Moderator: (Bill Finerfrock)
March 13, 2007
1:00 p.m. CT

Operator:

Good day everyone. Welcome to today's Rural Health Technical Assistance conference call series. Today's conference is being recorded.

At this time, I would like to turn the conference over to Bill Finerfrock. Please go ahead, Bill.

Bill Finerfrock:

Thank you, operator and welcome to everyone who's called in today. This is our regular Rural Health Clinic Technical Assistance; today's topic is Medicare Advantage.

We're pleased to have representatives from SecureHorizons, Humana Gold Choice, Sterling Health, and Today's Options/Pyramid Life.

I want to welcome everyone here. My name is Bill Finerfrock, and I'm the Executive Director of the National Association of Rural Health Clinics. Representatives today are representing some of the major Medicare Advantage plans, they're going to present information to you, we've asked them to hold their formal remarks to about 10 minutes, and then we'll open it up at the end for questions for each of you.

This call series is sponsored by the Federal Office of Rural Health Policy in conjunction with the National Association of Rural Health Clinics. The purpose is to provide Rural Health Clinic staff with valuable technical assistance and Rural Health Clinic specific information. This is the sixteenth call in the series which began late in 2004, and will continue for the next five years. As you all know, there's no charge to participate, because this is funded by the Office of Rural Health Policy.

We will take questions and answers, as I said. In the future, if you ever want to e-mail questions, you can send them to info@narhc.org. You all should have also received either the PowerPoint directly through e-mail, or a link to where you can go and download them.

Our first speaker today will be Gerry Payne, who will be representing SecureHorizons. Gerry, thank you and welcome to the call series.

Gerry Payne:

Thank you. My remarks are very general; I just wanted to take you over some of the branding that has occurred in the last year. As you may - as you may know, United has acquired PacifiCare, as well as John Deer and Oxford, and all of those Medicare Advantage plans have been placed under one national brand called SecureHorizons by UnitedHealthcare.

In 2007 in particular, the private fee for service plans changed to the brand name SecureHorizons Medicare Direct. This year we are filed in all 50 states, as you see in the little over 1,500 counties. And I'm sure, as you know, there is no restriction as to geography or affiliation, enrollees are free to go to any deemed doctor or hospital who will accept them.

We also have in some of our plans Part D coverage, and in other plans no Part D coverage. This year that allows for what are called the Medicare Advantage Only Plans without drug coverage to be marketed throughout the year past lock in at the end of this month. And as a reminder, we pay a five percent bonus on top of the interim rate reimbursement in lieu of your year end settlement.

As far as our provider materials go, my last slide shows you the link on the Web where you can go to get our latest materials. That concludes my remarks.

Bill Finerfrock:

Thank you, Gerry, and I appreciate your being concise, and that leaves more time for questions at the end or whatever. Our next speaker will be Robby Swinson, who's going to present on behalf of Sterling Health Plans.

Robby Swinson:

Hello there. I sent in a fairly long slide show, and so please bear with me, I've numbered the slides so that you can follow me accordingly, I've paired this down quite a bit. And I'll just let you know what slide that I'm talking on if you choose to follow along on the slides.

Sterling Health Plans is a Medicare insured only, our philosophy is that we want to keep the decisions of healthcare in the hands of providers, and we do as much as we can to try to stay out of that dilemma of having to make healthcare decisions. We do have a family of products, I'm on slide four. The Sterling family of products includes the Sterling Premier plan which is a basic supplement plan. The Sterling Medicare Select plan, which is also a basic supplement plan, with a hospital network restriction. And then our Medicare Advantage plans are the Sterling Option One, which is a Medicare Advantage Private Fee for Service Plan, and the Sterling Option Two, which is a Medicare Advantage Private Fee for Service Plan with prescription drug coverage included. We also have some - a Sterling RX and an RX discount, and a whole life product.

I'm now going to move along to page - or to slide number six, that just kind of gives a general overview of the payment under our plan. We find that in the market, the one thing that we really try to point out and make very clear are the differences between our plans, because you know, as I'm sure any other of these insurers have experienced, somebody can come in and say, you know, I need - I have Sterling, and the provider may have a difficult time discerning which plan they're actually on. So this slide actually just tells how we receive and pay claims.

I'm going to move right along to slide eight. The Medicare Advantage Private Fee for Service plan was created as a result of the Balanced Budget Act of 1997, Sterling did feature the first private fee for service plan in the United States through our contract with CMS. As, you know, we all know, it has the same coverage as original Medicare, but we do have some benefits in addition to Medicare. And it does have the deeming process; providers can accept members on a case by case basis.

I'm going to skip along to slide number 10. The premiums for our plans, the Sterling Option One plan, which is the - our fee for service plan with no Part D benefit attached to it, that plan is $9 per month, and the Sterling Option Two plan, which does have a Part D benefit, is 28.70 a month. Kind of in a nutshell, the Sterling Option One plan also has lower co-pays, and the Sterling Option Two plan you would pay a higher co-pay. Just a quick example of a co-pay would be $100 per day up to five days on Option One for an inpatient stay, and $150 per day for Sterling Option Two.

Other than the difference in co-pays and the Part D, they pretty much work the same way, there are no network restrictions, no referrals, no utilization review. I do want to point out, it might be in a later slide, but I do want to point out that we do require notification for DME purchase over $750. And that is the only thing that we require a phone call on.

Moving along to slide 11, the additional benefits that are above Medicare's benefits are just some preventive wellness benefits, preventive dental, hearing, vision, an annual physical exam will pay up to $150 per year. We also have a gym membership program called Sterling Forever Fit, and generally nationally, you know, it - it's variable, but generally Gold's and Curves are part of that Forever Fit program.

And just to elaborate a little bit on the preventive services, and I'm going to talk just on Option One to cut time here, but we do have a routine dental preventive service every year at $300, an eye exam for $100, lenses $200 every other year, $100 hearing test, the physical is worth $100. So just some examples of what our preventive benefits are.

We also on slide 12, we have a care coordination program where we have RNs here in our corporate headquarters who are all certified nurse care coordinators. And in addition to, you know, having the nurse care coordinators available, we have an outsourced nurse advice line that's available 24 hours a day, seven days a week, and our nurse care coordinators perform voluntary case management and voluntary disease management, and that is available with our Medicare Advantage plans only, and it's a free service, and it is voluntary.

If you look at page 13, it shows our Option One service area, where we sell the plan in the United States. And then slide 14 will show you our Option Two service area. Our service areas indicate where we sell the plans, however we will pay claims to every provider in the United States.

On to slide 15, which shows a copy of our Option One and Option Two membership cards. And as you can see on the card, it says do not bill Medicare, it - but rather bill directly to Sterling. And we accept those claims either electronically or manually.

Slide 16 talks more about the reimbursement for rural health care covered services. Which is - it's kind of broken out for you here, 80 percent of the lesser of the provider specific all inclusive rate, or the national limit, plus 20 percent of the rural health clinic's actual charge for the RHC covered service, minus the beneficiary cost sharing, which is currently $10 under the Option One plan.

To talk about that just a little bit further on slide 17, all non-rural health clinic covered services are reimbursed according to the respective C schedules. A non-RHC service would be billed on the revised CMS1500 with the point of service 72.

Effective for dates of service on or after January 1st, 2007, Sterling will reimburse rural health clinics on a retrospective basis for encounters paid at less than the all inclusive Medicare allowable amount, as determined after filing the cost report with Medicare. Reimbursement will be at the same rate allowed by original Medicare. In other words, Sterling is allowing you to claim the Sterling Option One and Option Two business on your cost report, and we will reimburse you from that cost report the same as Medicare does.

Quickly to slide 18, just has some billing guidelines, you must use Medicare billing guidelines and forms, such as the revised CMS1500, or UB92 or UB04 form. We follow national coverage determinations as set by Medicare, and local coverage determinations. All claims are paid by Sterling, not a fiscal intermediary, or Part B carrier, and the one thing that's very important to note is we do have a 360-day timely filing limit.

On to slide 19, claims should be sent electronically, and we take it through Emdion, which used to be WebMD, claims net or the health information network. And this information is also provided on the ID card. Rendering physicians must include their UPIN on the revised CMS1500 claim form in box 24 before May 23rd of 2007. After this date, the NPI must be included on the claims.

Again prior notification on DME purchase over 750, this does not apply to rental. If you wish to appeal Sterling's payment on our coverage determination, we require that within 60 days of your receipt of the explanation of payment statement date.

Bill Finerfrock:

Robby, you have one minute left.

Robby Swinson:

OK. Sterling terms and conditions on slide 24, we do not contract with providers, but rather we use the deeming process. I think as established under all Medicare Advantage private fee for service plans, we also use captive agents to sell our plans, we don't use any brokers at this time. And I think that's it, thank you.

Bill Finerfrock:

Thank you very much, Robby. Next, my apologies, Anthony, I got out of my own track, you were supposed to be second, but our next speaker is Anthony Girgenti, who is with Today's Options Pyramid Life.

Anthony Girgenti:

Thank you, Bill. Good afternoon everybody. My remarks today will be also pretty brief, the - really the purpose of my remarks are to introduce to you Today's Options, and to talk a little bit about Pyramid Life's Medicare Advantage private fee for service plan. Presently we are offered in 35 states and all counties within the 35-state service area. It's our expectation in the coming years to be in all 50 states, all counties within the 50 states.

But Today's Options is administered through Pyramid Life Insurance Company, and Pyramid Life Insurance Company, if you look at slide number four, is a subsidiary of Universal American Financial Corporation. And when you look there, I think it's important to note the strength and the integrity of the organization, it's $2 billion in total assets, with well over one point billion - $1.3 billion in premium in force now. And the plans Today's Options is marketed throughout this 35-state service area through 20,000 plus agents representing Pyramid Life Insurance.

I think one of the crucial questions that's asked of us all the time from providers is why should I welcome a Today's Options member? And one of the key components in answering that question is that Medicare Advantage plans, as indicated by CMS, results in an average savings of $100 a month per enrollee, which is in many cases a dramatic savings and a - and a significant one at that. And so we see a lot of enhancements and a lot of benefits that you've heard even today for things that are covered by Medicare Advantage plans that Medicare beneficiaries can inaudible. So there's a lot of interest and a lot of excitement surrounding Medicare Advantage programs by Medicare beneficiaries.

Some of the benefits, some of the enhancements or the features of the Today's Options program are similar to some of our colleagues that we've heard thus far. But just to give you kind of a high and broad overview, one of the things that's important to Pyramid Life Today's Options is what we call an innovative voluntary care management program. What this is in essence is a voluntary process that a company works directly with it - the enrollees in coordinating their care, and assuring that they understand what their care is, they are getting access to the care that they need, follow up, things like a welcome home visit, 24 seven nurse and other care services, where a nurse will contact them and just follow up with them and see how things are working, make certain that they're getting their supplies, like diabetic supplies, those kind of things.

So those are merely wonderful programs for the Medicare beneficiaries on the Today's Options plan. Also we have zero out of pocket expense for many of the preventative services, which are key components. Emergency and urgent care coverage worldwide, there are also key features. Optional prescription drug plans, Today's Options has four types of plans, we have a basic plan and a premier plan, and then we have a plus plan which includes the prescription drug program. So key options that Medicare beneficiaries have access to, personalized attention every step of the way from our calls to them to welcome to the plan, we review their applications, make sure they understood what was going on, understood what they were buying, understood how the plan worked, what was required of them, how they needed to interact with the plan, any of those kind of components, all the way to the end in terms of making certain that they got what they needed, and got what they wanted.

Then of course as we well know, with the deeming criteria and the deeming processor, there's no pre-defined network of providers. So it provides to them a lot of access and a lot of choice in terms of access and care.

One of the things that's been tremendously exciting for Today's Options, if you look at slide number eight, is that our current membership exceeds well over 150,000 new members with Today's Options plan. And it's been reported that we're the second largest private fee for service plan in the country at the moment. I saw a statistic just yesterday that said an enrollee selects Today's Options once every eight minutes, so that's a tremendous growth, and right now we're seeing approximately 5,000 new members come into the plan each week.

It's also important to recognize there's a lot of misinformation out there in terms of what a Medicare Advantage plan is, and product fee for service, and how it works, unlike other types of programs. So it's important to note that we're not an HMO, that as you've heard even in this call today, there's no contracting necessary, there's not credentialing required, there is traditional from other plans, there's no waiting periods, there's no pre-authorizations required, no referrals. And also we pay the same rate that you're currently experiencing right now. So there's no discounting, per say, and no change of the - I mean what you're currently experience is what you will currently experience with Today's Options.

We think we've set ourselves apart in a - in a number of ways. We have local provider representatives and Medicare specialists, specifically set apart geographically. In essence, we have provider relations reps anywhere from one to about four or five in a state in which we service. So in terms of the provider community, whether it'd be a doctor or a hospital, an RHC facility, you have access to somebody who's physically in the state, physically on the ground, who is accessible to you, and readily available to address your issues, cares, concerns, training, all those kind of things. And they're fully trained Medicare Advantage specialists with anywhere from nine to 25 years of experience in Medicare services in one way or another. So they're fully trained and they're very adept of understanding Medicare.

They're highly accountable, there's a strong accountability and a culture of accountability that we create in the provider community, you know, we say to ourselves, look, the only thing that we really have is our voluntary care management and provider relations, we have to do it better, we have to do it well, because that's what really makes a difference in your office. And of course we promote and we build strong relationships through our personal interaction, I mean that's the foundation of it.

I think one of the things that we feel comfortable saying is that really our promise to you as a provider is that we are visible in an active role in being your representative, we're physically on the ground, we've invested time and resources and commitment to be there when you need us rather than the call into a call center somewhere and get a call back days, weeks later, those kind of things. So we want to be an active role and participant in representing you.

We want to respond and resolve the issues before they become problems, or emergencies, and certainly we promise to keep our providers updated and informed about what goes on, and just continue to build a strong and positive relationship, that's what's brought us to this significant growth, and it's what we expect to continue that growth pattern into the coming year. And with that being said, I thank you for inviting us, and good day.

Bill Finerfrock:

Great, thank you, Anthony. Elizabeth?

Elizabeth Strombom:

Yes, I'm here.

Bill Finerfrock:

OK, you're up, and you've got about 10 minutes.

Elizabeth Strombom:

OK.

Bill Finerfrock:

Sorry, Elizabeth is with Humana Gold Choice.

Elizabeth Strombom:

Yes, I'm with Humana, Humana Gold Choice is obviously one of our key Medicare Advantage products, and I will try to get to the key slides. The first slide, actually slide two, the changing landscape of Medicare. So I don't know how many of you keep track nationally of what's going on, but I just wanted to give you some information from a national perspective about MA plans in general, and how much they grew in 2006, grew by 17 percent. So for those that have been around for years, we are - we are at the point where the maximum Medicare Advantage enrollment has ever been, and this really hearkens back to when it was Medicare Plus Choice, and when we called CMS, HCFA. So we're at a point now where the growth has been tremendous for all plans, and almost half of that growth has been with the private fee for service plans. The beneficiaries have access now, 100 percent of beneficiaries have access to some choice, which was the whole intent of the Medicare Modernization Act. And I'll let you read the other bullets there, those are statistics.

As far as Humana goes, I don't know how many of you all were in Washington, D.C. at the Rural Health Clinic Conference, but this is an update since then, Humana has been number one in growth also in the recent annual enrollment period, which was November through December. In total, we have nearly 500,000 private fee for service members, over five million MA, PD and PDP members nationally.

By working with Bill Finerfrock and others in the rural setting, we've implemented process improvements for our claim system, obviously working in the urban areas we are very familiar with the prospective payment system, and how to process DRGs and APCs. But in recognition of the unique requirements to reimburse the providers in the rural setting, we work very closely with some of the national leads, and they helped us tremendously to not only improve our systems, but conduct training around the country and for all of our service folks in Louisville.

We also expanded our service area and nationally 82 percent of the hospitals in the country are accepting the Humana Gold Choice product. I think that - it does exclude maybe Hawaii and Alaska. So I think the good news overall is that there's strong evidence that the provisions in the MMA are meeting the long-standing policy goals of increasing the beneficiary access to health plan options for the - for the seniors out there.

As far as the next slide, I think I'll let you read that, I mean obviously Humana's a national health plan, 11 million members when you add in the commercial. One thing that I think should stand out is that we've been with Medicare a long time, it's not, you know, we've been with Medicare for more than 20 years, we have the largest career agent sales force, they're with us all year round. And what we like to say is that they are here today, and they will be here tomorrow, and that's real important for the beneficiaries. So when the open enrollment period ends on March 31st, our sales guys that sold those seniors, whether it was across the kitchen table, or in a - in a seminar, they will be there throughout the summer, and they will be there next year to help answer their questions, and help guide them.

For the regional PPOs, Humana has the largest footprint; we're in 23 states, and local PPOs in the 26 markets. And I have a map that you can see - you can - if you print it in color, it makes a lot more sense.

And then our contracting has grown - our contracting has increased quite a bit over the last couple of years as far as developing the PPO network, and we are also able to do a contract for private fee for service in the event the provider is more comfortable having a contract in hand for that product.

As far as education goes, we have some key differentiators at Humana; we have a smart summary RX benefit statement. If you haven't seen one of those, they're on our Web site. And the - what's relative to the providers there is that the - there's a back page of that statement, and the folks that like it the most are the providers, the members can rip that off, it has a picture of all of the drugs they're taking, it has the dosage, who prescribed it, and it really is so much better than the bag full of pills, the colored pills that sometimes come into the office.

I was on the provider side for three years, and I saw many bags of colored pills. So that's something that Humana has that's unique.

Athena Health and then Humana is the top payer in the industry across many, many categories that were evaluated, and we're proud about that. And the next slide is a map, I'm not going to walk you through it, I don't have enough time. But it shows where we are nationally, the different products that are offered based on the coloring and the states.

The next slide is really just to highlight Humana Group Medicare. If you're familiar with the topic, you know, several of the public entities on the commercial side have an ability or have an option to receive a subsidy from the government when they convert their retirees over to Humana or to a group Medicare platform. So roughly 12 million of the 43 million seniors that are out there are covered by some type of employer or government sponsored retirement plan. So whether it's teachers, or the state, or municipal retirees, there are roughly 12 million of those, and Humana's seen tremendous growth in the group Medicare. And there - the ID cards for those retirees does say Humana Group Medicare, just to let you know.

And the next slide is our suite of products, and I thought it would be helpful to have the chart that shows you just the basic tenement of the product, you know, does - is a gatekeeper required? Is a referral required? Is admission notification required or requested? And then obviously provider choice out of network benefits, I don't think there's anything on there that is - that is questionable, or that you haven't seen before.

Why seniors choose Humana, I think many of the folks that have spoken before me have already touched on it. A couple of things that do differentiate Humana are the Humana Active Outlook Program, it's a - it has four modules in it, it's something as simple as taking a group of seniors to the grocery store to help them learn how to read labels if they are diabetics. All the way to, you know, very complex disease and case management. Silver Sneakers and Silver Steps are the exercise programs, so for Humana it's about keeping them not only physically fit and mentally fit with Posit Science. Posit Science is our exclusive benefit where it's a program that's scientifically proven to reverse the aging of the brain, and the exciting news is that we've also reached agreement with Posit Science to offer it to all of our supporting providers exclusively.

So if you go to Humana's Web site, you can get information about that, I gave Bill a - one of the coupons that go along with that program for providers, because what we found was nine times out of 10, in any setting when we talked about Posit Science, because it's so exciting, the providers - the providers would say well what about me? How can I get it for myself? So we acknowledge that request and have reached an agreement with Posit Science to offer you all that too.

The next couple of slides are basic information about PPO, and then private fee for service. And I think I will let you read those on your own since you do have the slides. Obviously the private fee for service has grown significantly I think for all plans, because the network is not contracted, it's a very - it should be a very simple product to administer, and the seniors that are buying the product still experience the freedom of choice amongst the providers in the community to the extent that they accept the plan's terms and conditions.

Bill Finerfrock:

You have one minute, Elizabeth.

Elizabeth Strombom:

OK. Thank you, Bill. The next slide is just a reiteration, we keep this in all of our presentations where there is internal or external. Just to reiterate the CMS regulations about the deeming status under private fee for service. And then also the Medicare participation status, because there have been a lot of questions about balance building depending on one of those three.

If there are questions, please feel free to e-mail me about this slide, this slide usually generates, you know, a good half hour of discussions. But I don't have that time at this moment.

The next is our private fee for service, our participation terms and conditions, and those are also available on our Web site. And then the next slide, I'm on slide - I think it's 12 - is the detail on the critical access hospital and the rural health - or rural health clinic payments. And really for us, it's mirroring what you get for Medicare, we created a Medicare settlement unit a couple of years ago, we've - we're seeking some consulting help from folks like yourself out in the markets, and as long as we have your FI rate setting letter, and we understand if you're a critical access hospital that you - and you may be attached to one about method one or method two, we think that we fully understand it now, we're getting it right, at least that's the feedback that we're getting.

The questionnaire comment at the bottom, if you have not filled out a Humana questionnaire - and it's not a questionnaire like a survey, so please don't misunderstand, it is a detailed reimbursement questionnaire, it's not a contract, but what it does is it helps us make sure that our systems are prepared to pay you correctly. So if you haven't seen one for your facility type or your group type, please send an e-mail to Imogene Milton and - so we can get that to you. This is another document ..

Bill Finerfrock:

You need to wrap it up ...

Elizabeth Strombom:

OK, this is another document that would be very helpful. The rest of the slides are basic administrative information on admissions, how to file claims, and then of course our E capabilities.

Bill Finerfrock:

OK, thank you, Elizabeth, and thank you to all of our participants today. Before we begin the Q&A, I have a couple of questions, or some issues I'd like each of you to speak to before we open up the lines.

First if each of you could briefly discuss what - how you handle bad debt issues with regard to rural health clinics. As you know, rural health clinics are allowed to claim bad debt on their cost reports. How would - how would that be handled by each of your plans? And you can go - just chime in whoever wants to go first, or I can call out the names, whichever is easiest.

Robby Swinson:

I'll go ahead and start it off, this is Robby from Sterling. We - Sterling, just recently made a change effective for claims as of 1/1/07, I think actually we're going back for claims in '06. But you can recoup for bad debt under Sterling, you would use the exact same form that you would use for Medicare, and Sterling is paying 101 percent on the bad debt, so you really just use the same requirements that you do for Medicare, in other words, you have to make every reasonable effort to collect for that bad debt. And if you are unable to collect, and we're talking specifically about the uncollectible co-pays under this plan, and then you can use the same form for Medicare and receive reimbursement for bad debt under Sterling Option One and Sterling Option Two.

Bill Finerfrock:

Great, thank you. Whoever, Gerry, Anthony or Elizabeth? Whoever wants ...

Female:

Hi, this ...

Anthony Girgenti:

This is ...

Female:

Oh, go ahead.

Anthony Girgenti:

This is Anthony Girgenti with Today's Option. Currently at the moment, Today's Options does not reimburse for bad debt. However, we're - our expectation is to reimburse for bad debt within the last quarter of this year.

Bill Finerfrock:

OK. Gerry or Elizabeth?

Elizabeth Strombom:

This is Elizabeth. At Humana, we have agreed early on that our goal is to mirror the reimbursement and we will process bad debt reimbursement for any of our members similar to the way that you do for Medicare. So the same as mentioned by Sterling, if you keep the same logs, the same information, we will cost settle that with you as well.

Bill Finerfrock:

OK. And either Gerry or is - Jaime, are you on? Whoever wants to answer that for your folks.

Gerry Payne:

I received a confirming e-mail that Jaime had logged on, but I don't hear - I don't ...

Jaime Reynoso:

This is Jaime, I'm here.

Gerry Payne:

Oh, go ahead, Jaime.

Jaime Reynoso:

Yes, and we have the same process as well, that the providers would just need to complete the form, the same form that they would fill out for Medicare, and then we would go in and again process those claim by claim and make the adjustments for the bad debt.

Bill Finerfrock:

OK. Are all of your plans able to test for the NPI? And are you recommending providers to start using their NPIs along with their legacy numbers prior to the May 23rd effective date?

Elizabeth Strombom:

Bill, this is Elizabeth. We are - we have been testing for quite some time, and if a provider does bill with both, we can handle that. It actually would be better if you - if they were doing that early on just to sort of debug any issues that come up. But it's not a requirement.

Bill Finerfrock:

OK. To the others, are you all capable of processing testing with the NPIs?

Robby Swinson:

Yes, this is Robby from Sterling, we are in the - in the testing phase, but we are accepting both.

Bill Finerfrock:

OK.

Anthony Girgenti:

Anthony with Today's Options, the same, yes.

Jaime Reynoso:

Yes, and this is Jaime with United, same here, we can accept both.

Bill Finerfrock:

OK. One last question before we open it up to the others, similar to the bad debt, how are each of your plans handling flu and Pneumonia Vaccine payments for the RHCs? As you know, those are separately determined payments for those on a separate sheet of the cost report, and those are 100 percent covered costs for the RHC.

Jaime Reynoso:

Yes, this is Jaime from United. We have it set up to where if the provider submits either on a 1500 or a UB, we can pay those against the CMS fee schedule.

Bill Finerfrock:

OK.

Rachel Graybill:

This is Rachel with Sterling, we also have it set up for UB or CMS1500 to pay that physician fee schedule.

Bill Finerfrock:

OK.

Anthony Girgenti:

Anthony with Today's Options. Once again, same, UB - or 1500.

Bill Finerfrock:

OK.

Elizabeth Strombom:

And this is Elizabeth, we have - we make it optional for the providers to either cost settle, again mirroring exactly how you do it for Medicare, or to get paid on an interim basis.

Bill Finerfrock:

OK. Operator, at this point, we'd like to open it up to questions from the audience. When a - when your phone lines - the operator will give you the instructions, we do ask that you identify where you are calling from so we get a sense of the state. Also that would probably be - might be helpful to the folks from the plans to know where the calls are coming from, feel free to direct your question to a specific plan, or to all of our presenters today. Operator, would you please go through the instructions for - to submit their - or ask their questions?

Operator:

Certainly. If anyone does have a question, you can signal at this time by pressing star one on your touch-tone telephone. If you're on a speakerphone, please make sure your mute function has been turned off to allow your signal to reach our equipment. A voice prompt on your phone line will indicate when your line is open to ask a question. Please state your name and location before posing your question. Again if you have a question, please press star one at this time.

And we will take our first question.

Bill Finerfrock:

Go ahead.

Linda Oatman:

Hello?

Bill Finerfrock:

Hello.

Operator:

Your line is open.

Linda Oatman:

My question is for all the plans, wondering what's ...

Bill Finerfrock:

Will you please identify yourself?

Linda Oatman:

Oh, I'm sorry, Linda Oatman with Mercy Medical Services in Iowa.

Bill Finerfrock:

OK. Go ahead, Linda.

Linda Oatman:

This is for all plans. I'd like to know if they have general procedures and/or forums to do voluntary refunds, appeals, inquiries or adjustments. I kind of get different answers every time I call, so I just kind of want to know what to do specifically for each plan. And that's it.

Bill Finerfrock:

Go ahead. I'll just call out everybody and to facilitate it. Gerry, you want - or, Jaime, you want to go first? Hello?

Jaime Reynoso:

Yes, this is Jaime.

Bill Finerfrock:

Do you want to answer her question first? And we'll ...

Jaime Reynoso:

Sure, I guess I want to clarify, are we talking refunds when you feel that there's been a duplicate payment or an overpayment?

Linda Oatman:

That's correct.

Jaime Reynoso:

OK. Yes, the process is you can either contact the provider services phone number, or you can mail that directly to our regional mail operation, and those requests would actually go through our audit and recovery units, they're the ones who handle any refunds, or any overpayments, or duplicate payments, and get those processed appropriately. But I think your best bet would be to go through the provider services unit to get that ...

Linda Oatman:

Do you have a form in place that providers can use?

Jaime Reynoso:

Yes, they would have a form that you could fill out and get that submitted. And I'm - I'll have to refer to Gerry, I'm not sure if it's posted on our Web site, but if it's not, we could actually get that posted there.

Linda Oatman:

That would be nice.

Bill Finerfrock:

OK. Robby or Rachel?

Female:

We do, with the providers that contact our customer service department and let us know that there has been an issue, at that time we would enter it and submit a letter to the provider asking them for the money back, or they can go ahead and just mail in the refund along with documentation stating who the patient, date of service and to bill charges on the claimant in question.

Linda Oatman:

So again there is no form?

Female:

There isn't at this time, but it's definitely something we can look into.

Bill Finerfrock:

And that was Sterling, correct?

Female:

Correct.

Bill Finerfrock:

That was Rachel or Robby from Sterling? Just ...

Female:

Right.

Bill Finerfrock:

... so that folks know when they answer who was answering that - that was - I don't know whether it - but that was the Sterling?

Female:

Yes.

Bill Finerfrock:

OK. Anthony?

Anthony Girgenti:

Hi. Under Today's Options, the - ideally you would contact your provider relations representative in your state, and/or the provider relations department, and they would coordinate the completion of any form necessary to address that. But that's the - that's the traditional route to go through.

Bill Finerfrock:

OK. Humana, Elizabeth?

Elizabeth Strombom:

Yes, same information here. Contact our provider services department at the 800 number, or contact your local director of operations, which they have regional responsibilities.

Bill Finerfrock:

OK. I'm going to ask one of the questions that was e-mailed in. When an established Medicare patient gets one of the Medicare Advantage plans, what are we as rural health clinics obligated to do? We do not participate in any of these plans yet, it is difficult to handle when your long time established patients now has this coverage. If we accept the card and bill, are we then locked into their reimbursement for that date? Can we balance bill the patient even though the EOB states we can't? Or are we out of any reimbursement because we accepted this card? Jaime or Gerry?

Gerry Payne:

Jaime?

Jaime Reynoso:

Hello.

Bill Finerfrock:

Hello.

Jaime Reynoso:

Yes, I just want to confirm, you're talking about if the - did the provider know in advance that the member had private fee for service, or did they not?

Bill Finerfrock:

Apparently they've accepted the card; I presume that that meant that they had some level of advanced notice.

Jaime Reynoso:

Yes, as long as they accept that card, then that provider is considered deemed, and then they have to abide by the terms and conditions of the plan.

Bill Finerfrock:

For that particular visit?

Jaime Reynoso:

That's correct, for that visit only.

Bill Finerfrock:

So they are not part of the program.

Jaime Reynoso:

Right, it's a visit by visit basis.

Bill Finerfrock:

OK. And is that the same for everybody else? Just - I know it is, but I just - you know, for everybody to confirm.

Anthony Girgenti:

Yes, that's true under Today's Options as well.

Bill Finerfrock:

OK. And are they out of any reimbursement because they've accepted the card?

Female:

Well they're entitled to receive whatever that plan's reimbursement is for that service.

Bill Finerfrock:

They should be receiving an amount equivalent to what they would have received had that patient come in under traditional Medicare?

Male:

Correct.

Female:

That's correct.

Bill Finerfrock:

Right, OK. All right, next call, operator, open up the line for a call from the participants.

Operator:

And caller, please state your name and location before posing your question.

Bill Finerfrock:

Go ahead.

Sue Morrison:

Hi, this is Sue Morrison from Hickory Flight Clinic, Hickory Flight, Mississippi, and this is concerning flu and pneumonia vaccine reimbursement. You stated that you pay us the same as our traditional Medicare does, submit it on claim forms. Well currently we send that roster billing to River Bend, and that is how they know how many vaccines that we gave, and we also do the calculations determining the cost of each vaccine, you know, that's part of the submission of paperwork. So how do you want to receive this information?

Bill Finerfrock:

Jaime?

Jaime Reynoso:

Yes. The way that it's set up is that we have to - you have to submit that to us on a 1500 or on a UB. Those - River Bend and those other providers will not allow you to submit it for reimbursement through them, it'd have to come to us to get on a schedule ...

Sue Morrison:

Well that's - I understand that, but are you saying we wait until we get our - until we do our cost report, and then we submit to you the cost per vaccine on a 1500, or a UB92 form?

Jaime Reynoso:

No, you can actually submit it on as soon as you see the patient and you get that vaccination ...

Sue Morrison:

But you're talking charge then, you're not talking cost.

Male:

We're giving you the option to either do it - if you do it cost, then you do it at the end of the year, for some there may be a cash flow issue, because you're getting it ...

Sue Morrison:

Correct.

Male:

... the year, some folks may want to get that money immediately, maybe it's a little bit less than what you would have if you waited, but you have a improved cash flow situation. So I believe what the plans are saying is you have the choice of doing it on the 1500 and getting charges, or doing it at the end of the year and doing it on a cost settlement.

Sue Morrison:

So do you ...

Male:

Correct.

Sue Morrison:

... do you have an established reimbursement amount per vaccine then that we will know out front what we will be receiving if we do it, you know, as the patients come in versus waiting until the end of the year?

Female:

Yes, the reimbursement for the flu and pneumonia are driven off of what the - what CMS publishes for those.

Male:

It's off of the Medicare fee schedule.

Female:

That's correct.

Male:

OK.

Female:

And each of the carriers out there publish those.

Sue Morrison:

Having never used one, because we've always done rural health clinic reimbursement, I don't know what that number is. Can you tell me?

Male:

I suspect it varies from carrier to carrier because of geographic adjustments that can occur.

Sue Morrison:

But we do know ...

Female:

Correct, if you go to your ...

Sue Morrison:

... we do know what the, you know, or has been the maximum rate they will pay us if we do a - if we sent it in under cost, you know, under roster billing.

Male:

Right.

Sue Morrison:

And ...

Female:

Yes, if you go out to the carrier Web site for your particular area, for Mississippi you would just go out to the carrier Web site, and you can actually punch in the code that you would be billing, and it should be able to give you what the fee schedule amount is.

Sue Morrison:

Is it possible to submit the ...

Male:

We're going to have to move on; we have a lot of questions. And I understand that you've got questions here, but I think that ...

Sue Morrison:

I think this probably is a question by most rural health clinics, excuse me, Bill.

Bill Finerfrock:

That's all right. Well I'm just trying to - there may - there are other questions that people want to ask too. So if you could try and make it quick.

Sue Morrison:

Well that's all; I will cut my own self off.

Bill Finerfrock:

OK. I apologize, it's just I know we've got other people waiting to ask questions. And hopefully we can create opportunities to do this again.

Operator, next question.

Operator:

And we'll take our next question. Please state your name and location before asking your question.

Bill Finerfrock:

Go ahead.

Georgeen:

Good afternoon, my name's Georgeen, and I'm calling from North Carolina. And for the ones, especially Humana, that have said that they will cost settle, where is an address? I have called several different times, and everybody's saying they don't know anything about cost settlement.

Bill Finerfrock:

Elizabeth?

Elizabeth Strombom:

Yes, this is Elizabeth. Bill, I don't know if it would be appropriate to provide my e-mail address to anyone on the phone, but if you send me an e-mail, we will send - I can send you the address in Louisville for the Medicare settlement unit.

Bill Finerfrock:

Yes, any e-mail addresses, any Web sites that anyone wants to give out, particularly if it facilitates the movement of information, please feel free to share those. So, Elizabeth, if you want to give your e-mail address out, go for it.

Elizabeth Strombom:

Sure. It's Estrombom@humana.com, which is E and then S-T-R-O-M like Mary, B like Boy, O-M like Mary at Humana.com.

Bill Finerfrock:

And just one of the written in questions, did ask that - who is the contact person for each of your organizations that rural health clinic questions should be directed to, the name, phone and e-mail? Can all of you give that out as to where questions rural health clinics have questions, they can direct those to?

Elizabeth Strombom:

Bill, this is Elizabeth again. I'd offer to give you a map of the country that shows our regional directors, and I can e-mail that to you, so that was from our conversation in San Antonio.

Bill Finerfrock:

OK, we will - we - anything that any of the plans want, we will distribute through the rural health clinic technical assistance list serve, and we can also arrange to have that posted up on the - or if it's a rural health policies Web site so that if you can't receive the e-mail, you can go and download that.

Anthony Girgenti:

Right. And that's the way that we handle it with Today's Options that we have a map of our service area with the provider relations rep in that area that are the immediate contact for any questions, concerns, issues, et cetera related to providers.

Bill Finerfrock:

OK. Either Jaime or Rachel?

Rachel Graybill:

This is Rachel with Sterling. If providers have questions in regards to rural health reimbursement or their claim submission, they can actually contact me, my number is 888-858-8544, extension 20129.

Bill Finerfrock:

OK.

Rachel Graybill:

And my e-mail address is Rachel, it's R-A-C-H-E-L dot Graybill, G-R-A-Y-B as in boy, I-L-L at Sterlingplans.com.

Bill Finerfrock:

And Jaime for SecureHorizons?

Jaime Reynoso:

Yes, actually that would be a Gerry question; I'm not familiar with the provider relations.

Bill Finerfrock:

OK, Gerry.

Gerry Payne:

We have two ways of reaching us, the first is through our customer service number, 866-579-8774, and in each state there is a Senior Medicare Executive who can be reached, and if you want to contact me, I can let you know who that individual is. My e-mail is GPayne, P-A-Y-N-E, at UHC.com.

Bill Finerfrock:

OK. Next call from the phones.

Operator:

And our next question.

Bill Finerfrock:

Go ahead. Caller?

Operator:

Caller, your line is open. Hearing no response, we'll move to our next question.

Bill Finerfrock:

Go ahead.

Sue Morrison:

Hello?

Bill Finerfrock:

Hello.

Sue Morrison:

Hi, Bill, I have a question please, I just want a verification.

Bill Finerfrock:

Could you identify yourself?

Sue Morrison:

Yes, I'm sorry, this is the other Sue Morrison at Sparta Hospital; I understand there was one previously.

Bill Finerfrock:

OK.

Sue Morrison:

I have a question, I just want a verification that none of these Medicare Advantage plans follow like the local Medicare coverages for certain things, such as Procrit or Nupigen injections, is there criterias you have to follow? Or can you advise us on how some of that is determined please?

Bill Finerfrock:

OK. Let's just mix it up a little bit, Elizabeth, you want to go first?

Elizabeth Strombom:

Sure. I think someone had said it earlier in their presentation, and the same goes for Humana that we are responsible for covering the national coverage decisions, and as well as the local coverage decisions. So if there's something that we're not covering that we should be, then I would like to know about that.

Bill Finerfrock:

OK. Rachel, how do you handle local coverage decisions, determinations?

Rachel Graybill:

We also follow Medicare's local and national coverage determination.

Bill Finerfrock:

OK. Anthony?

Anthony Girgenti:

As well does Today's Options.

Bill Finerfrock:

And Gerry or Jaime?

Female:

Yes, it's the same here; we have a national committee that reviews all of the NCDs and LCDs.

Bill Finerfrock:

OK. How do you - this is a question that was e-mailed in. They wanted to know how you determine the payment rate for your rural health clinics when you're paying your rural health clinics, how do you determine the rate? Elizabeth?

Elizabeth Strombom:

I think I mentioned it during the presentation, we need the FI rate setting letter, and we would load that information into our system to process the claims in accordance with that, and we request that anytime you have an update to please submit that to us.

Bill Finerfrock:

OK. Rachel?

Rachel Graybill:

We make every attempt to get the rate letter provided to the provider, and if we're unable to obtain a copy of that rate letter, we do use a national limit that is set at that time, use 80 percent of that plus 20 percent of the rural health billed charges ...

Bill Finerfrock:

OK.

Rachel Graybill:

... to come up with the Medicare allowed for that visit.

Bill Finerfrock:

OK. Jaime?

Jaime Reynoso:

Same here, we request that the facility submit the fiscal intermediary rate letter at the time of the first claim submission, and then also in - when they do get a new rate letter that they would submit that change to us as well.

Bill Finerfrock:

OK and Anthony?

Anthony Girgenti:

Exactly is the same way, we request the - initially the rate letter, so we set the provider up correctly in our system, and then certainly any subsequent changes to the rate letter for them to notify us as well.

Bill Finerfrock:

OK. Next call, operator.

Operator:

And just a reminder for our questioners, a voice prompt on your phone line will indicate when your line is open to ask a question. We'll go to our next question.

Bill Finerfrock:

Go ahead.

Waneta:

Hey, this is Waneta, and I'm calling from Hainesville, Louisiana. And my question is for Humana. I see where there's different plans, the HMO, the PPO and the PFFS, and we are part of the PPO. Now does that pay the rural health clinic reimbursement rate?

Elizabeth Strombom:

The PPO is a contracted product, so it would pay in accordance with the terms of your contract.

Waneta:

OK.

Elizabeth Strombom:

So I don't know - you know, specifically what the language in your contract is that you signed, but for the most part, the contracts that we are signing in the rural setting do mirror the reimbursement that you get on - from regular Medicare. So it should look very much like the private fee for service.

Waneta:

OK. All right, thank you.

Bill Finerfrock:

Next caller.

Operator:

And our next question.

Marty Bennett:

Hi there, this is Marty Bennett from Riverside Family Medicine in South Louisiana. I am directing a question specifically to Humana. We file electronically through a clearinghouse now our claims that are being filed to the choice plus program; are they going to - can they be submitted the same way just on a institutional claim?

Elizabeth Strombom:

Yes, they should be able to go through the same way.

Marty Bennett:

OK. Is there any additional paperwork that's required to - will they be channeled by whatever patient identifier?

Elizabeth Strombom:

They should be routed - yes, they should be routed appropriately. But again, we'd still need that FI rate setting letter to make sure that we know how to process the claim.

Marty Bennett:

And who is the - I mean is it just provider relations, or provider enrollment that we call to submit that information to?

Elizabeth Strombom:

Yes, we have a national provider relations number.

Marty Bennett:

OK.

Elizabeth Strombom:

And you know what, Bill, when I send you the map that has all of the directors and their e-mail address and telephone numbers, we will list that other information ...

Bill Finerfrock:

OK.

Elizabeth Strombom:

... on there. And I also have the settlement unit, I don't know if Georgeen is still on, or if she would just e-mail me, I have the address for the settlement unit here in Louisville.

Bill Finerfrock:

OK. I'll take a question that was e-mailed in, this is actually SecureHorizons, this person is having trouble getting their claims paid. They say they submitted a claims, to have them come back stating that they didn't - first time didn't have a CPT, second time they didn't have the rate letter, and then the last time they said, oh by the way, this person isn't on our plan. If the - if folks have questions, or are having problems, is there a particular person or place they should go as a rural health clinic for SecureHorizons? Gerry? And maybe it's the information that you gave out earlier if that's the case.

Gerry Payne:

Yes, the first - the first point of contact would be the number I gave out initially.

Bill Finerfrock:

OK.

Gerry Payne:

If there are any long standing issues that have not been resolved, I would - please submit them to my e-mail address, and I can forward them on to a specific service recovery unit that can address them.

Bill Finerfrock:

OK.

Gerry Payne:

Again that e-mail is Gpayne@UHC.com.

Bill Finerfrock:

OK, great. We're going to go a little bit over, if we've got some more questions, operator.

Operator:

We do have several in the queue.

Bill Finerfrock:

OK, let's try and take some more from the calls.

Operator:

And our next question.

Bill Finerfrock:

Go ahead.

Marian:

Yes, my name is Marian, and I'm calling from Minnesota. And I guess I along with some of the others have had many issues and problems with our pneumonia vaccine and flu shot vaccines with Humana. I still have not been reimbursed for 2005. And I'm hoping that with this e-mail address, that Elizabeth will be able to help me get this resolved.

Elizabeth Strombom:

Absolutely, please send me that information so we can - now do you know if you've submitted the roster bill ...

Marian:

I have submitted I think six or seven times roster billings ...

Elizabeth Strombom:

OK.

Marian:

... and they seem to get lost, and then the people I've contacted disappear, and I'm lost again.

Elizabeth Strombom:

OK. If you could send that to me ...

Marian:

OK.

Elizabeth Strombom:

... I'd be happy to work on that with you.

Marian:

OK, I really appreciate that. Thank you.

Elizabeth Strombom:

Sure. I apologize for that.

Bill Finerfrock:

Take another call.

Operator:

And our next question.

Bill Finerfrock:

Go ahead, caller.

Gary Brand:

Yes, hello, this is Gary Brand at Riverside Medical Center. I'm - we're a critical access hospital, and I have a question about how the fee for service will reimburse us for the outpatient claims. Will they pay them at the same rate that our Medicare pays, you know, from our cost report percentage rate?

Sandy:

Yes, this ...

Bill Finerfrock:

Go ahead.

Sandy:

... hi, this is Sandy from UnitedHealthcare.

Gary Brand:

Yes.

Sandy:

For critical access hospitals, we set you up the same, we would get a copy of your most recent interim rate letter, and we would set you up with the appropriate per diems if you have acute or swing bed, or even if you have psyche and rehab. And then we would put the appropriate outpatient percentage that's on your rate letter.

Gary Brand:

All right. And is there - I heard you say that we could get our bad debt paid by filing the same form that we used for Medicare at the end of the year.

Sandy:

That's correct.

Gary Brand:

And is there any other advantages? Our hospital has been inundated with people with - the Advantage plans, fee for services, and we - the only one we're taking that we have had so far is Sterling, because we were afraid how it will affect our cost report at the end of the year, since it would diminish our payer rate.

Bill Finerfrock:

I don't know whether folks can handle that, and the topic here is more rural health clinics.

Gary Brand:

Understand.

Bill Finerfrock:

... hospitals. So perhaps with the e-mail information that you've got, you can contact some of the folks directly, and they would be able to give you more information on how they're handling critical access hospitals.

Gary Brand:

All right, but to recap, you actually would pay - be paid at the same rate that Medicare pays, and we could do our bad debt - send them to the fee for service plans at the end of the year?

Female:

That is correct.

Gary Brand:

OK.

Bill Finerfrock:

OK, next question callers - from the callers. Go ahead, caller.

Lisa:

Hello, this is Lisa with - in Emmett, Idaho, and I have a general question, and then also a question for SecureHorizons.

Bill Finerfrock:

OK.

Lisa:

For SecureHorizons, we have been getting rejections trying to send electronic claims because of the ...

Female:

ID number.

Lisa:

... the ID number.

Bill Finerfrock:

OK.

Lisa:

Do we - do you have a different ID number that we should be using for the ...

Female:

Are you using 87726? Do you know? The payer ID?

Lisa:

That's - yes, that's probably - I think that that's the one - it's the one for UnitedHealthcare

Female:

That's correct.

Lisa:

OK, I believe that's the one we had tried to use in the past, and we were still getting rejections on it.

Female:

If you would e-mail that to Gerry, he can forward that on to us, and we can take a look at that and find out why it's rejecting.

Lisa:

OK, we'll do that. Thank you.

Female:

It might be an issue with the clearinghouse that you're using.

Lisa:

It's Emdion Sage.

Female:

OK.

Lisa:

... whatever their name is these days.

Bill Finerfrock:

OK.

Lisa:

And then my general question was about the deeming, and I'm - I had not heard that term before. I'm assuming that that means we are deeming if we - if a patient presents with a new ID card for one of these Medicare replacement products, and if we see that patient, we are thereby deemed, is that correct?

Female:

That is correct.

Male:

Yes.

Lisa:

And if we don't know that the patient has changed insurances until we actually see them, we're still obliged to ...

Bill Finerfrock:

Well what Medicare says is that if you know that the patient has enrolled in the Medicare Advantage product, and you treat that patient, you are deemed to have accepted the terms and conditions of payment from that plan. I think what you're asking is what if you don't know that the patient has enrolled in a Medicare Advantage plan, does that change anything? And ...

Lisa:

That is correct, my question ...

Bill Finerfrock:

OK, would one of the plans care to - how to - what happens when a provider sees a patient without knowingly - without knowing that they've enrolled in one of your products?

Rachel Graybill:

This is Rachel with Sterling. If a provider sees a patient from Sterling that they did not know had Sterling, and they had attempted to inaudible on Medicare, and get the denial stating that they had a Medicare Advantage plan, they can actually contact our customer service department and that claim will be reviewed, and it will be determined if that provider was not deemed at that date of service, and we would make sure that it was reimbursed at the exact rate they would have gotten from original Medicare.

Bill Finerfrock:

Will Medicare tell them what plan that patient's enrolled in?

Rachel Graybill:

I believe they have to contact Medicare to find out, I don't believe the denial shows them which Medicare Advantage plan they have.

Bill Finerfrock:

OK. All right, we'll take one last question from the callers, we're going to have to wrap it up, we've gone over, and I've - I appreciate everybody's willingness to go longer, I know we had a lot of questions. And we can take one last call from the callers.

Operator:

Our next question.

Rosie:

Hi, this is Rosie from Venture Care Clinic in Minnesota. And on Humana, they are talking about the HPSA PSA bonuses saying that it's not necessary for a provider to request this bonus payment. What about the other ones? Are you going to be paying on those HPSA PSAs also for non rural health?

Jaime Reynoso:

Yes, this is Jaime from UnitedHealthcare. We accept those; however, you would have to file with the appropriate modifiers in order for us to know that you're eligible for that reimbursement.

Rosie:

But we don't have to for Medicare, but we would for you?

Jaime Reynoso:

That's correct.

Rosie:

OK. How about the other ones?

Rachel Graybill:

This is Rachel with Sterling. I'm not myself familiar with how the HPSA bonus works, but if you want to e-mail me your information, I can have someone contact you in regards to how we do process the HPSA bonus.

Rosie:

OK.

Bill Finerfrock:

All right, well I want to thank first of all, all of our plan participants, Gerry Payne and Jaime Reynoso with SecureHorizons, Elizabeth Strombom with Humana Gold Choice, Robby Swinson and Rachel Graybill with Sterling Health, and Anthony Girgenti with Today's Options Pyramid Life.

It's - you know, the - it's - the time that you're spending is greatly appreciated by the National Association of Rural Health Clinics in general, and the rural health clinics providers in particular. And taking the time to answer their questions, and sometimes folks have problems, and sometimes things are great, but the way we can resolve it is through communication and questions and answers such as this. So we really appreciate it.

I want to thank all of our participants today, and I also want to thank the office of Rural Health Policy for sponsoring this series. A transcript of today's call will be made available and will be posted on the ORHP Web - ORHP Web site, and we'll announce when that is available.

The next rural health clinic call is tentatively scheduled for Tuesday, May 8th, 2007 at 2:00 Eastern, topic and the presenter information will be announced shortly. But if you'd like to put that on your calendars as a reminder, go ahead.

In the next call, we will also e-mail announcements about that, if you know others who would benefit from participating in this series, please direct them to the ORHP Web site, and there's instructions on how to sign up so that we can have e-mail addresses for those folks.

Again thank - I want to thank everyone for participating, and the time you spend with us today.

Female:

Thank you.

Operator:

That does conclude today's conference. We thank you for your participation.