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

Member attendees: Kim Brummett, Ronda Buhrmester, Mindy Eberhart, Valerie Eriole, Sharee Hummer, Kimberly Hanson, James Herren, Crissy Hill, Dawn Jorgensen, Paul Kesselman, Tugba Koca, Maria Koehnlein, Bridget Lascala, Jeannette Leon, Gary Marano, Noel Neil, Bill Noyes, Yvette Nugent, Jan Palmer, Joyce Perrone, Kristine President, Kimberlie Rogers-Bowers, Wendy Russalesi, Mary Stoner, Rachelle Tritinger, Rhonda Turner, Yvonne Weiler, Nicole Kutassy, Carol Lernihan, Randy Stevens

Noridian attendees: Cindy White, Colleen Harryman, Kate Petersen, Kloe Roberts, Mary Reineke, Melissa Kuznia, Ruth Reese, Shelly Carlson, Tanya Gillies, Tracy Schutt, Diana Duchscherer

Standing Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities in place
  • CMS resource pages
  • Noridian resource pages
  • Beneficiary Authorization of Benefits (AOB) - Needs signature prior to billing. Noridian and CGS have gone through our official channels including our contract officers to communicate supplier concerns to CMS
    • Supplier question - Are there any prohibitions obtaining the signature electronically?
      • Noridian response - No, there is no prohibition, electronic signatures are acceptable
• Targeted Probe & Educate (TPE)
  • No update on resumption
• Post-Payment Clinical Review
  • Please follow the Medical Review page for added codes on review
    • Surgical dressings added December 2020 (A6010, A6496, A6197)
• Education for Practitioners
  • We continue to seek opportunities

Follow-up Information from Previous Meeting

General

• Physician based education for prior authorization
  • Pending
• Text alert option for companies not allowing usage of other electronic platforms
  • Noridian unable to launch at this time, however suppliers may be able to change FB settings to allow notification when there is a new posting.
• Weekly listserv for upcoming webinars
  • Implemented August 2020
• Advertisement on NMP for upcoming webinars
  • Implemented August 2020
• Additional Standard Written Order (SWO) education requested
  • Monday Live Chat has been addressing
  • SWO specific webinar held December 30
• Specific training on telehealth
  • It is on our schedule for a collaborative webinar with Part B in November 2021
  • We are checking with Part B on the possibility of an earlier time

DME

• L200 Ventilator webinar
  • In process
  • Noridian continues to seek examples of scenarios from the supplier community for inclusion in the webinar
• Provide denial rate affirmation on prior authorization and conduct targeted training
  • Investigation remains on-going
• Suggestion for education on billing oxygen when beneficiary has commercial insurance primary and Medicare secondary
  • Project in progress
  • Update - Even if the primary paid 100%, Noridian would need a claim in our system to track the full history
• Home infusion codes moving to Part B January 1, 2021
  • Webinar that was cancelled at the end of December is in process of being rescheduled
• Post COVID-19 PHE Guidance
  • Send questions and Noridian forwards to CMS
    • DMEPOS-POEAG@Noridian.com
• Patient owned equipment billing for supplies/accessories
  • Education being developed
  • Noridian requested examples from the member stating last meeting that denials for supplies are occurring when information on date of purchase is not on all subsequent claims even when Medicare purchased the base item?

O&P

• Competitive Bid
  • Webinars were held November 25, December 2, December 15 and January 6
• New York State Podiatric Medical Association (NYSPMA) - On the last meeting Noridian was asked if we could attend virtually and we responded that we would do our best, however we needed a speaker form completed and submitted. Unfortunately, that request was not received.
• Lower Limb Prosthetic (LLP) Prior Authorization (PA) - Yes coding verification is required for LLP only. Medical review reports that suppliers are complying with this requirement.

New Items

General

• CMS transmittal clarifying use of PRN on orders
  • Frequency is no longer a required element of the order, so the PRN language is being removed
  • Medical records will be utilized to support the administration of the of the order and quantity provided
• Noridian relocated our Pricing Data Analysis and Coding (PDAC) page of the website under the Policies section for greater visibility.
• Noridian is working on our partnership webinars with our A/B counterparts that match our jurisdictional states for 2021. The following topics are under consideration: Diabetic Shoes/Podiatry; PAP/Polysomnography; Documentation requirements; Telehealth/Telemedicine
  • Supplier suggestions:
    • Home infusion services
    • Local Coverage Determination (LCD) A53497 applies or does not apply to code E0486. It is being interpreted by many suppliers that the supplier can bill an evaluation service.
    • Coordinate on same or similar for oral appliance therapy (OAT)/positive airway pressure (PAP), only the two Noridian jurisdictions deny for reasonable useful lifetime (RUL).
      • These are same or similar and there must be a clinical reason for the change. We cannot speak to another Jurisdiction’s claim processing.
    • Enteral/Parenteral Nutrition
• 2021 Ask the Contractor Teleconference (ACT) schedule: February 11, May 15, August 12, November 11
  • All at 3 p.m. ET
  • All general DMEPOS
  • Suggestions from members?
    • Supplier question: Can we submit questions prior to the ACT or add a question asking for questions to the registration?
      • Noridian response: Email DMEPOS-POEAG@Noridian.com and also after registering, an email address is provided.

DME

• Intravenous Immune Globulin (IVIG) demonstration - update - extended through December 2023

O&P

• Any concerns to date with competitive bid?
  • None currently.

Suggestions from POE Advisory Members

• Clarification article or Dear Physician letter regarding oxygen, hospital admission/discharge, and COVID. Also offer recorded webinars so we can refer suppliers back to it.
  • Due to CMS publications, Noridian can’t publish one but we can offer another webinar and investigate offering a DME on Demand self-paced tutorial.
• Sometimes the webinar presenters are reading from the screen. It would be nice to have a subject matter expert available to answer questions.
  • Noridian is thankful for the constructive feedback and is working to address this.
• Is there a certain time period for post-payment MAC reviews?
  • Noridian will check with Medical Review.
• Regarding clinician letters, some have revised dates on them, and some do not. Can they be updated with the new Medical Director and dates?
  • Education will work with the Medical Directors on the potential to have these updated.
• Are there plans to do more education on the enteral/parenteral local coverage determination (LCD) retirement as there are still unanswered questions?
  • Noridian held webinars earlier this month and was unaware there were still questions. The member will email questions.

Do you have any feedback on the Contact Center that could be provided to them?

• Benefit Protection sends suppliers a letter asking for documentation for a specific beneficiary and date of service. We couldn’t get a fax to get through, so we called the Contact Center because those are the phone numbers on the letter. The representative could not help at all.
  • Noridian will investigate how this type of situation can be handled better.

Next meeting: April 22, 2021