POE AG Meeting Minutes - October 20, 2022 - JD DME

POEAG Attendees: Rhonda Buhrmester, Glenn Closurdo, Todd Dodds, Patty Donndelinger-Bogyo, Pamela Fritz, Rosa Gomez, Dawn Jorgensen, Noel Neil, Robin Nyberg, Jan Palmer, Charles Robinson, Maria Sanchez, Jera Sitton, Kelly Troutman, Tanya Ward, Michelle Wullstein, Lesleigh Sisson

Noridian Attendees: Ruth Reese, Kate Petersen, Cindy White, Shelly Carlson, Kloe Roberts, Kelsey Slettebak, Mary Reineke-Ferguson, Amber Mertz, Melissa Betts, Ashley Decoteau, Colleen Harryman, Dan Schmitt

POE Advisory Group Mission and Goals

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 Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities remain in place
    • Extension announced October 13, 2022
• Post COVID-19 PHE Guidance
  • Send questions to DME POEAG email (DMEPOS-POEAG@Noridian.com) and Noridian forwards to CMS
• Sequestration adjustment returned to the full 2% on July 1, 2022
• Education for Practitioners
  • Continue to seek opportunities

Follow-up from Previous Meetings

General

• Joint POEAG to develop education for clinicians ordering DMEPOS
  • Three meetings have been held focusing on sleep
  • Great suggestions
    • Provide education during residency
    • More webinars for providers on DME requirements
    • Update clinician checklist
  • Looking for supplier volunteers for a similar Glucose meeting, willing to recruit practitioners
    • Meetings to start 2023
• Collaborative MAC education
  • Therapeutic Shoes for Persons with Diabetes CERT Taskforce
    • November 2, 2022
  • Respiratory
    • December 1, 2022
• MLN Connects January 12, 2022
  • CMS released the required face-to-face (F2F) and written order prior to delivery (WOPD) list effective April 13, 2022
  • Seven items in addition to the power mobility devices
  • Additional items added to the required prior authorization list
  • Five orthoses and six power mobility devices
  • MLN Matters Number: SE20007 Revised
• Hospice and DME education
  • In the process of creating education

DME

• Philips Respironics Respiratory Products Recall
  • On going
  • Medical director discussions
    • During the PHE, if there is documentation from the treating provider that states the beneficiary’s medical condition has not changed since the previous sleep study and the evaluation by the treating physician is within a year of the DOS for initial issue of a CPAP, then DME MACs will accept this documentation in lieu of a repeat sleep study to meet the timely documentation requirement.
• Removal of Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
  • January 2023

O&P

• PAR emergent situations
  • CMS released additional information on emergent situations
    • The ST modifier should be utilized by suppliers when a beneficiary requires a brace on the same day. If the health or life of the beneficiary is jeopardized without the use of the orthic device. And the beneficiary’s emergent need cannot wait for the two-day turnaround time.
      • These claims will be subject to prepayment review
  • Providers under the competitive bid exception
    • Should continue to utilize the KV modifier
      • These claims may be subject to prepay review

New Items

General

• Ask the Contractor teleconference (ACT)
  • Scheduled for 2022 - November 10
  • General - all topics
• Level 200 webinars
  • Please send scenarios you would like to see included
  • Send to the POEAG email address
• Considering 2023 in-person event
  • Held centrally for JA and JD
    • Attendees expressed interest
• Quarterly updates
  • DME highlights from weekly email
  • Hot topics
  • New format went out in September
  • Is this beneficial?
    • Attendee noted this as a benefit

Suggestions from POE Advisory Members

• Is there data on prior authorization for orthotics
  • Feedback we have received is that it is going well. Biggest issue is that prior authorization is being requested after the brace has been provided.
• Regarding CO-261 denial appeals, what documentation is required when the amputation was 15 years ago?
  • Need record of amputation to be included in appeals
• CO-261 denial follow-up - doesn't this requirement to save documentation go against statue with having to maintain records for seven years?
  • A photo can be taken of the beneficiary's amputation to support level of amputation. If it's a photo, it can come from supplier. If it's a record, that needs to come from physician. There is no direction on proving if that's the actual beneficiary in the picture.
• Suppliers would like in-person seminars
• L200 webinars: could we do a webinar specifically on successful and unsuccessful prior authorizations for orthotics, more specifically when a surgery is a factor?
  • We can hold a future webinar with examples of approved and non-approved prior authorizations.

Upcoming Meeting

• Next Meeting: 2023