EAPG Bi-Weekly Meeting 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Room B Conference Line: 1-877-820-7831 Passcode: 294442# Kevin Martin, Andrew Abalos, Andrew Larson Jan-18 1
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • PLEASE MUTE YOUR LINE UNLESS SPEAKING • Please speak clearly when asking a question and give your name and hospital • We are going to try to avoid muting the phone lines to encourage conversation, so please don’t: Put us on hold • Drive in your car w/window open while listening • Sit in a noisy location • Be cautious of side conversations and language (we can hear you • and it is being recording) 2
Welcome & Introductions • Thank you for participating today! • We are counting on your participation to make these meetings successful 3
Upcoming Meetings 2018 Meetings 2:00pm-4:00pm 01/12/2018 01/26/2018 02/09/2018 03/02/2018 03/16/2018 03/30/2018 04/13/2018 05/04/2018 05/18/2018 06/01/2018 06/15/2018 06/29/2018 Please Note: All 2018 Meetings will be held at 303 E. 17 th Ave Denver Conference Room 7B 4
Continued Discussion of Drugs in EAPGs • Attention to appropriateness of drug payments under EAPGs • Obtained ceiling price list • Discussion of 50% payment reduction for drugs reported with UD modifier • Solutions? 5
EAPG Grouper Version Update • 3M released new grouper version on 12/27/2017 ➢ Queued for implementation in DXC’s system • Accommodates distinct procedure modifiers ➢ XE, XP, XS, XU ➢ Modifier 59 is still available for use and will have same payment impact when reported on outpatient claim 6
Mass Adjustment Updates • Currently ~1.6 million claims processed through EAPG grouper in interChange ➢ Isolated to final paid claim • Since mid-November, have requested adjustment of just over a million claims in total ➢ Overlap between adjustments to address various fixes 7
Mass Adjustment Updates • Roughly 175k claims still being reprocessed as of end of last week • Completed transmittals have resulted in additional $18 million in claims payments across all hospitals ➢ Impact varies by hospital due to billing practices 8
Mass Adjustment Updates • Currently 4-5% of existing EAPG claim volume not currently scheduled for reprocessing unable to be accurately repriced ➢ NCCI, duplicate lab services, service limits, EOB 2580 likely culprits ➢ Department continuing investigation – please continue submitting claims with unanticipated price variances 9
Mass Adjustment Updates • Resubmission of denied claims ➢ Received several claims from various hospital provider groups ➢ Redeveloping process to better track incoming claims ➢ Only meant for denied claims – paid claims that have had payment impacted by one of the various fixes since interChange implementation will be reprocessed 10
Mass Adjustment Updates • Crossover claim logic still being worked in DXC’s system ➢ Claims should be paid as sum of Medicare Coinsurance and Medicare Deductible ▪ Represents overall increase in payment for crossover claims ➢ No definite schedule of mass adjustment 11
Challenges • EAPG module in DXC system did not contain full redistribution functionality ➢ Will be addressed in update to v.2018.0.1 3M Module ➢ Claims will be identified and reprocessed upon completion • Due to variety of hospital billing practices, unable to accurately determine claims with correct coding for EAPG to EAPG duplicates 12
Challenges • EAPG Claims processed in Xerox MMIS as Percent of Charge ➢ Working to validate converted data to ensure massive unintended takebacks do not occur ➢ Schedule yet to be solidified, but will make it a top priority to discuss with hospitals prior to adjustments 13
Questions or Concerns? 14
Contact Information Kevin Martin Fee-for-Service Manager Kevin.Martin@state.co.us Andrew Abalos Outpatient Hospital Rates Analyst Andrew.Abalos@state.co.us 15
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