POE AG Meeting Minutes - July 20, 2022 - JA DME

Attendees:

POEAG: Ronda Buhrmester; Kristine Cram; Dawn Cetti; Melinda Eberhart; Pamela Fritz; Sharee Hummer; Catherine Hamilton; Kimberly Hanson; Crissy Hill; Paul Kesselman; Tugba Koca; Maria Koehnlein; Bridget LaScala; Gary Marano; Noel Neil; Bill Noyes; Yvette Nugen; Jan Palmer; Caryn Plessinger; Erica Rochelle; Kimberlie Rogers-Bowers; Randy Stevens; Rhonda Turner; Yvonne Weiler; Donald Weschler; Debbie Gangemi

CMS: Pamela Durbin

Noridian: Amber Mertz; Brenda Swancy; Cindy White; Colleen Harryman; Conner Dingle; Dan Schmitt; Kate Petersen; Kelsey Slettebak; Kloe Roberts; Melissa Betts; 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 Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities remain in place
  • Last extension expired July 16, 2022
• Post COVID-19 PHE Guidance
  • Send questions to DME POEAG email (DMEPOS-POEAG@Noridian.com) and Noridian forwards to CMS
• Sequestration adjustment returned to the full 2% on July 1, 2022
• Education for Practitioners
  • Continue to seek opportunities

Follow-up from Previous Meeting

General

• Joint POEAG to develop education for clinicians ordering DMEPOS
  • Two meetings have been held focusing on sleep
    • Great suggestions being worked on
      • Provide education during residency
      • More webinars for providers on DME requirements
  • Looking for supplier volunteers for a similar Glucose meeting, willing to recruit practitioners
• Collaborative MAC education
  • Glucose Monitors and Supplies
    • August 25, 2022
  • Respiratory
    • November (TBD)
  • Pneumatic Compression Devices CERT Taskforce
    • October 5, 2022 (tentative)
• 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
• Hospice and DME education
  • In the process of creating education

DME

• Philips Respironics Respiratory Products Recall
  • On going
  • Medical director discussions continue

O&P

• 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 orthopedic 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

General

• Ask the contractor teleconference (ACT)
  • Scheduled for 2022 - August 9, and November 10
  • General - all topics
• Removal of Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
  • January 2023
• Level 200 webinars
  • Please send scenarios you would like to see included
  • Send to the POEAG email address

Suggestions from POE Advisory Members

• Joint POEAG
  • If participating as a supplier, how many physicians need to be recruited? There isn't a set number but in order for these to be the most successful, we need feedback from both sides.
  • What information do you need? We need the practitioner's email and they will receive an email invite from Noridian.
  • When will the meetings start? We hope to have one before the end of this year if we have interest after this meeting.
  • I have a number of resources in refractive lenses and can bring providers together, information will be emailed.
• Level 200 webinars
  • We are seeing frequency issues on urological supplies, do we send an email explaining what we would like to see the training on? Yes, please send the scenarios but do not include Protected Health Information (PHI).
  • We are not seeing improvements on post pay and Targeted Probe and Educate (TPE) results on spinal orthoses and looking at the denials, most of them are regarding placing it on the beneficiary prior to surgery.
  • A supplier had complex case and wanted Medicare to look at it before submitting it. Does Noridian have a pre-review of medical necessity? No, Noridian does not, we are aware that CGS has this. These would be great scenarios for L200 webinars.
• Competitive Bidding (CB)
  • Is this back for next year? CB 2021 goes through December 2023 and we haven't received notification of any changes. The reason we continue to have these webinars is because we still receive questions on what items are included CB and there is confusion with prior authorization.
• PDAC Verification
  • Documentation Checklists, AFO/KAFO L1906 and L2006, and KO L1845 and L1852, can it be noted that these codes need PDAC verification? Yes, Noridian will look into adding this information.
  • Can an article be written that lists all of the codes needing PDAC verification, especially with the additional codes coming up in October? Yes, Noridian will look into writing this article.
• There were new Lower Limb Prostheses codes in October 2021, K1022 and K1014, that are not in LCD yet so I don't expect them to be on the documentation checklist yet, but we are seeing a fair amount of denials and when we appeal, they are being approved. Can the edits be looked at to eliminated the need for appeals? Yes, Noridian will look into this.
• Search has improved on website
• CMN and DIF Elimination
  • We submit dummy DIFs to put a pump on file in order to only bill supplies. How will this be addressed? Starting in 2023, DIFs won't be submitted at all and we haven't received information on how this will be handled but we will provide information as soon as we are able.
  • We use the portal to find equipment dates to qualify and replace equipment and we know those dates often times come from DIFs. There is concern with being able to obtain this information in the future. Noridian wants to let suppliers know this information will still be available in the portal for same and similar purposes.
  • CMS' announcement stated this was to relieve administrative burden, but it might introduce new burdens.

Upcoming Meeting

• Next Meeting: October 19, 2022