Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - July 15, 2020

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.

Reminder: We meet on a quarterly basis to discuss educational opportunities that Noridian Education can provide to suppliers through workshops, our website, and our listserv. We aren't able to discuss claim-specific questions or issues you may be seeing with claims. Please direct those questions to our Supplier Contact Center where they can be researched and resolved.

Member attendees: Kim Brummett, Ronda Buhrmester, Tami Carter, Dawn Cetti, Ricky Clark, Kristine Cram, Paula Doherty, Melinda Eberhart, Valerie Eriole, Kimberly Hanson, Sharee Hummer, Dawn Jorgensen, Paul Kesselman, Tugba Koca, Maria Koehnlein, Jeannette Leon, Bridget LaScala, Gary Marano, Joe McTernan, Rica Nebrich, Noel Neil, Yvette Nugent, Jan Palmar, Joyce Perrone, Caryn Plessinger, Erica Rochelle, Kimberlie Rogers-Bowers, Wendy Russalesi, Ernestina Smith, Randy Stevens, Rachelle Tritinger, Rhonda Turner, Yvonne Weiler

CMS attendee: Alikia Mack

Noridian attendees: Cindy White, Courtney Willis, Elizabeth Barton, Jessica Bennett, Kate Petersen, Kelsey Sagvold, Melissa Kuznia, Tanya Gillis, Tracy Schutt

Standing Agenda Items

  1. Coronavirus (COVID-19) Public Health Emergency (PHE)
    • Waivers and flexibilities in place
    • Resources on CMS and Noridian websites
    • Feedback
      1. With the changes coming in August to restart audits, is there any instruction from CMS?
        1. Noridian: We are aware there is an FAQ, but we do not have finalized education we can provide.
      2. Does this mean CMS will rescind the blanket waiver protocol once audit is reintroduced or will there still be some carve outs?
        1. Noridian: Until we are provided final guidance by CMS, we are not able to address this
      3. Is Noridian looking for questions from POEAG?
        1. Noridian: Since the purpose of this group is to provide education, send questions to DMEPOS-POEAG@Noridian.com and we will provide answers in the education we provide
  2. Targeted Probe and Educate (TPE)
    • Suspended during the COVID-19 PHE
    • No update on when TPE will resume
  3. Education for Practitioners
    • Addition as we look for opportunities
    • Suggested emphasis on dictation of medical records which Noridian incorporates into all practitioner education opportunities
    • Noridian partners with A/B for global education opportunities with Oxygen at the end of the month

Follow Up Information from Previous Meeting

General

  1. Increased Fraud & Abuse education
    1. Education slides were created and have been incorporated into Monday Live Chat as well as other webinars
    2. Noridian webpages provide contact information
  2. Tool that encompasses codes that are not covered/allowed
    1. There is a listing of the most common non-covered items under the “Browse by Topic” header

DME

  1. L200 for Ventilators
    1. Currently in Process of creation
    2. Noridian continues to seek examples of scenarios from the supplier community for inclusion in the webinar. Send examples to DMEPOS-POEAG@Noridian.com.
  2. Provide denial rate affirmation on prior authorization and conduct targeted training
    1. On hold at this time due to the Public Health Emergency (PHE).  Prior Authorization Request (PAR) is voluntary until further direction from CMS
  3. Suggestion for education on billing oxygen when the beneficiary has a commercial insurance primary and Medicare secondary
    1. Project is in progress

Orthotics & Prosthetics (O & P)

  1. O & P Training Program for Competitive Bid
    1. Webinars and educational materials are being prepared. Plan to launch in the fall.
  2. List of same and similar tips to avoid unnecessary denials
    1. Suggest use of Browse by Topic > Remittance Advice > Denial Code resolution
    2. Are there other denial code combinations you would like to see included?
  3. Off the shelf coding more visible/training
    1. O & P Associations received information on the Joint DME MAC publication, Off-the-Shelf versus Custom Fitted revised article in the 2020 Q2 Newsletter
    2. The article is also being promoted in webinars with a targeted informational slide.
    3. DME on Demand moved to YouTube, June 25, 2020

New Items

General

  1. All DME on Demand tutorials are now on the YouTube platform.

DME

  1. Jurisdiction D is partnering with the corresponding Part B states for an Oxygen Coverage and Documentation requirement webinar on July 29
    1. Success will be evaluated and then offered to the Part B jurisdictions corresponding to JA states as well.
  2. Ask the Contractor Teleconference (ACT) DME focused scheduled for August 13

O & P

  1. Ask the Contractor Teleconference (ACT) specific to O & P scheduled for November 12

Suggestions from POE Advisory Members

  • You mentioned TPE and PAR, it’s our understanding based on the FAQs that audits are resuming August 3. Do you have additional information you can share?
    • The DME MACs have received preliminary information and we are waiting for final direction from CMS on the resumption of audits and moving the four states into prior authorization for Lower Limb Prosthetics (LLP). All our education is ready for LLP and we will roll that out as soon as we get the go ahead from CMS. We are also preparing educational material regarding Competitive Bid for both Orthotics and Prosthetics as well as general webinars for those that may not have participated in past rounds.
  • Three home infusion codes are transitioning from the DME MAC to the Part A/B MAC. DME pharmacies are providing the drug to the eligible providers. Is there co-education planned for this? With the final rule not coming out until November and the effective date is January 1, it will happen very quickly.
    • Yes, we are preparing educational material and we’ve attended CMS calls. As you stated, it’s important we do the education in conjunction with what A/B as it does help them understand what’s happening with the codes transitioning and the codes being added.
  • Something that will be very important for suppliers once we do have clarification from CMS  is in reference to when the PHE is lifted, is how the existing patients will be treated with  dates of services outside of the PHE, especially ongoing supply patients and what documentation will be looked for during audits for patients set up during the PHE.
    • We continue to keep this at the forefront and are preparing to provide guidance to suppliers once we receive the direction from CMS.
  • Do you plan on providing physician-based education relative to the prior authorization rollout? I think it is equally important for the physicians prescribing these to know what is required to facilitate the prior authorization of these codes.
    • This is something we will investigate with our Part B counterpart. The DME MAC focus is to educate the DME supplier and historically, the supplier has been tasked with educating the practitioner community. DME has developed more partnerships with A/B, trying to get the message to them. We will take this as a follow-up to reach out and see what we can do to create a collaborative webinar.
  • Are these prior authorizations all for LLPs?
    • Power Mobility Devices (PMDs) were the first group, then Pressure Reducing Support Surfaces (PRSSs) were added, and now six codes for LLP are being added.
  • Is the PHE having any effect on the Local Coverage Determination (LCD) reconsideration process?
    • As far as we know, it’s not having any effect because the DME MACs have been open for business the entire time and medical directors have been meeting.

Next meeting: October 14, 3 p.m. CT

 

Last Updated Wed, 05 Aug 2020 16:00:46 +0000