Happy Holidays to all of you! As you read this edition of The Monitor perhaps you will be able to take a breather and reflect on how busy you’ve been recently. Here at AAMAS your board has been wildly busy too! In October we met as a board in
All in all it’s been a busy and educational year here at AAMAS;. We look forward to the New Year with anticipation of great
things for our organization and for a great spring conference. Thank you to all the AAMAS members for your
support and hard work to improve our organization in 2003. I want to extend to each of you a very warm
and heartfelt wish for a Happy and Prosperous New Year! Thanks for a great 2003!
AACCA V. AAMAS
UPDATE from
As promised, I pledged to bring you all up to date on the AACCA plagiarism legal situation with AAMAS. In August, 2003 it was noted that the AACCA did openly copy the AAMAS website content and represented it as their own material. Upon discovery the AAMAS Board of Directors took swift legal action to protect your organization and preserve the integrity and assets of our membership. We did receive a letter from the leadership of AACCA through our attorney in late September 2003. In this letter they indicated that the website had been corrected and that they meant no harm to AAMAS and offered an apology. There was no explanation of why they had copied our website or for what purpose or intent the copyright infringement occurred. We consider this response sufficient and the matter closed at this time. We will continue to monitor the website for any further offense. Under our attorney’s advice we have copyrighted our exam and materials on the website to avoid any confusion and protect our hard work.
EDUCATION COMMITTEE
The
2004 10th Anniversary AAMAS Conference is approaching very rapidly.
The membership response to last year’s break out sessions were very positive
so I am delighted to announce we will be offering them again this year.
In order to meet the needs of our growing membership, we will begin
offering RN and CPE educational units in 2004.
Your
board has been working very diligently to assure this 10th anniversary
conference will be the best ever. Please
join us at the Opryland Hotel in
Mary Correa, Chair
MEMBERSHIP from Barb Thompson
Our membership for 2003 ended with 376 members in 36 states. We had a few members not renew but we gained 73 new members in 2003. Membership renewals have gone out and I hope everyone returns them by January 31 to meet Certification requirements. I would like everyone to make a copy of the membership application before filling it out and give the extra copy to a fellow auditor and potential member. My goal for this year is to increase membership to 400.
FISCAL YEAR 2003 IMPROPER FEE-FOR-SERVICE PAYMENT REPORT
Released by Medicare
On
The Medicare FFS Improper Payment Report is an annual report that
started in 1996 by the Office of Inspector General (OIG). From 1996 to 2002, the OIG conducted this program
using approximately 6,000 paid claims by the Medicare contractors. The error rate gradually improved from a starting
point of 13.8% in 1996, down to 6.3% in 2001/2002. This report basically compares the error rates
of four major components across years – documentation errors, coding errors,
medically unnecessary services, and non-covered services.
This year’s report was produced for the first time by CMS through two programs – Comprehensive Error Rate Testing (CERT) program, and the Hospital Payment Monitoring Program (HPMP) established to monitor the accuracy of Medicare FFS. The error rates were calculated by contractors with each component representing 50% or the error rate. CERT is responsible for the Carriers and the DMERC (Durable Medical Equipment Regional Carriers), and the Fiscal Intermediaries (FI), while the HPMP is responsible for calculating error rates of the QIO (Quality Improvement Organizations). Approximately 128,000 claims were reviewed with a focus on errors by provider and service types. In addition, a significant increase in the rate of non-responders was noted. Initial error rate found was 9.8% including the non-responders. This rate however was adjusted to achieve a more reasonable estimate, and was based on previous OIG’s past experience.
This is a big relief to the Inpatient PPS (Prospective Payment
System) hospitals where majority of medical auditors and members of AAMAS
are employed, and/or involved in the field of medical audit practice. Inpatient PPS hospital ranked second to
the last of all providers with the least number of errors producing
an error rate of 3.5%. Chiropractors,
Physical Therapy and Internal Medicine ranked the first three specialties
by provider type with the most payment, compliance, and service processed
error rate.
To view the entire FY 2003 Improper Medicare FFS Payment Report,
visit this site: http//www.cms.hhs.gov/providers/psc/Medicare-“Error-Rate-Short-Report.pdf. You will need an acrobat (pdf) file to access
this site. To request a long version
of this report, you will need to send an e-mail to CERT@CMS.HHS.GOV
From
Marilyn Balcita
NOMINATION COMMITTEE from Nelda Fetters
The Nomination Committee is still accepting nominations for the
Offices of Vice President, Secretary, and Treasurer.
During the AAMAS Board Meeting in October, Joyce Lovett-Adkins,
AAMAS Parliamentarian, did a presentation on the Parliamentary Responsibility
in Nominations and Elections. Since
the Board members learned a lot of new information about the Nomination process,
I would like to share some of that with the membership.
Joyce Lovett-Adkins explained that the Nominations Committee is
responsible for obtaining as many nominations as possible prior to the thirty-day
deadline before the Annual Membership Meeting. These nominations can come from the general
membership or a Board or Committee member.
The nominee must agree to serve if elected. The Nomination Committee must evaluate the qualifications
of all of the potential candidates and vote on whether the candidate’s name
will be submitted to the Board for approval. The Nomination Committee is comprised of three
members so that a consensus can be obtained on each candidate.
The Nomination Committee’s responsibility is to determine the best
qualified person or persons for each available office. The nominee(s) for each office will be the person(s)
who the Nomination Committee has chosen as the most qualified person(s) to
run for office. Per the bylaws, the
Nomination Committee is responsible for providing one nominee per office.
The order of the candidate names on the ballot can be chosen randomly
or placed in alphabetical order on the ballot.
Nominations from the floor will be accepted. These individuals will be given an opportunity
to summarize their qualifications. The
same person cannot nominate two people in a row. Write-ins can also be added to anyone’s individual
ballot and these do not need to be presented to the membership. When there is a write-in candidate, this person
does not have to give prior approval to serve if elected.
Each member is entitled to one vote in person and a maximum of
four votes by proxy. Proxy forms must
be filed with the Secretary at the time of registration at the Annual AAMAS
Conference. Based on feedback from
the membership, the Board has decided to eliminate the Notary requirement
for Proxy Ballots in 2004.
Prior to the Annual Membership Meeting, the current President of
AAMAS will choose three people at the annual meeting who will serve on the
Teller’s Committee. None of these people
can be currently serving on any AAMAS Committee. All ballots will be kept until the end of the
General Membership Meeting. The Teller’s Report and ballots can be reviewed
by any member.
The President will announce who has been elected to each office.
I hope that you have found this overview of the Nominations process
as informative as the Board members did.
Members of the Nomination Committee will be contacting potential
candidates soon.
All nominees must be CMAS certified, an active AAMAS member for
the past two years, and be able to attend Board meetings. There will be a Board meeting the day before
the conference in
If you would like to know more about what the responsibilities
are and time commitment for any of these offices, please contact me. I will arrange for you to talk with the current
Vice President, Secretary, or Treasurer. Please forward any nominations to one of the
following members of the committee: Nelda Fetters @ NKF@aol.com or 504.433.3327; Marie Bott @ marie.bott@aig.com or 713.666.1947; Dorothy
Russo @ gndrusso@msn.com or 707.258.0236.
REPORT OF THE PRESIDENT ELECT
Happy Holidays to all of you. I
would like to thank you for the support I have received over the last year
as I prepare to become the 5th President of AAMAS. Having been a Board member for 6 years, I have
seen incredible growth. When I was
appointed Secretary in
All of the candidates that are running for the Board this year
have been in the mentoring program, which is a testament to its success. I would encourage you all to consider mentoring
with a Board member, as it is an effective way to see how the organization
is run, and is a great stepping stone for Board positions.
I have been very fortunate
that most of the committee chair positions have been filled for the next term, and we are already
making plans for the 2005 conference. I
am excited to work with you all. The
Governmental Affairs Committee is the only leadership position I have yet
to fill. If this is an area of interest
to you, please consider this opportunity to give back to the Association by
committing to a term as Committee Chair.
Thank you again for your support. I am looking forward to my new position, and
getting to know as many of you as possible.
Theresa Crothers, President Elect
“The Expanding Role of the Medical Auditor”
Mary Jane Stratman, Chair
Howdy Y’all!!!Yes, we have had our board meeting in
We are going to begin the conference with a reception Wednesday
evening April 21. It is titled “Denim
and Diamonds” so bring your boots and jewels.
We are planning some surprises that we know that you will enjoy. The roon rate is $145.00 single or double occupancy
and you can start at any time to make your reservations at the Gaylord Opryland
Resort at (615) 883-2211 and identify yourself as part of the American Association
of Medical Audit Specialists or Group Code X-AAMAS.
The program and speakers should be confirmed shortly after the
first of the year so more information will be coming to you all. Please start to make your plans now for what
will be a great conference and time for all.
We are putting together
a panel on the “The Expanded Role of the Medical Auditor” for the Nashville
Conference. If you are involved in
a new venture or have taken on new responsibilities, we are interested in
your transition. We would like also
to include anyone who is involved in the following areas: consulting, workers comp/casualty, med-legal,
compliance (both regulatory and contract), IS, DRG/Medicare, administration.
Susan King has agreed to be Moderator.
If your auditing experience has led you to new pathways, we want
to hear from you. Please send your
resume by January 31 to tcrothers@att.net. or mail to:
Theresa Crothers
7835 Mapleridge
BYLAWS REPORT
The Bylaws Committee consists of Marie Perez, Margie
Sokolowski, Joel Grossman, MD, and myself. We have reviewed the current bylaws and have
found a couple of items that we will have to address in our next annual meeting.
Watch for those proposed amendments in the next newsletter.
The Bylaws Committee wishes you all a very safe and
happy holiday season.
Genene Miller, Chair
AAMAS Conference
10th Anniversary Celebration
BOARD MEMBERS
PRESIDENT
PRESIDENT
ELECT
Theresa Crothers
VICE
PRESIDENT
Beverly Coleman
SECRETARY
Pamela Schutz
TREASURER
Ruth Gahan
COMMITTEE
CHAIRS
Barb Thompson
Advisor
Marilyn Balcita
Bylaws
Genene Miller Texas genenem@bhcs.com
Certification
Pamela Ofsanik
Communications
Lois Rayome
Education
Mary Correa
Government
Affairs
Marketing
Annie Sinanan
Nominations
Nelda Fetters Louisiana nkf@aol.com
Parliamentarian
Joyce L-Adkins
Program
Mary Jane Stratman Californiamjauditor@aol.com
For more complete information consult the Membership
Directory.
National audit company is seeking experienced nurse auditors for hospital bill auditing. Must be detail oriented. Extensive clinical background preferred. Please fax resume to National Audit Services at (305) 669-8811.