Quick recap

The meeting focused on discussing various challenges and updates related to billing, contract management, and operational issues faced by providers. Carrie shared multiple concerns, including issues with the HHSC contract closeout for 2023, problems with uploading the security attestation form in CCMS, and a payment voucher error that resulted in duplicated claims. The group also discussed difficulties with Medicare claims, particularly regarding traditional Medicare being attached to the wrong provider type within their organization. Noelle provided an update on the ASAP website's new features, including member-exclusive groups and discussion forums to help address questions between meetings. The conversation ended with an introduction to the website's functionality and encouragement for members to use the platform for ongoing discussions and questions.

Next steps

• Carrie: Follow up with HHSC regarding the definition and reporting requirements for "program income" to ensure correct reporting in future closeouts.

• Carrie: Continue to monitor and seek resolution with Columbus/IT regarding the inability to upload the security attestation form for the CCMS contract, and document all communication for auditors.

• Carrie: Review and reconcile the payment voucher issue in Columbus to ensure the double payment display is documented and explained for auditors, and follow up with IT/help desk as needed.

• Luci.Silva: File a formal complaint with Medicare regarding ongoing claim denials related to OTP and group credentialing issues, as the next step after repeated unsuccessful appeals.

• Luci.Silva: Post the Medicare credentialing/claims issue on the member exclusives website/group for broader input and to potentially identify others with similar issues.

• Noelle: Bring up ongoing contract manager transition and communication issues (including lack of updated contact information and responsiveness) at the next meeting with HHSC.

• Noelle: Encourage group members to utilize the new website/group discussion board for posting questions and sharing issues between meetings.

• All members: Post relevant operational and billing questions to the appropriate group(s) on the member exclusives website to facilitate faster information sharing and resolution.

• Ivonne/Noelle: Consider requesting HHSC to invite Medicare representatives to future provider meetings to address Medicare-specific billing and credentialing issues.

• Kathy: Continue to monitor Texas Children's medical claim denial issue and follow up for resolution by end of May; update group as needed.

Summary

HHSC Agency Challenges Discussion

Carrie discussed recent challenges with HHSC affecting their agency, noting that resubmitting the closeout for 2023 should resolve the issues. She shared details about her upcoming 20-day vacation to Italy and Greece with three friends, including plans to visit Milan, Switzerland, Florence, Rome, and the Amalfi Coast. The meeting appeared to be just beginning when the transcript ended, with Carrie preparing to discuss specific bullet points about her agency's situation.

Women's Center Open House Updates

Carrie reported positive outcomes from the Women's Center open house, including successful licensing changes that allowed state funding for the residential component and helped address billing challenges with TRA. She mentioned some initial operational issues with plumbing at the facility but noted these were resolved. Carrie also discussed a previous issue with fiscal year 2023 closeout forms where program income was incorrectly reported, but an appeal has been filed and approved to correct the forms.

Contract Income Reporting Clarification

Carrie discussed a contract closeout issue where she was required to repay $200,000 due to confusion over the definition of "program income" in state reporting requirements. Ivonne explained that the state cannot impose its requirements on contracts funded by other sources, and clarified that different contracts (state, probation, and Medicaid) should remain separate. Carrie expressed continued confusion about the program income definition and its relationship to her other contracts, particularly regarding whether client copays would qualify as program income.

Funding Compliance and Reporting Challenges

The group discussed challenges with funding compliance and program income reporting, particularly around avoiding double-dipping and accurately tracking client expenses across different programs. Noelle explained the complexity of showing how clients participate in multiple programs simultaneously, emphasizing the need for precise accounting. Carrie shared her experience with a confusing closeout year involving a lump sum payment, which was resolved through a special meeting with CFOs and auditors. The discussion concluded with Carrie describing ongoing technical issues with uploading security attestation forms to the CCMS contract, which has resulted in potential penalties and continues to be unresolved despite IT claims of fixes.

HHSC Issues and Payment Discrepancies

Carrie discussed several issues with HHSC, including challenges with a contractor who was uncooperative and later moved away. She also mentioned problems uploading a security attestation form, though it appears this was specific to her situation as others haven't experienced similar issues. Finally, Carrie reported a payment discrepancy with a TRA claim in Columbus where claims were duplicated, resulting in an incorrect amount showing in reports despite receiving the correct payment.

Billing Reconciliation and Payment Issues

Carrie discussed issues with billing reconciliation and payment deductions, with Luci Silva providing guidance about checking contract activity for double billing concerns. Ivonne clarified questions about residential billing for Carrie, who confirmed they had previously handled both men and women's cases but no longer manages residential work. Kathy provided an update on an ongoing issue with Texas Children's regarding denial code DCS201, noting that the business side identified a problem but requires more time to determine the cause, with an expected update by the end of May.

Insurance Claims Processing Challenges

The team discussed issues with insurance claims processing, particularly with Superior insurance. Luci Silva highlighted problems with claims being incorrectly routed to the medical side instead of behavioral health, despite using the correct payer ID. The group also discussed Medicare credentialing challenges, where Luci explained that as an OTP (oxygen treatment program) and now an LPC (licensed professional counselor) group, there are complications with claims being incorrectly attributed to the wrong credentialing type. Noelle suggested reaching out to Medicare and Extra for answers about these issues.

Medicare Claims Processing Issues Discussion

The group discussed ongoing issues with traditional Medicare claims processing, where Luci.Silva reported denied claims since January due to unclear attribution between credentialing and claims issues. The team explored potential solutions including contacting higher-level Medicare representatives through HHSC meetings and filing complaints as a next step. Noelle demonstrated the new website features including member groups and discussion forums, encouraging participants to use these resources for faster issue resolution between monthly meetings.