POEAG 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

Attendees:

• Member attendees: Kim Brummett, Ronda Buhrmester, Mindy Eberhart, Valerie Eriole, Sharee Hummer, Kimberly Hanson, Crissy Hill, Dawn Jorgensen, Maria Koehnlein, Jeannette Leon, Eileen Levis, Gary Marano, Yvette Nugent, Tina Padden, Jan Palmer, Caryn Plessinger, Cristine President, Erica Rochelle, Peter Rugh, Rebecca Russon, Randy Stevens, Rachelle Tritinger, Yvonne Weiler
• Noridian attendees: Cindy White, Diana Duchscherer, Amber Mertz, Brenda Swancy, Daria Gabai, Kate Petersen, Kathy Fulton, Kloe Roberts, Mary Reineke-Ferguson, Melissa Kuznia, Ruth Reese, Shelly Carlson, Stacy Dahl, Tanya Gillies

Standing Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities remain in place
  • Sequestration suspension extended to December 31, 2021
    • Member question: Have we heard anything about the percentage being changed?
      • Noridian has no information to share on a percentage change.
      • AAHomecare member commented that the House said they are going to change it in 2036 but nothing more right now.
    • Member question: Has Noridian started releasing claims that were held?
      • Yes, the goal was to make sure they were released within the normal floor time.
• Targeted Probe & Educate (TPE)
  • No update on resumption
• Post-Payment Clinical Review
  • Please follow the Medical Review page for up to date review information
    • Member question: How many codes are being reviewed and how long will post-pay review continue?
    • Noridian responded that per direction from CMS, the medical review team will look at many factors in determining codes for review. This can include date, claim volumes, etc. as well as overall impact to the Medicare trust fund. Currently, we have no end date for post-payment review.
• Education for Practitioners
  • We continue to seek opportunities

Follow-up Information from Previous Meeting

General

• New! Per your request! Mini Ask the Contractor (ACT) June 9, 2021 Glucose Monitor and Supplies Policy and Therapeutic Shoe Policy focus
• Is there a certain time period for post-payment Medicare Administrative Contractor (MAC) reviews?
  • Program Integrity Manual - IOM 100-08, Chapter 3, 3.3.1.1
    • For post payment, which are the reviews currently being conducted, the MAC must make a review determination and mail the review results notification within 60 calendar days of receiving the requested documentation.
• Benefit Protection sends suppliers a letter asking for documentation for a specific beneficiary and date of service. We couldn't get a fax to go through, so we called the Contact Center because those are the phone numbers on the letter. The representative could not help at all.
  • The contact center was notified and have included direction in their internal training.
• Additional Enteral and Parenteral education following retirement of Local Coverage Determinations (LCDs)
  • Education will continue per the National Coverage Determination (NCD).
  • Updated education will be provided upon completion of the new proposed LCDs.
• Updated Dear Clinician letters
  • DMDs have been actively updating content and signatures.
• New supplier training and checklists
  • Checklist review in process
• Concern expressed over presentations coming across as being "read" and requesting subject matter experts
  • Education adjusted our process
    • Dedicated presenters with Subject Matter Experts (SMEs) present to handle questions on all webinars
• Request for more education on COVID-19 PHE
  • Updated collaborative webinar held March 31, 2021
• Physician based education for prior authorization
  • Pending due to time constraints
• Additional Standard Written Order (SWO) education requested
  • Great suggestion!
  • Emphasizing SWO education and finding that many still have questions
• Specific training on telehealth
  • On our schedule for a collaborative webinar with Part B in November 2021
  • Checking with Part B on the possibility of an earlier time
    • No earlier date has been set at this time

DME

• L200 Ventilator webinar
  • Continues to be 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
  • Only top reasons for denials will be published
  • Top Reasons for PAR Program Non-Affirmations
  • Top Reasons for Non-Affirmation for Pressure Reducing Support Surfaces - Group Two
• Suggestion for education on billing oxygen when beneficiary has commercial insurance primary and Medicare secondary
  • Project closed
  • Suppliers would have to bill each month even if the primary paid 100% and suppliers have indicated that their systems won’t accommodate that billing.
• Post COVID-19 PHE Guidance
  • Send questions to DME POEAG email (DMEPOS-POEAG@Noridian.com) and Noridian forwards to CMS
• Beneficiary owned equipment billing for supplies/accessories
  • Recent global education focus
    • Denial examples can still be sent for review
  • Note: Beneficiary owned information must be on all accessory/supply claim lines.

O&P

• Nothing pending

New Items

General

• January 2021 fee schedule potential fee schedule errors
  • Article published March 31, 2021
    • Call the contact center, provide PTAN(s) needing adjustment or submit special project request
    • Notify "Corrections to the 2021 DMEPOS fee schedule amounts"

Suggestions from POE Advisory Members

1. Member asked if there could be physician education for prior authorization. Indication provided that customers are receiving a non-affirmation for lack of medical necessity or medical records. It seems like there’s a disconnect between non-affirmation and what was sent. Can we provide education back to O&P practitioners and can we provide something in the letter to send back to the physician community? Suppliers are seeing many errors in O&P documentation!
   1. Noridian suggested calling hotline. POE can also partner with the prior authorization team to see if we could develop additional education for the supplier community and expand to focus on practitioners. This has been an on-going request that time constraints have not allowed POE to fully explore.
2. Member noted ongoing chatter in the field regarding the CR modifier. It has been noticed that webinars are mentioning the COVID-19 public health emergency (PHE), but suppliers don't feel that there is a lot of guidance or reference where DMEPOS suppliers should be using the CR modifier.
   1. Noridian noted that there’s an FAQ from CMS and this is the best guidance on the CR modifier. Per interim final rule, if claim is impacted in any way from the PHE, use the CR modifier and narrative.
      1. Supplier was specifically asking about an insulin pump. Beneficiaries must be seen every 6 months, if they miss that follow up, do they still use CR?
         1. Any time coverage criteria are missed because of the PHE, suppliers are to use the CR modifier.
   2. Suppliers are requesting policy specific information on how the CR modifier affects each one. Maybe give scenarios.
      Suggested it may be helpful to give a reference sheet on when NOT to use the CR modifier.
3. Supplier expressed thanks for getting new medical director on the Dear Physician letters. Any idea of how long this will take? Specifically, the documentation letter.
   1. The medical directors are working on them regularly. It may depend a little bit on what comes up in the next month. DMDs are busy but are hoping to get them updated sooner rather than later.
4. Noridian requested feedback on whether suppliers on Facebook vs. Did You Know (DYK). How do we reach them the best?
   1. Only one supplier commented, and she doesn't use FB as much at work but does use it on her phone. She does read the DYK.
5. Supplier suggested to consider alternative ways of engaging people. She shared that NGS has pop quizzes and may be something like that would be helpful. Shows up in email that they are doing it and they have an hour to answer the questions. It's kind of a race for those that are a bit competitive.

Next meeting: July 21, 2021