Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - April 20, 2022

POE Advisory Group Mission and Goals


POEAG Members: Kim Brason, Dawn Cetti, Pamela Durbin, Valerie Eriole, Pamela Fritz, Sharee Hummer, Catherine Hamilton, Kimberly Hanson, Crissy Hill, Dawn Jorgensen, Paul Kesselman, Tugba Koca, Maria Koehnlein, Jeannette Leon, Bridget LaScala, Richard Longway, Gary Marano, Amanda McFaddin, Noel Neil, Bill Noyes, Yvette Nugent, Erica Rochelle, Randy Stevens, Mary Stoner, Rhonda Turner, Yvonne Weiler, Tina Padden, Jon Shreter
Noridian: Ruth Reese, Kelsey Slettebak, Kloe Roberts, Shelly Carlson, Tanya Gillies, Amber Mertz, Brenda Swancy, Cindy White, Colleen Harryman, Kate Petersen


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


  • 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
    • Last extension expired April 2022
      • Now extended to July 16, 2022
  • Post COVID-19 PHE Guidance
    • Send questions to DME POEAG email ( and Noridian forwards to CMS
  • Sequestration suspension extended to March 31, 2022
    • Effective April 1, 2022 - June 30, 2022, adjustment will resume at 1%
    • Effective July 1, 2022, adjustment will increase to 2%
  • Education for Practitioners
    • Continue to seek opportunities
    • PEN education after checklists are updated

Follow-up from Previous Meeting


  • Joint POEAG to develop education for clinicians ordering DMEPOS
    • First meeting held focusing on sleep
      • Great suggestions being worked on
        • CGM and glucose is a suggestion for future development
  • Miscellaneous codes reimbursement
  • Collaborative education with A/B MACs
    • Documentation
      • May 26, 2022
    • Surgical Dressings and Supplies CERT Taskforce
      • June 15, 2022
    • Glucose Monitors and Supplies
      • August (TBD)
    • Respiratory
      • November (TBD)
    • Pneumatic Compression Devices CERT Taskforce
      • TBD
  • 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
    • PAR webinars have been scheduled
    • Orthotics
      • April 26 and May 12, 2022
    • PMD
      • May 11, 2022
  • Hospice and DME education
    • In the process of creating education


  • L200 Respiratory webinars
    • Oxygen placed on hold due the upcoming policy changes
    • PAP May 25, 2022, 1 p.m. CT
    • Nebulizers placed on hold
    • Continue to look for scenarios
  • Frequently Asked Questions – Philips Respironics Respiratory Products Recall – Revised
    • Initially published June 25, revised July 16, 2021
    • Frequently Asked Questions (FAQ) posted on Noridian website
    • No updates, waiting on further direction
  • Noridian is aware of the oxygen decision memo
    • Webinar May 19, 2022
  • Regarding the HCPCS code K1006 Purewick urine collection system, there was an article explaining coding, but it was unclear if it was going to be a covered item, and it is not in the Local Coverage Determination (LCD). Is this a covered item?


  • 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


  • Ask the Contractor Teleconference (ACT)
    • Scheduled for 2022 - May 11, August 9, and November 10
    • General - all topics

Suggestions from POE Advisory Members

  • In the infusion space, we are experiencing shortages of equipment, particularly pumps covered in the External Infusion Pump (EIP) policy. There are alternative pumps that are disposable so we are asking if there would be any consideration during PHE to cover the disposable pumps using the CR modifier.
    • We are unaware of any ability to cover a disposable pump in this circumstance as the disposable pumps are not considered DME. We do not have any guidance from CMS to make any changes in consideration at this time. For supplies to be covered, there has to be a covered pump.
    • Information will be submitted to Noridian for distribution to the other group members per request.
  • Could the link for gap filling payment methodology be shared?
  • Have the MACs considered the Purewick catheter system for payment? Have we received any claims for this?
    • Noridian will research
  • More education on Advanced Beneficiary Notice of Noncoverage (ABN) is needed - Suppliers would like to see clinical scenarios for methods of deliveries when beneficiary refuses to sign an ABN but services are emergent, or when a beneficiary has equipment but is not meeting coverage requirements (example: PAP fails compliance but beneficiary refuses to return equipment).
    • Noridian will review our ABN education
  • Eagerly awaiting education on Hospice and DME
  • A recent four-part Power Wheelchair webinar was presented, and these were supposed to be published, however only part two is available. Can you explain the reason that the full series is not available?  
    • We had some technical difficulties, so all parts were not published.
    • Suppliers were asked to type in a question about electronic Power Mobility Devices (PMDs). Before the written question was entered a nurse came on and gave the response verbally. Is there a way to have the response in writing?
      • Noridian evaluates all Q&A to make sure that the webinar content responds to questions, so future webinars will contain updated content.
  • Thank you for updating the Continuous Glucose Monitor Dear Physician Letter!!
  • For knee orthosis, can the dear clinician checklist be updated with the new face-to-face and written order prior to delivery requirements?
    • The checklist has been updated
  • The intermittent urinary catheter letter states physicians should be clearly documenting the number of times per day the beneficiary is self-catharizing. Suppliers are under the impression that frequency needs to be on the SWO, but the medical record should support test of permanence. Can we use medical records from three years ago for test of permanence?
    • Current medical record must support frequency. 
    • There was an update to standard documentation article A55426 stating that ongoing medical need does not need to be established annually. We will review the dear clinician letter to make sure it includes the update.
  • Moving back to ABNs and further education if a supplier uses DocuSign for the beneficiary to sign, will this be valid?
  • Hizentra for chronic inflammatory demyelinating polyneuropathy (CIDP) was added to EIP. Dosing is higher for this medication and patients are hitting or exceeding the medically unlikely edit (MUE). This is valid for chronic inflammatory demyelinating polyneuropathy (CIDP) but not primary immunodeficiency disease or disorder (PIDD). Would it be appropriate to request a reconsideration of the Local Coverage Determination (LCD) to get this raised?
    • Reconsideration would be the appropriate approach; however, remember that medically unlikely edits (MUEs) are set by CMS.
      • Claims will deny each month, correct?
        • Yes, these will need to be appealed.
  • Is there anything coming up regarding Refractive Lenses?
    • There is a webinar scheduled for April 28, 2022, at 11:00 CT
    • It would be appreciated if we could get reports that show error rates for refractive lenses.
    • CERT for refractive lenses is available. This is different than TPE. We do not have any individualized rates for this that we can publish because these are supplier specific. CMS publishes per policy category. These are published every November (the CERT projected error rate)
  • For catheters we encourage updating the policy article because of RAC audit activity. This would allow suppliers to point to the updated article.
  • Thank you for quick turnaround for knee orthoses prior authorization requests!!! Kudos!
  • Thank you to the education team for attending NHIA, great presentation!
  • Can you tell us how case by case codes are processed? Is a certain process used?
    • The instructions for this are located in the Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 23. Although, direct pricing for codes that do not have a fee schedule is not available to suppliers the methodology is available within the IOM. No further information on unpublished fee schedules is available.
  • Member noted appreciation of all upcoming training.
  • Prior authorization for orthosis is positive for CMS!! Well done, Noridian!
    • Education will pass on the kind words to our medical review team.

Upcoming Meeting

Next Meeting: July 20, 2022


Last Updated Jul 21 , 2022