Data Analysis

Highmark Medicare Services has a comprehensive CERT program. HMS analyzes CERT data on a bi-annual basis and plans to expand this analysis to all five of its jurisdictions.  They focus on key variables such as BETOS group, bill type, procedure, county and specialty.  HMS utilizes several methods to address these topics.  An Evaluation and Management (E&M) section was created on their website which focuses on the topics and includes an E&M scorecard.  The CERT program was a key driver behind their part A education.  HMS conducted an outpatient hospital workshop which educated providers on the top three CERT errors for hospitals in the outpatient setting.

Pinnacle Medicare Services performs in-depth analysis of the telephone and written provider/supplier inquiries and utilizes this information on a monthly basis to formulate educational offerings.  The results are discussed internally as well as with their Process Improvement team (PIT).  The findings from their Inquiry Analysis Program will be incorporated in denial management presentations, focus groups, specialty organization presentations, FAQs and one-on-one contacts.  Additionally, special newsletter articles are developed when appropriate.

Educational Events

FCSO introduced three education programs: Right Start, Right Track, and Rural Provider Assistance. The results have been promising. They also host an annual "Medifest Symposium" which includes 23 interactive workshops.

WPS hosted a CERT workshop "Save Dollar, Avoid Denials" which provided specific examples of unprocessible denials and modifier usage.  The information shared in this program resulted in significant reduction in their claim error rate.

Partnering with External Entities

NGS  invited the Recovery Audit Contractor (RAC) to participate in Provider Outreach and Education (POE-AG) meetings as well as education sessions. Based on discussions during the advisory meeting, they determined that a special training session should be developed for IP Rehabilitation providers to be presented at the California face to face sessions. They partnered with the RAC and the ratings were positive. Providers indicated it was extremely beneficial to have all the  players in one room. With the transition to the new RAC, several requests were received from the provider community to schedule similar programs like the one presented in California.

Internal Development of Provider Issues

PBSI forwards the suggestions of their POE-AG group to their various internal workgroups for them to evaluate and consider possible enhancements to their current program.

NAS utilizes the interdepartmental meetings to identify training needs of CSRs, Written Correspondents, and Provider Relations Research Specialists (PRRS).

Technology

CGS DME MAC utilizes  an "Audion hybrid"  which allows for digital audio recording of all Webinars, ACT calls etc. and will allow them to post "encore" education from their website.  CGS also videotapes messages, workshops, and seminars and packages them for viewing on their website.  They plan to offer DVD copies of any online video instruction for those without internet access.

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Page Last Modified: 01/14/2009 9:38:31 AM
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