EAPG Bi-Weekly Meeting 303 East 17 th Avenue, Denver, CO 80203. 7 th - - PowerPoint PPT Presentation

EAPG Bi-Weekly Meeting

303 East 17th Avenue, Denver, CO 80203. 7th Floor Room B Conference Line: 1-877-820-7831 Passcode: 294442#

Kevin Martin, Andrew Abalos, Andrew Larson

1

Jan-18

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

4 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. 17th Ave Denver Conference Room 7B

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
• f 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

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Kevin Martin Fee-for-Service Manager Kevin.Martin@state.co.us Andrew Abalos Outpatient Hospital Rates Analyst Andrew.Abalos@state.co.us