POE AG Meeting Minutes - January 22, 2025 - JA DME

Attendees

Members: Kim Brummett; Ronda Buhrmester; Melinda Eberhart; Lisa Gannon; Dawn Jorgensen; Tugba Koca, Maria Koehnlein; Marsha Lawrence; Februari Lester; Gary Marano; Anna Markiewicz; Marisa Mort; Noel Neil; Buffy Nelson; Bill Noyes; Jan Palmer; Maria Sanchez; Randy Stevens; Barb Stockert; Mary Stoner; Yvonne Weiler; Heather Werner; Michelle Wullstein
Noridian: Amber Mertz; Ashley Decoteau; Brenda Swancy; Corinne Medina; Dan Schmitt; Julie Dallman; Kelsey Slettebak; Mary Reineke-Ferguson; Shelly Carlson; Tanya Gillies; Tracy Schutt

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 Items

• Education for practitioners
• Continue to seek opportunities
• Collaborative MAC education
• A/B DME Workgroup
• TBD

Follow-up from Previous Meeting - General

• Level 200 webinars
• Please send scenarios you would like to see included to DME POEAG email
• DMEPOS-POEAG@Noridian.com
• Supplier complaints due to differences between CGS/Noridian processes
• None currently
• Reminder - Effective October 1, 2024, through January 6, 2025
• Capecitabine billed as J8999 (prescription drug, oral, chemotherapeutic, NOS)
• Include drug name Capecitabine in narrative on claim

• Dates of service on/after January 7, 2025
• Capecitabine resumes billing with new HCPCS J8522
• Discontinue billing with J8999

New Items

General

• Upcoming events Noridian will be attending
• Medtrade February 18-20, 2025, Dallas, TX
• AAOP February 26-28, 2025, Atlanta, GA
• NHIA 2025 March 29-April 2, 2025, Washington D.C.
• Power Symposium April 12-15, 2025, Denver, CO
• PAMS April 23-25, 2025, Lancaster, PA
• Ask the Contractor Meeting (ACM) - February 12, 2025
• General - all topics
• HIV PrEP went live as a DME benefit September 30, 2024
• Noridian website > Fees and News > Fee Schedules > PrEP HIV
• NCD 210.15: PrEP for HIV Prevention
• MLN Matters: MM13843

O&P

• Bilateral orthoses prior authorization requests
• Can be submitted on the same request
• Medical necessity documentation must support the need for bilateral orthoses
• Order can state a quantity of two or indicate right and left side; or
• Medical record documentation can indicate the need for bilateral
• Reminder - DME MACs issuing coding verification requirement effective for DOS on/after 12/1/24
• 1951: Ankle-Foot Orthosis, spiral, prefabricated, custom fit
• L1843: Knee Orthosis, single upright, prefabricated, custom fit
• L1845: Knee Orthosis, double upright, prefabricated, custom fit
• https://www.dmepdac.com

Suggestions from POE Advisory Members

• Thank you for putting together education material on the wildfire; FAQs helpful; thanks for getting it up and running so quickly
• Update same or similar in the Noridian Medicare Portal (NMP) to mirror the other DME MAC. Theres is a streamlined process.
• For the upcoming Urological Supplies webinar in February, will the new HCPCS codes, effective January 1, 2026, be addressed?
• Brenda reaching out to Anna
• We noticed that many recipients have a new Medicare number. In the past it was due to a breach, but we have not heard or seen any announcements about it.  Can you comment?
• According to the CMS website, in October, new MBIs were issued for beneficiaries affected by the breach. It is not a new issue.
• What action can we take when beneficiaries are noncompliant with PAP therapy in the first 90 days, and they refuse to sign an Advance Beneficiary Notice of Noncoverage (ABN) or return equipment. We've been told we can file a police report but is there anything in writing?
• We do not have anything in writing; however, filing a police report is a step suppliers can take.
• Thank you for having POE staff attend NHIA. Don't see anything immediately needed for education on infusion, enteral, or parenteral nutrition. Request education be provided when new policies or changes come out in 2025.
• Is the Educational Experience email still active?
• Yes, the email is active. Please send comments, suggestions, and feedback regarding the Learning Management System (LMS).
• When Noridian does a special project, can there be set times for a quick touch base meeting where everyone who is working on the project (suppliers) can join in on a call for progress and talk through things in real time?
• POE will keep this in mind for future projects, thank you!
• Is there an update on the Power Mobility Device (PMD) calculator (showing rental and purchase pricing) that was requested during the last meeting?
• Noridian is evaluating the request but does not have a timeline established.
• Does the just announced hold on Department of Health and Human Services (HHS) communications impact our communication with Noridian?
• The recent hold on communications from HHS is primarily aimed at federal health agencies like the CDC, FDA, and NIH. However, it's not expected to impact communications related to health emergencies or routine operations with entities like Noridian.
• Using the CGS same/similar tool, no matter what UE code we type in, all UE codes populate as being same or similar. I have contacted CGS repeatedly, but they insist the tool is correct.
• Noridian is unable to respond for CGS
• Are there any updates on telehealth visits being accepted or not for DME face-to-face note requirements? Some of our referral sources state they can no longer accept them, but I haven't seen anything in writing yet.
• There have been some updates regarding telehealth visits and DME face-to-face note requirements. As of now, telehealth visits are still accepted for DME face-to-face requirements, but there are some nuances. The Consolidated Appropriations Act, 2023, extended many telehealth flexibilities through December 31, 2024. However, starting January 1, 2025, certain pre-pandemic policies will be reinstated, which may affect telehealth services.
• It's possible that some referral sources are preemptively adjusting their policies in anticipation of these changes. Noridian recommends checking official CMS communications or reaching out directly to Noridian for the most accurate and up-to-date information.
• I saw a post on social media this morning that Noridian dropped same and similar between oral appliance and PAP. Is there any truth to this?
• PAP and oral appliance are no longer considered same or similar, effective for claims submitted on or after October 1, 2024.
• Would KX modifiers be applied to labor and material codes for prosthetics L7510 and L7520?
• The KX modifier could be applied to the labor and material codes L7520 and L7510 for prosthetics. Check out our modifier lookup tool for more assistance with modifier usage. Noridian Medicare website > Browse by Topic > Modifiers > Modifier Lookup Tool.

Upcoming Meeting

Next Meeting: April 30, 2025