Michigan



Reimbursement Committee MinutesJune 15, 2016 @ 9:30am Call to Order: Attending: Dawn, Eric, Stacy, Beth, Lori, Mary, Kim, Mike, Tim, Fred, Barry Introductions: Kerri Allen Acceptance of Minutes: AcceptedReports Executive Director Report – Barry CargillHospice has been invited to now join the Reimbursement committee meetings, this will be on the agenda as a discussion as to whether this should be a joint meeting or if Certified and Hospice have separate meetings. Old BusinessBCBSM SCIO Audits: Some have started to get another round of audits but they seem to be doing better as far as rejecting or pass from SCIO. New Business BCBS - Hospice working to address combined rate in fee schedule, they are not getting the 227.00- all are experiencing the issue. Nancy has talked with Rose at BCBS but has yet to hear an answer, she will follow up with Rose at the end of the week.BCBS Complete: Placing of these patients in nursing homes, Nursing homes are saying they don't participate. This may be state issueBenchmarking: Not discussed but should remain on the agenda for JulyFlu Shots: Roster billing for Medicare Plus Blue continues to be a problem that arises every year. Many providers are having to bill the claims individually instead of Roster Billing. This should remain on the to do list and be submitted to MaryMedicare Prior Authorization pilot program: There was an open forum from CMS last week, there will be another one on June 28th from 2-3. Suggest we have a speaker come to the Reimbursement Committee meeting to discuss issuesValue Based Purchasing: This is in 9 states and will come to Michigan in the next few years. This needs to be added to the monthly agenda and a possible speaker on the issue within the next few months General Business Payer Line DiscussionMedicare: ADR Probe & Educate was discussed complete results have not yet been received. Medicare as of today still does not have the pricer out for 2016Hospice: 5 days for notice, this is hard to getMedicare Advantage: No commentMedicaid: No commentBCBS MI: A discussion took place as to whether there are still communication problems with Blue Cross and if not are the liaison meetings still necessary.Other Payers Product Line DiscussionCertified: no commentHospice: no commentHME/Private Duty: no commentTo Do Items: Speaker on Value Based purchasingBenchmarkingRe-vamp agendaSpeaker on Prior AuthNext meeting July 20 2016 teleconference ................
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