Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - July 24, 2024

POE Advisory Group Mission and Goals

Attendees

POEAG: Anna Markiewicz; Barbara Stockert; Carolyn Koster; Crissy Hill; Dawn Jorgensen; Heather Werner; Jason Freeman; Kimberlie Rogers-Bowers; Kimberly Hanson; Kristi Sanders; Kristine Cram; Lisa Gannon; Maria Koehnlein; Maria Sanchez; Marsha Lawrence; Michelle Wullstein; Noel Niel; Paul Kesselman; Randy Stevens; Rhonda Turner; Sharee Hummer; Tugba Koca; Wayne Bradberry; Yvette Nugent; Yvonne Weiler

Noridian: Ashley Decoteau; Brenda Swancy; Colleen Harryman; Conner Dingle; Corinne Medina; Kate Petersen; Kelsey Slettebak; Mary Reineke-Ferguson; Melissa Betts; Ruth Reese; Tanya Gillies; Tracy Schutt

Mission

  • To determine the best methods of providing quality education and training to our supplier community.

Goals

  • Develop timely, useful, relevant educational opportunities for our suppliers
  • Provide input in the creation, implementation and review of Provider Education and Training
  • Determine innovative, cost effective methods of using technology in provider education and training CMS Internet Only Manual (IOM), Publication 100-09, Chapter 6

Standing Items

  • Education for practitioners
    • Continue to seek opportunities
  • Collaborative MAC education
    • A/B DME Workgroup
      • Positive Airway Pressure (PAP): September 19, 1 p.m. CT
      • Lower Limb Orthosis: TBD

Follow-up from Previous Meeting - General

  • Level 200 webinars
    • Please send scenarios you would like to see included
  • Supplier complaints due to differences between CGS/Noridian processes
    • None currently
  • Member question: Education regarding place of service 27 would be helpful. Some services (infusion, for example) cannot be provided on the street. What is the intent for using 27?
    • Noridian response: The current POS code 27 - "Outreach Site/Street". The code's description is as follows: "a non-permanent location on the street or found environment, not described by any other POS code, where health professionals provide preventive, screening, diagnostic, and/or treatment services to unsheltered homeless individuals." As well as to potentially allow for the tracking of care provided through outreach sites. Contractors shall treat POS 27 the same as POS 12 (home) for processing purposes. That indicates that the same rules apply as well. Policies that are not "follow-up" intensive may be more likely to utilize this POS such as, braces, canes, crutches, etc.
  • Lymphedema
    • FAQ posted to website in June
      • Noridian Medicare website > Browse by DMEPOS Category > Lymphedema Compression Treatment > Frequently Asked Questions (FAQs)

O&P

  • Level 200 webinars
    • Lower Limb Prosthetics (LLPs) scenarios

New Items

General

  • Ask the Contractor Meeting (ACM)
    • Scheduled for August 8, 2024, 2 p.m. CT
    • General - all topics
  • Methotrexate billed as J8999 effective July 1, 2024, through September 30, 2024
    • On/after October 2, 2024, Methotrexate resumes billing with new drug code
    • Discontinue billing with J8999
    • Do not bill with newly established HCPCS codes J8611 (Methotrexate (Jylamvo), oral, 2.5 mg) or J8612 (Methotrexate (Xatmep), oral, 2.5 mg)
  • Immunosuppressive Drugs LCD L33824
    • Added J2919 as methylprednisolone HCPCS code
      • Requires diagnosis code
      • Requires KX modifier
      • Removed: J2920 and J2930 as methylprednisolone HCPCS codes
      • Revised: HCPCS J7516 narrative from "CYCLOSPORIN, PARENTERAL, 250 MG" to "INJECTION, CYCLOSPORINE, 250 MG"
      • Noridian Medicare website > Browse by DMEPOS Category > Immunosuppressive Drugs

DME

  • Additional codes added to the Required Prior Authorization List
    • Osteogenesis Stimulators: E0747, E0748, E0760
      • Phase one: California, Florida, Ohio, Pennsylvania
        • Effective for dates of service on/after August 12, 2024
        • Suppliers may begin submitting requests on July 29, 2024
      • Phase two: required nationwide
        • Effective for dates of service on/after November 12, 2024
        • Suppliers may begin submitting requests on October 29, 2024
  • Codes added to the Required Face-to-Face and Written Order Prior to Delivery List
    • Effective nationwide for dates of service on/after August 12, 2024
      • Hospital Beds: E0290, E0301, E0304
      • Osteogenesis Stimulators: E0747, E0760
  • Prevent claim denials for hospital beds and accessories
  • Manual wheelchairs home assessment based on indirectly obtained information - revised language
    • Regardless of the method used for home assessment
    • I.e., physical layout, surfaces to traverse, and obstacles must be addressed by and documented in home assessment
    • Question: If someone goes in the hospital and they are homeless, how does this work for the manual wheelchair home assessment?
      Response: The documentation needs to state the beneficiary is homeless.
    • Question: I see patients virtually in 30 different states. The patient is supplied a chair, but the chair won't fit inside the patient's home. I've made multiple attempts to help the patient get a new chair and keep getting denied. Why is this change being made in the home assessment, especially for the initial chair? Do Medicare Advantage Plans also follow this guideline?
      Response: A home assessment is still required but the guideline is opened up to doing these virtually. As a supplier, you can call our Contact Center and report this specific situation to help them in receiving the correct chair. Noridian is unable to speak to Medicare Advantage Plan guidelines.
      POEAG Member Response: This change is only regarding manual wheelchairs, not power chairs. Also, regarding an in-home assessment, some places this is not practical due to distance.
  • Question: CGS offers frequently asked questions (FAQs) on Targeted Probe and Education (TPE), specifically regarding continuous glucose monitors. Does Noridian provide information on what happens if a beneficiary's condition changes and it is not documented?
    Response: Noridian does not provide FAQs; however, we will look into updating the Clinician Checklist and request the DME Medical Directors look into updating the Dear Clinician Letter. Our Part B side offers physician education on CGMs and we do provide information on our website regarding continued coverage: Noridian website > Browse by DMEPOS Category > Glucose Monitors.
  • Question: As a manufacturer, when it comes to an individual who has had a spinal cord injury, they spend time in a rehab facility. When can a DME provider (intermittent catheters, for example) because the discharge date can change?
    Response: Supplies are not included in the two-day pre-discharge delivery; they need to be shipped on or after the date of discharge.

O&P

  • L1833 (knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the-shelf) requires prior authorization only for dates of service prior to August 12, 2024
  • Codes added to the Required Prior Authorization List
    • Effective for dates of service on/after August 12, 2024
      • Knee orthoses: L1843, L1845, L1951
      • Spinal orthoses: L0631, L0637, L0639
  • L1833 requires a face-to-face encounter and written order prior to delivery only for dates of service prior to August 12, 2024
  • Codes added to the Required Face-to-Face and Written Order Prior to Delivery Required List
    • Effective for dates of service on/after August 12, 2024
    • Knee Orthoses: L1845, L1852
    • Spinal Orthoses: L0635, L0636, L0638, L0639, L0640, L0651
  • Question: What is the typical method the information is communicated when items are added or removed from the Master List?
    Response: CMS announces it through the MLN Connects. Noridian then sends in our listservs and the information is added to the Browse by DMEPOS Category webpages, tutorials, and webinars.
  • Updated LLP LCD and PA, effective 9/1 - Can you speak to any planned education in the coming months?
    • In the process of updating webinars, tutorials, checklists, etc., and they will be coming soon.
  • Question: Will the Noridian Medicare Portal be set up to accept prior authorizations for the new codes being added?
    Response: Yes, starting July 29, the portal will be set up to accept prior authorizations.

Suggestions from POE Advisory Members

  • Education is lacking in modifier use with the prefabricated for custom fit codes without a mirrored off-the-shelf code, the -99 codes, when the code technically requires the KX modifier, but the system doesn't allow this. Can this information be included in upcoming education? Member will fax claim examples to Noridian.
  • To help determine admission and discharge dates, enroll in health information exchanges locally. An email will be sent if a beneficiary is admitted or discharged.

Upcoming Meeting

Next Meeting: October 23, 2024

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