Prior to the presentation given by Paul, Ms. Lorraine Tunis Doo, Regulations Specialist in the Office of HIPAA standards at CMS, and one of the individuals at CMS who is responsible for the proposed rule on electronic health care claims attachments, provided background information on the pilot. She also offered words of encouragement to the participants.

Participating in the electronic claims attachment pilot are Memorial Sloan Kettering (MSK) Cancer Center and Montefiore Medical Center. Anne-Marie Lesny, associate director for Patient Accounting Systems at MSK, provided an overview of their current ADR processing and then a pilot overview. Anne-Marie's presentation also outlined what the perceived benefits would be if this transaction is implemented into production. MSK will be participating in the pilot from a Part A perspective and the medical records they return will be in an imaged format.

Nancy Sanchez-Caro, director of Systems Faculty Practice at Montefiore Medical Center, also presented an overview of the pilot project. Montefiore will be participating in the pilot from a Part A and Part B perspective, and will also support imaged formats.

In addition to the electronic claim attachment pilot, Paul Root presented information on the necessary steps a provider needs to take to implement the 276/277 Claim Status Inquiry and Response transactions. There are currently three providers testing this transaction. They are Glens Falls Hospital, Montefiore Medical Center, and Memorial Sloan Kettering Cancer Center.

At the Syracuse session, Steve Ramaswamy and John Dudla of Glens Falls Hospital presented an overview of their internal processing system, and how the claims status inquiries are generated.

At the NYC session, Noam Nahary of Montefiore Medical Center also gave an overview of Montefiore's processing system and how the electronic claim status inquiry and response transaction can provide benefits and cost savings to the hospital.

It was announced at the meeting that EMS would begin marketing the claim status transaction, especially to providers who have a high percentage of calls related to claim status inquiry.

For the month of September, the three providers with the highest number of calls to Provider Services had 390, 289, and 255 total calls. As much as 65% of these calls could have been resolved by utilizing the 276/277 transaction. Any provider interested in obtaining more information regarding this transaction should either call the EMS Help Desk at 1-866-889-7322 or review the 276/277 Companion Document for the steps necessary to submit the transaction at http://www.empiremedicare.com/hipaa/tpaindex.htm.

Following the presentation on the 276/277 transaction, Mario Tedesco (Syracuse) and Andreas Christodoulou (NYC) of NY Medicaid provided information on the October 6, 2004 HIPAA compliance deadline, and the process in place for exception processing.   Providers granted exception processing will have until December 29, 2004 to complete their testing and bring their transactions into HIPAA compliance. A HIPAA Exception Processing Application must be filed by October 15, 2004.

More information on Medicaid and HIPAA can be found at https://www.nyhipaadesk.com.

Before the group broke for lunch, Scott Levine of CMS gave a status via telephone of the HIPAA Contingency elimination. Scott said that there are no immediate plans to end HIPAA contingency but there will be plenty of advance notice when the plans are in place.

Scott said that on a national level, almost 98% of claims are HIPAA compliant, and as of week ending 10/1/04, 99.7% of Empire Medicare Services claims are HIPAA compliant. CMS's main concern is that there are pockets of areas around the country that are still noncompliant. CMS wants to end contingency on a national basis so these noncompliant pockets must be addressed before contingency is lifted.

Lifting HIPAA contingency for the 835 will be addressed after the claim, and 837 COB will be addressed with the implementation of the national COB contract.

After the lunch break, the next item on the agenda was a discussion of Multiple Proprietary Acknowledgement Reports given in Syracuse by Douglas J. Bilbrey of SSI, and in NYC by Mike Perna of Siemens.

Subsequent to Doug and Mike's presentation was a status from Joyce Cianciola in Syracuse, and Stu Presser in NYC, of the development of the 5010 Implementation Guide.

The last item on the agenda was an overview given by Paul Root of the October Medicare Release changes, and a look at what's coming for January 2005.

At both sessions, a demonstration of the FISS DDE CBT course was provided by Suzanne Benz (Syracuse) and Victor Martin (NYC). That CBT will be available on Empire Medicare Services website sometime in the near future. Watch for the announcement.