reps are having a huge
turnover and IHS has to continually train new people on IHS procedures.

**[Nashville]{.underline}**: Deborah Burkybile

Nashville Area has been busy establishing Catawba SU in NC. Obtained
provider #s for Medicare and Medicaid as a Free Standing Clinic.
Manliess NY is also a new Service Unit.

The Area still provide continuous Tribal Consultations.

Medicare Discount Drug Card trainings. Tribes wanted two trainings.
Problems occurred. Boston NA rep took care of the agenda and it included
other areas. There was a recommendation to form another tribal
consortium at the meeting which upset existing tribal consortiums. It
became a controversial issue.

There is a reimbursement issue involving UNITY RTC with NC Medicaid. The
State owes Unity \$330,000. Deborah will attend the meeting on Thursday
in which all of the State Medicaid Directors and all of their assistants
will be in attendance to discuss guidelines and define barriers.

Tribal sites are interested in compliance certifications. NAO is working
to provide Coding certification and CEUs. Health Directors are
interested in phased process for educating staff on Pt Reg 7.1 and
Process to include when, where and how it is going to be done.

**[Portland Area]{.underline}**: Leah Tom

For the past year, out of seven Service Units, there are five new CEOs.
It has been a challenge to educate them on the process and facilities
for both Leah and David.

Continue to struggle with HIPAA testing. PAO collected an increase of
13% from the 2003 collections. Now back to square one due to having to
retest for one payer due to IP change. A/R backlog is at 33% and
teaching them the process. PAO wiill be working on this area this fiscal
year. Working with the States of OR, WA and ID. David and Leah were
taken away for a month to work on special CHS data export project. They
ended up exporting over 3 million files.

PAO is gearing up for PAMs. The Area is interested in cleaning up
Patient Registration files. Most of facilities are set up for PCC plus.
Need to work on defining check-in and Patient Registration.

Partnering with VA and Air Force bases to do Radiology readings and it
is a real savings for a lot of their sites. Site Reviews are being done.
David and Leah go out to the facilities. Had Drug Card training and MMA
billing. Some of the A/R backlog issues are due to Pharmacy POS issues.

[**TOPIC: Staffing Levels on National Initiatives**. BOCs]{.underline}

**DISCUSSION:** BOCs have done a minimal job of planning for staff that
are necessary to implement past initiatives. We should use the new
Revenue Generation Policy and the ROM to define Skill Sets and staffing
levels for A/R levels. Another major item will be PAMS and requiring Pt
Registration staff to know how to work on Insurance plans, etc with
increased skill sets. Why doesn't headquarters define national
directives to tell the SUD to define a corrective action plan.

**ACTION:** Recommendation was made to Identify the skill sets in the
new A/R Policy and lead to comprehensive plans. BOCs stated that there
was an opportunity to follow up on Accounts Receivable if staff were
available.

**[TOPIC: ROM Update]{.underline}**. Sharon Sorrell

Sharon stated that the plan is to inquire and pull together all Policies
and Procedures from BOCs. Final document will be sent out to BOCs for
review.

**[Business Office Issues]{.underline}**

**[TOPIC: Clearinghouse Status]{.underline}**.

**DISCUSSION:** At the June NBOC meeting, Robyn York, Yolanda Reyna and
Art Gonzales attended the meeting and requested the NBOCs to define a
Scope of Work for clearinghouse services. This was due to Art by the end
of July. This was completed with the assistance of Sandra Lahi and John
Rael.

A recent inquiry was made to the Contracting Officers and they stated
they never received any documentation. Art stated he sent it to Elmer.
Elmer will review the email from Robyn York on status. Question was made
as to how will IHS be implementing 270/271 procedures? Do estimates have
to be done by Area for 270/271 and 837 transactions to determine a cost
for the Acquisitions plan? Attempts were made to invite Art tomorrow to
be on a conference call. For the record, Art did not respond to calls so
was unavailable to participate in this discussion.

Question was made, can the Area BOCs agree to work with one
clearinghouse? The following poll was made:

Tucson: No

Oklahoma: No. More than one

Albuquerque: If it is going to be open ended, there is no reason to put
any effort into a national contract.

Billings: No

California: Tribes are going out and getting their own clearinghouse and
this is causing the same problem with IT support issues. California
would like IHS to chose 1-2 and they can relate these recommended
clearinghouses to the Tribes

Alaska: Tribes are working independently so this is not an issue for
Alaska.

Navajo: Already purchased Quovadx so they will have one for the Area.

Portland. Portland is in the same situation as California for both
tribal and IHS. Have been testing with existing clearinghouse with Web
MD but have been having a few issues.

Tucson: Wants a choice

Phoenix: PAO wants a choice. PAO is currently using Claimsnet.

IT: The issue is that if there are multiple clearinghouses,, the
detailed support issues will be very timely and cumbersome. This is
based on the historical experience of the 837 transaction only. What
will happen when we move to the remaining six transactions? Resources at
ITSC for support issues are minimal. Some Areas as Tucson do not want to
wait for the time that is necessary to deal with their HIPAA issues with
existing resources.

**ACTION:** The NBOC would recommend that contracting go through the RFC
process and let a key group of NBOCs assist with making the final award
based on the Scope of Work submitted. Elmer to get with Robyn to
finalize the acquisitions document and see about getting it sent out for
bid. NBOC agreed to at least two with the understanding that existing
contracts can finish their existing time frame before converting over to
the new choices.

**IT support**: The BOCs were requested to send the concerns to Leah to
list with the IT issues section in the IHS reorganization.

**[TOPIC: CAH IT issues]{.underline}**: Cynthia announced there is a
problem with the 837 formats for CAH sites. If sites are having
problems, they should contact the ITSC Help Desk for Shonda to assist.
For information only.

**[TOPIC: Medicare Drug Card billing:]{.underline}**

**DISCUSSION:** IHS has two contracts in place for us to bill POS.
Criterion Advantage (Computer Science Corporation) and Pharmacy Care
Alliance (Express Scripts). RPMS POS has the NCPDP format for Express
Scripts available now. The NCPDP format for Criterion is available and
ready for testing once a patient is identified.

Oklahoma Area reported that after all of the training that was held, the
biggest SU has reported that there are five patients who were identified
eligible for this service. Oklahoma Area is predicting about 50
participants in Oklahoma Area. Mary will continue to monitor. It is
income based. Elmer stated that IHS wide, QMB and SLMB patients will not
qualify if you are on Medicaid. Billings reported that they had
training. Cynthia's two assistants are working with Pharmacy. Browning
has done 200-300 applications. Portland is signing people up and found
one patient who was approved. Waiting for patient to come in and have a
visit so we can submit the claim. Phoenix and Tucson did training
jointly. A conference call in the area and staff are busy signing up
patients. Tucson Area has applications and Benefits Coordinator is on
leave. Follow-up will be done. Navajo had 145 people attend their
training. A follow-up conference call was done last week with staff.
Radio skits were also done in the local language with a full page ad on
the Drug card in the local newspaper. Patients are now coming in.

Portland has 80% of patients who go outside for Pharmacy services. They
plan to save CHS dollars for this amount.

Alaska had training. Had participants from all over the state including
Pharmacists and Care Coordinators. ANMC felt they wanted to bring on
their own staff to do the screening for this type of patients.

Albuquerque Area Office had the training with about 145 people. There
were a lot of IT questions. Santa Fe has already seen the auto assigned
cards from a few patients. SFSU has printed out the list and is having
the Benefits Coordinators contact them.

California stated there will be a lot of Non-bens that will be
addressed. Billings had the training from urban, IHS and tribes well
represented.

Overall, it is not expected that there will be millions of dollars
generated. Elmer stated that there were 30,000 that had both Medicare
Part A and B but only a few would qualify due to the income guidelines.
Another 30,000 have Medicaid and will be excluded. Of the QMBs and SLMB
patients, it was unclear of who would be eligible of that population. So
40,000 or so are the patients that are potentially eligible IHS wide.
IHS sent forward that maybe 10,000 were eligible.

**ACTION:** BOCs to continue to support training, outreach and billing.

**[TOPIC: RPMS Pharmacy POS and the Medicare Drug Card]{.underline}**

**DISCUSSION:** Pam Schweitzer sent out a document outlining the steps
to set up RPMS Insurer file and Pharmacy POS with existing contract
information for the two I/T/U benefit plans. It was recommended for all
sites to use the document to set up Insurer files based on actual names
noted on the document.

The other issues identified are:

-   Insurer files will be set as a PI Insurer Type and not Medicare.

-   The document states to put in ending eligibility dates if the
    patient reaches their \$600 limit even though the patient is still
    eligible.

-   here was an auto enrolling done by CMS which we do not have access
    to the patient names due to HIPAA Privacy issues.

**Other Pharmacy POS issues** **noted**:

-   How do we do a refund in POS and how to we handle Return to Stock
    items.

-   There is no denied claim data coming across to A/R.

-   Contracts is an issue. NBOC needs to get someone assigned to getting
    the national contracts in place. Pam is not available to assist with
    this anymore.

-   Question was made to move the POS module into third party billing.

No decision or approach was made on the above items.

**[Wednesday, November 17, 2004]{.underline}**

**[NCEO Third Party Collection Workgroup - Ron Grinnell/Sandra
Winfrey]{.underline}**

See Powerpoint presentation provided by Mr Grinnell.

See NCEO Third Party Collections Workgroup Executive Summary and Matrix

**DISCUSSION:** Workgroup met one time to define the charge and identify
matrix information that would be needed to update A/R Policies I and II.
A meeting is also scheduled next week to finalize the A/R Policy III.
Skill sets was also addressed for personnel in the third party billing
and collection process. The group should assist with identifying reports
for analysis and metrics tools for management to use. Also look at areas
of standardization across IHS. Think about PAMS and UFMS.

Sandra Winfrey reviewed the contents of the matrix and asked the group
for input on any missing items that the workgroup may have missed.
Sandra also talked with Dr Grim about the importance of having IT tools
to be able to follow the A/R Policy III.

Carl Harper also reiterated that Dr Grimm, the Area Directors, the
Executive Officers and other higher leadership are in support of
ensuring the new policy is enforced. The workgroup needs to think about
what to include in the policy as it relates to Skill sets at all levels
including the local level. Cynthia also mentioned that there must also
be enough resources available to be able to meet the policy. Sandra also
mentioned the importance of providing training to inform all parties of
why they are doing their part of the process.

Kurt mentioned that some items were going to be long term specific to
how all clinical services will be entered into RPMS. He felt we had to
wait until PAMS and check-in were available to be able to do that. It
was stated that even though we are waiting for PAMS, the sites can
implement the critical items in the interim. It is also important to
have all checks received from all clinical services to be maintained and
captured in one system, RPMS.

Kurt questioned separation of duties. In Tucson, AR is done by Finance
and Finance is doing posting and receiving electronic checks. If the
site is not able to separate duties due to lack of staffing, sites will
have to implement internal auditing.

A/R should not be generalized and each area has a different definition
of what A/R is. We need to redefine billing as Account Management and
have different functions as a part of Account Management.

Policy name is changed to Third Party Revenue and Internal Control
policy. The policy is beyond just third party so the name will be
re-reviewed at the meeting next week.

**ACTION:** The BOCs are charged with providing feedback to the
workgroup on the matrix and any items that might need to be included.
The due date for comments is by 5:00 PM, November 22, 2004, Monday to
Sandra Winfrey or Sandra Lahi to allow time for the group to review to
be incorporated into the Final policy workgroup meeting.

# [ITSC Update -- Sandra Lahi]{.underline}

#  

# TOPIC: HIPAA Transactions and RPMS. Current Status of Electronic Transactions

# 

# DISCUSSION: 837 & 270/271. The 837 transaction which includes the electronic health claims & equivalent encounter information has been status quo for some time. The same sites in the same areas are submitting electronic claims except for Phoenix Area, there has been more activity. 

# 

# There is a Trailblazers Part A Status Report that Sandra will email to the group separately. The developer is providing real time support as sites are reporting their issues. Delays are occurring with getting task orders processed to the contract staff. Version 2.6 is on the pended task order listing. 

## 270/271 -- Electronic Eligibility for a Health Plan. ITSC is working with the Navajo Area with their Quovadx contract. The 270 is complete and the 271 is to complete testing by the end of this month. ITSC is anxiously awaiting the completion of this testing so more payers can start testing and the RPMS edits can be completed and released. 

## 

## 835 ERA - ITSC is working with PNC bank due to PNC having many resources available to work with sites in setting up all of the systems to receive 835 files from the different payers. Currently, the following payers have this status: 

## [In production]{.underline}: TB Part B, AHCCCs, MEDCO, MN Medicaid, BCBS MN

## [Reviewed and awaiting test production Posting:]{.underline} OK Medicaid

## [In Review]{.underline}: BCBS of AZ and OK

## [To Be Reviewed]{.underline}: NV Medicaid, TB Part A and NM Medicaid

## [Reviewing Volume]{.underline}: MH, AETNA, United Healthcare & CIGNA

## 

### For 835 development support, Linda Lehman is currently on maternity leave but Tim Frazier is covering for her while she is on leave. For the 276/277, there is no new testing activity. For the 834, electronic eligibility file, Phoenx Area is working with Navada Medicaid and there has been some inquiry for the Minnesota Medicaid file. 

# HIPAA Standard Code Sets -- Catherine Thompkins has the assignment of keeping RPMS current with all of the code sets. The 2005 ICD 9 file was released on September 21, 2004. She is actively working on the 2005 CPT/HPCPCs codes. There are efforts to try to receive an electronic file from 3M of updated ICD 9 codes which is currently handled manually. This may be a major update once it is done. We are also keeping abreast of the NPI discussion with a conference call being scheduled in December. 

# ITSC Ongoing HIPAA Efforts ITSC still holds an internal meeting with developers every two week meetings since 6/2002. Carl Gervais is the HIPAA Technical Project Lead for this discussion. The HIPAA Support staff is Dyanne Leyba, Transactions Testing Coordinator, Catherine Thompkins, HIPAA Standard Code Sets, Quovadx and 834 and Mike Pike, MOU for Development Support of Error Report software. 

### Other ITSC Ongoing Efforts including providing updates to the Transaction section of the IHS.gov HIPAA website, sponsoring the HIPAA Transaction Conference calls which has proven effective for networking, identifying RPMS issues and support areas and area/Area/ITSC reporting. The HIPAA Online Training Tools has moved forward and will provide training on the 837 and 835 and RPMS. The planned delivery date is May 2005.

# 

## TOPIC: PAMS Project Status including Patient Registration 7.1. 

# 

### DISCUSSION: The new PAMS timeline is that the first alpha site will install the software the week of 11-29-04. The site, Chickasaw Hospital, will also be hosting PAMS training for the staff 12-14-16-2004. Sandra and Adrian will be attending the session for IHS. The other alpha sites, Gila River, Choctaw and GIMC will be installed after January 1^st^. The beta sites in March 2005 to include Wind River, Maniilaq, SEARHC, Phoenix site TBD, Sacramento Urban Health. The plan is release June 2005

## 

# The three major Steps to consider for PAMS deployment include Patient Registration V7.1 including the Error Report Utility. Business Process Changes in which s haron Sorrell is available under an MOU with GIMC to assist Areas with planning and training. The last step is the PAMS software installation in which the Areas were asked to start planning for deployment dates, data conversion and training of all billing staff. 

# Step one. Patient Registration V7.1 is in development and the plans are to move to alpha testing in November 2004. The alpha sites are GIMC, Zuni, Chickasaw Hospital. To support V7.1, sites will have to run the error report Utility option. The plan is to release this prior to the release of 7.1. A copy of the errors listing was provided to the group. Once the report is printed, sites responsible for cleaning up the errors. There are also schedule Patient Registration V7.1 Train the Trainer sessions scheduled. V7.1 also emphasizes Sequencing and Order of Billing. Training on this aspect must also be considered. 

## Step two. Business Process Changes. Sharon Sorrell provided an update of how the checklist is being revised to include guidance to sites on how to complete each step. This document is in draft and will be distributed once it is finalized. There is also a Process Timeline grid that will be provided to the sites as guidance on how long they need to allow for each step. The group also asked if there is a Powerpoint available that can be shared on the basics of PAMS and the highlights of what needs to be completed. Sharon stated she had a PP available to share. Once these documents are finalized, distribution can be made. Sharon is also available to travel to provide Area training. Currently, her focus will be on the PAMS beta sites and preparing them.

# Step Three. PAMS software installation. The biggest issues that need to be addressed with installation include backlogs and data conversion at each site. The Coordinators will also need to consider how the training of staff will occur. ILC has a questionnaire for defining readiness that they are using to work with Chickasaw. When this is more final with additional alpha sites, the questionnaire will be distributed. The other major issue will be continuing the reporting requirements as the current A/R current policy timelines and how this will be reported from the old system to the new PAMS system.

## 

# IHS Support Role & Planning. ITSC has tentative dates scheduled for PAMS Train the trainer sessions for three weeks in April. ITSC is also responsible for providing the software support from Beta to release to Deployment. There is a proposal from ILC that is being reviewed. The Consortium also asked that the IHS TAG review the PAMS software for the contract requirements. This was initially scheduled for January but it may be moved up due to the alpha testing being moved to after January 1^st^. It is better to have a stable software for the TAG to review. Areas need to think about post PAMS deployment. The time frame will be June 1, 2005 to June 1, 2006. ITSC will be responsible for providing support of 3P AR system until that time frame. 

# Future Questions and concerns with PAMS is that the Area BOCs did not respond to a request for a deployment schedule for all three steps. It was recommended that ITSC provide the software and the Areas will be responsible for deployment with no additional support but the request is still on the table for discussion. If ITSC is to assist, resources will need to be planned for. Training of new application will require additional resources. The software will also have to be coordinated as far as HIPAA transaction testing . 

# 

# ACTION: To continue to support the software timely, it is recommended that OIT look at the contract development and support infrastructure to delegate out the Project Officer role. Carl Harper stated he and Elmer would discuss with OIT leadership.

# 

# Area BOCs will plan for deployment for all three steps. ITSC will work with Sharon to get the Process documents and Powerpoint presentation out to the group for local training. 

## 

# [TOPIC: TAG reports]{.underline}

## Third Party/Accounts Receivable

### Conference calls are held on monthly basis with minimal participation from members. NBOC was asked how do they want to want the TAG to proceed with participants who do not participate? NBOC stated to have the leaders send an email out to each participant asking if they will be involved or not. 

### Current leadership to change March 2005

## Patient Registration

### Adrian and Leah have been holding conference calls and providing updates to the group on the new version and patches that are released. 

# 

# [TOPIC: 3P AR RPMS FY 2005 Training Schedule]{.underline}

### Schedule of Basic and Advanced 3P AR Training sessions was provided for the months of November 2004 through June 2005. After June, focus will be on providing PAMS training. 

### Patient Registration V7.1 training schedule was also provided. 

## 

# [TOPIC: ITSC Business Process Development Support Staff]{.underline} 

# Currently, support staff includes the following staff: 

## Sandra Lahi, Team Lead

## User Support Specialists

### Adrian Lujan 

### Yolanda Trent

### Letha Runnels (started 11-1-04)

## HIPAA

### Dyanne Leyba

### Catherine Thompkins

### Mike Pike

## Developers 

### Shonda Render, Third Party Billing, HIPAA 837, ICD9 file, CPT file, Medicare Eligibility File, HIPAA 837, 834

### Linda Lehman, Accounts Receivable, HIPAA 835, 276/277, AR Standard Adjustment & Reason Codes

### Ed Gartner and Tim Frazier, Patient Registration, HIPAA 270/271

**[TOPIC: Trailblazers Part A -- Cheryl Cowan Sweetin]{.underline}**

Introduction was made of Ms Pam Bellows, Cheryl Cowan Sweetin's new
sidekick, who will also be available to assist Indian Health Service
with Medicare Part A issues.

Packet was provided with documents that Cheryl reviewed.

-   Request was made to have a listing of all claims that have RTP'd by
    Provider number. Cheryl reported that this type of report is not
    available.

-   Medicare Payment for Drugs and Biologicals Furnished Incident to a
    Physician's Service.

-   Medlearn Matters. IHS or Tribal Hospitals including CAHs payment
    methodology for Inpt Social Admissions and Outpt Services Rendered
    at a Separate Facility.

-   Method 2 Billing for CAH. The RPMS system must include both A and B
    services on the same claim. Bill 510 for facility charges and
    another revenue code (summarized by revenue code) but the charges
    are itemized. Site will get 115% of the charge based on Physician's
    fee schedule. Lump sum all inclusive rate and itemized charges all
    on the same bill. Crow SU is considering this but it will not happen
    any time soon. To do this, stop billing Medicare Part B and do an
    885A to start billing provider services to Medicare Part A. Only
    applies to CAHs. ACTION: Cheryl will find out how the billing
    process will proceed and how the itemized charges can added to a
    UB92.

-   MMA authorized payment of ambulance services for hospital ambulance
    services to be filed to Part A. Part B authority is total. If
    hospital owns and operates the ambulance, it has Ambulance is a part
    B service. Hospitals: Sells, Ft Belknap, Eagle Butte. Tribal
    hospitals have always had the authority and have been billing to
    their local carrier to bill Part B.

-   **ACTION:** Ambulance billing. Medicare Part A. The RPMS system
    needs to be able to bill both Outpatient services and Ambulance on
    the same bill. TB will not allow separate claims. ITSC needs to look
    at it.

**TOPIC: Medicare Part B- Denise Mohling/Sherry Varner**

-   [Quarterly Report, Nov 2004, Issue 10.]{.underline}

Effective Jan 1, 2005, Part B claims will need to go through the appeal
process instead of submitter making corrections to the claim and
resubmitting. If resubmitted, claims will be denied as a duplicate.
Remittance Advices have both denials and rejections. CO16 is a reject
and must be re-filed.

-   [Quarterly Report, Nov 2004, Issue 10]{.underline}. FQAs -- Incident
    to cannot be billed for other providers.

-   [Top 10 Part B IH Billing Errors and Denials]{.underline}. These
    errors are occurring systematically for both electronic and paper
    claims.

-   [MNT and DSMT]{.underline} cannot be billed as incident to for
    hospital based or free standing clinic. If person as PAs, NPs,
    Dieticians, RDs are providing services, you can bill. If nurses are
    providing services or running the program, you cannot bill for DSMT
    services.

-   [HIPAA compliant claims]{.underline}. The 1.5% that are not HIPAA
    compliant will be contacted individually to find out why they are
    not HIPAA compliant.

ACTION: TB Part B will be trying to get a list of how these sites are.

-   [HPSA]{.underline}: Must use QA and QB modifier and completed
    box 32. Effective January 1, 2005, zip codes will determine HPSA
    payment. If sites are not on the zip code listing provided by the
    references provided, Elmer needs to be notified to update the
    listing and make it current. There were over 200 sites who should
    have been on the list but were not. This applies to the tribes as
    well who are not using Trailblazers as an FI.

-   [Overpayments]{.underline}: This usually occurred for wrong Place of
    Service codes since July 2001. Refunds need to be processed in one
    of two ways. When notified, TB Part B will run a report to identify
    all of the claims that were paid in error. There will be a mass
    adjustments sent out to each facility. If we decide to write a
    check, Medicare Part B will send a demand letter for each patient
    that was billed erroneously. The mass adjustments will not occur in
    30 days.

-   [October 2004 Top Billing Errors/Claim Denials Indian
    Health]{.underline}. Differences with Top Billing Errors and Claim
    Denials.

-   [Three fields to bill Medicare as Secondary]{.underline}. Primary
    insurance company allowed, how much did they pay, OTAF (obligated to
    pay for full has to have a zero on there). Applies to PPOs, etc.

> **ACTION:** RPMS needs to be fixed to allow for this. For MSP claims
> for IHS, is done paper with RAs. Loops and segments can be found on TB
> website. Wait for 10 days to get the information. Look at section on
> back of MSP manuals for segments and loops for those pieces of
> information. Will need to add the information in 3P. The allowed
> amount in 3P. If you roll over and roll back and find Medicare as
> secondary, add the amount that was allowed.

-   [2005 Medicare Training Suggestions]{.underline}. Received from the
    field. For hands on training, TB A&B needs to know if sites have
    computer rooms. Many areas do have Training Rooms available to do
    this.

> **ACTION:** Areas will notify them of training rooms that are
> available for hands on for RPMS.
>
> **[Thursday, November 18, 2004]{.underline}**

**[Business Office Issues -- Elmer Brewster]{.underline}**

[TOPIC: Partnership Meeting.]{.underline}

**DISCUSSION:** The potential dates will be in March 2005 due to other
scheduling conflicts.

**ACTION:** Balerma to do evaluation of sites

[TOPIC: Combined Councils Meeting. February 28 -- March 4, 2004, San
Diego, CA]{.underline}

**DISCUSSION:** We need to get on the agenda. Need to get with EY Hooper
or the representative from .

**ACTION:** Carl Harper will find out if we can get on the agenda.

**[TOPIC: Business Office Managers Training, January 25, 26, 27,
2005]{.underline}**

**DISCUSSION:** Revenue Generation 101 Follow Up training. Is there a
need to provide this training?

Many Areas reported they have a huge changeover in SUDs and Health
Center Directors. We also need to think about the Urban programs as
well. For the past sessions, there were quite a few representatives from
the Administrative Officers and SUDs. The Clinical Directors were
somewhat not available. It might be a good idea to provide this in the
spring or late summer to include A/R policies, PAMS, Business Process
and UFMS.

The intent of the Business Office Managers training was the how to and
the basics of what is happening nationwide.

For CEO training, what would be the training objective for them?

First day would be emphasis for internal controls, IG processes,
cascading performance plans, PAMS and HIPAA.

**ACTION:** Group recommended to combine CEO training with Business
Office Managers training in January. Cynthia to schedule next Planning
meeting conference call for Tuesday, November 30, 2004 at 11:00 AM MST.

**[TOPIC: FY 2005 SCHEDULE]{.underline}:**

December 14,15, 16 2004. Pt Reg 7.1, Business Process and PAMS updates
at Wind River SU, Wyoming. Sandra, Cynthia and Sharon Sorrell to attend.
Others invited.

January 2005. 19, 20, Pt Reg Train the Trainer.

January 25, 26, 27, - BOM, CEO training, San Diego

February 15, 16, 17, 2005. Pt Registration Train the Trainer session,
Albuq

Feb 28- March 4. Combined Councils meeting in San Diego

April 2005. PAMS train the trainer sessions (three weeks in Albuquerque)

May 3, 4, 5, 2005 or Mar 10, 11, 12 2005 BO/MR Partnership Meeting. Look
at Phoenix, Scottsdale or Dallas. Has to be in a convention center.

June 14, 15, 16, 2005. NBOC Meeting. Minneapolis, MN Mystic Lake,
Bemidji Area. Kathy Bristlin to sponsor.

November 15, 16, 17, 2005. NBOC Meeting, Rockville, MD

**[TOPIC: Training for NBOCs]{.underline}**

Possible attendance to HFMA Annual Conference. Health Financial
Management Association. Attend their annual meeting. Usually held in
Spring.

**[NBOC Workplan -- FY 2005 review]{.underline}**

Review of the NBOC work plan items with the recommendation that the NBOC
list short term and long term to identify the top items that will be
completed this year. This was completed with adjustments made to the
wording, identifying completed items and regrouping the workplan.

Leah will send out the draft Workplan by next week with the top items
identified on a separate sheet. Sandra will send out the draft minutes
for review by next week as well.

**With no further items of discussion, the meeting was adjourned.**