News Index | The Kentucky EMS Connection Main Index

#

Task

Status

1

Resolve the issue of the HCFA Program Memorandum referred to in the KY Ambulance Association meeting on 10/5/00 and recommend corrective actions as appropriate

10/20/00: Letter to KY Lt. Governor drafted and forwarded to D. Vargas, Chicago Regional Office.

Corrected letter sent 10/23/00.

Task Closed

2

Conduct an internal sample of previously denied ambulance claims in both IN & KY to determine:

1. proper procedures followed
2. difference between EMC vs. paper
3. denial reasons

Sample size increased to 30 from each state. Review of the sample is complete. Preliminary numbers indicate 17% of the denials should have been paid. Further analysis is required. We anticipate completion by 10/31.

3

Conduct an internal review of Appeal reversals in IN/KY for indication of:

1. internal procedures
2. % reversed from the sample of reversals
3. who are the providers and what is pending/ completed for each.
4. Determine % developed for "run sheets"

Sample size increased to 30 from each state. Review of the sample is complete. Preliminary numbers indicate 17% of reversals in IN were incorrect and 27% of reversals in KY were incorrect. Review of additional documentation provided at the review level should be complete by 10/31/00. Cases pending and cases complete by provider will be complete by 10/30/00.

4

Gather and document CPT and denial rates for ambulance claims for the last 12 months in both IN & KY.

Will add a total # processed to the summary sheet.

Sent to HCFA 10/27/00

Still working with programming staff to include nonassigned claims.

5

Verify SOP for processing ambulance claims is consistent between IN & KY.

1. resolve differences

b) do we agree with the SOPs

Inconsistencies in process have been identified and will be standardized by 11/15. We are still reviewing internal policies for any changes deem necessary. This will partially be driven by the results of items 2 & 3.

6

Customer Service processes for responding to ambulance providers telephone inquiries will be reviewed/evaluated.

1. Retrained selected Provider telephone staff
2. Effective 10/23/00 a new vector option will allow ambulance calls to go directly to the select staff
3. Clarified and rewrote SOP for Bene liability inquiries

7

All telephone CSRs will be prepared to respond to bene or provider inquiries due to any media coverage.

Action completed 10/13/00

7a

Contacts to CSRs from media forwarded to Manager for referral to Media Relations.

Action completed 10/13/00

8

A standard response to Congressional inquiries will be developed and shared with media relations staff.

Complete 10/13/00

9

Congressional liaison staff will contact key congressional offices by telephone to share our actions regarding the Ambulance Associations’ concerns.

IN contacts made 10/16/00. Contacts continuing.

10/19/00 communicated progress to D. Vargas.

All IN/KY offices were contacted by 10/31/00.

All IN/KY offices will receive the External Action Plan on 11/17/00.

10

Define action items resulting from the 10/5/00 KY meeting.

Complete. See items 10a through 10f.

10a

KY association requesting use of condition codes not yet mandated.

Draft is being written. . Received comments from Indiana Ambulance Assoc., comments forwarded to HCFA 11/9.

10b

Medicare/Medicaid crossovers – KY association reports problems.

Researching.

10c

60-day flag on ESRD beneficiaries – special request from KY association.

Request will be denied based on MM 4115 to review services on a per-visit basis for medical necessity.

10d

ICD-9 codes for EMC claims – KY association requesting ASF to assign ICD-9 codes to providers who file electronically.

Initial feedback to KY association is that ASF does not feel this necessary.

10e

Re-submission of denied claims in KY currently in Appeals inventory when provider believes sufficient documentation was submitted with initial claim.

10-30-00 – approximately 200 claims have been resubmitted for re-evaluation; two errors have been found to-date. These require additional validation, progress will be reported 11/28, the complete review will extend beyond that date.

10f

Downcoding of ALS to BLS – KY only

Training issue in KY MR - corrected.

11

Establish initial and on-going meetings between the ambulance associations and ASF.

Both associations contacted – initial meetings set.

IN – 10/20/00; KY – 10/26/00. 11/14 second KY meeting held. IN several dates offered, waiting final date from Ambulance assoc. Both associations will receive the External Action Plan on 11/17/00.

12

Update Action Plan weekly with copy to HCFA.

Last updated plan sent to HCFA on 11/16/00.

13

Notify ambulance providers of progress and/or additional education needs.

ASF will begin mailing a monthly newsletter to each ambulance provider in IN & KY with updates and status.

First newsletter to go out 11/6. Being mailed 11/15.

14

Identify ATP (Automated Transaction Processing) specifications for HCFA.

Completed 10/27/00.

15

Confirm current claims inventory in IN & KY as it regards ambulance claims.

Updated inventory report sent to HCFA on 11/16/00.