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: Ronda Buhrmester, Kim Burmmett, Mindy Eberheart, Valerie Eriole, Pamela Fritz, Kimberly Hanson, Sharee Hemmer, Crissy Hill, Dawn Jorgensen, Tugba Koca, Maria Koehnlein, Jeannette Leon, Eileen Levis, Gary Morano, Noel Neil, William Noyes, Yvette Nugent, Tina Padden, Jan Palmer, Caryn Plessinger, Kristine President, Erica Rochelle, Kimberlie Rogers-Bowers, Randy Stevens, Mary Stoner, Rachelle Tritinger, Yvonne Weiler
• Noridian attendees: Shelly Carlson, Teresa Cirelli, Kathy Fulton, Daria Gabai, Collen Harryman, Melissa Kuznia, Amber Mertz, Kate Petersen, Ruth Reese, Mary Reineke, Kloe Roberts, Tracy Schutt, Brenda Swancy, Cindy White.

Standing Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities remain in place
    • Extended until October 2021
• Targeted Probe & Educate (TPE)
  • No update on resumption
    • Member comment: Talked to Centers for Medicare & Medicaid Services (CMS) and they indicated they are looking to restart TPE towards the end of the summer.
• Post-Payment Clinical Review
  • Please follow the Medical Review page for up-to-date review information
• Education for Practitioners
  • We continue to seek opportunities

Follow-up Information from Previous Meeting

General

• Updated Dear Clinician letters
  • Still have a few remaining
    • Majority updated including:
      • Documentation of Continued Medical Necessity
      • Medical Records
      • Medical Record Authentication - Tips for Clinicians
      • Many policy-specific
    • Done in early July
    • Member comment: The updates on resource letters have been good. Continuous Glucose Monitoring (CGM) is prominent now. Could that checklist be updated along with the letter to explain the Blood Glucose Monitor (BGM) and returning to that therapy?
      • Noridian: That is great feedback, we’ll take a more in-depth look to see if there’s something we can do to assist.
• New supplier training and checklists
  • All current
• Physician based education for prior authorization
  • A draft presentation has been completed and is in the review process
    • Noridian continues to attempt to partner with Part B Medicare Administrative Contractors (MACs) in the states shared by JA suppliers
• Specific training on telehealth
  • Collaborative webinar with A/B held July 13
    • Did anyone attend? Was it beneficial?
    • Member comment: The united front approach is appreciated. It will help to understand the entire process…what A/B goes through vs. what DME goes through. Continue emphasis on the concept that we’re all in this together, suppliers want to understand physicians challenges. Also sharing what suppliers deal with directly working with beneficiaries.
    • Member comment: Insulin with pump would be a good topic.
    • Member comment: Infused drugs would be another opportunity for education because there are differences and limited coverage. A part B drug is not always a part B drug, there are differences between use in physician’s office, and use in the home. Some education on limited coverage and the intersection of home infusion services could help. A lot is dependent on site of care and that is creating much confusion.
      • Noridian: Good example, we usually base our education on the Comprehensive Error Rate Testing (CERT) error rate, however that is a good point.
    • Member comment: Another example, is the insulin pump covered by Medicare. This falls under part B, but you do not go to the doctor or the pharmacy to get that item. Do workgroups have Medicare A/B people or A/B and DME people that would be able to survey volunteers from supplier community and physician community and hear their feedback on issues that they are facing and base education on that?
      • Noridian: This is a great idea; we will explore further.
• Additional education requested for use of the CR modifier
  • New resource slides were developed following the April meeting and have been utilized in most webinars for the past two months.
    • Member comment: A couple of her team members went to the webinar and they told her they felt it was a great discussion and great information! They did have follow up questions, but the education was informative.
• Suggestions for engaging audiences
  • Still evaluating options like the “pop quiz” suggestion

Durable Medical Equipment (DME)

• Additional Enteral and Parenteral education following retirement of Local Coverage Determinations (LCDs)
  • Webinar held July 20
  • Draft policies are out on the website for review, comment period ended in April
  • No updates on projected dates as of this meeting
• L200 Ventilator webinar
  • Continues to be in process
  • Noridian continues to seek examples of scenarios from the supplier community for inclusion in the webinar
• Post COVID-19 PHE Guidance
  • Send questions to DME POEAG email (DMEPOS-POEAG@Noridian.com) and Noridian forwards to CMS

Orthotics and Prosthetics (O&P)

• Nothing specific to O&P pending

New Items

• Frequently Asked Questions (FAQ) - Philips Respironics Respiratory Products Recall - Revised
  • Initially published June 25, revised July 16
  • Frequently Asked Questions (FAQ) posted on Noridian website
• Use of the KU modifier extended for dates of service after July 1
  • Impacts wheelchair and  wheelchair accessory codes
• New article “Correct Billing for Custom Fitted Orthotics when no Custom Fitting is Completed with no Off the Shelf Equivalent”
  • Published May 7, 2021
  • Member comment: First article came out from the Medicare Contractor for Pricing, Data Analysis and Coding (PDAC) back on March 15 but gave no guidance for dates of services. Was the guidance in effect as of the date of the publication? Do we have to rebill the claims prior to this guidance?
    • Noridian: This information is not new but thinks it wasn’t thoroughly understood by the supplier community. There is no need to go back unless there is an issue in case of an audit. Suppliers should have been billing like this all along.
      • Member comment: Agrees, but suppliers are hesitant to bill miscellaneous 99 codes without having clear guidance. Majority have not been doing that, this is new information for the community, effective dates should have been communicated.
        • Noridian: While we can’t say what will happen in case of a review, if you’re billing correctly going forward, that should be ok.
        • Noridian: Noridian did create an article under Browse by DMEPOS category under orthotics giving clarification how to bill and the appropriate narrative that should be included on those claims. 
          • Member comment: Read the article, very thorough, has passed it on! Appreciates the practical examples.

General

• Member comment: SC Hizentra for Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) has been covered by Part D. Coverage is effective as of July 18 without retroactivity. In the past, if someone was on Hizentra for CIDP the DME supplier may have a non-payable DME Information Form (DIF) on file for Part B DME. Now that it’s payable, will MACs automatically change that to payable or do they need to submit a new or revised DME Information Form (DIF)?
  • Noridian: If there is a denied DIF on file, you’ll need to submit a revised DIF. 
    • Member clarification: Even though it’s revised and nothing changes is that ok?
      • Noridian: Correct.
• Member comment: I’m wondering if Noridian is aware that 1-800-Medicare is calling suppliers with beneficiaries on the phone regarding the recall saying Medicare will replace the machines. Beneficiaries cannot be rerouted to DME MACs to get the correct information. How do we handle that?
  • Member addition: They’ve had lots of situations where 1-800- Medicare is calling with beneficiaries on the line. CMS was educated on the extent of the challenges with the issue. Phillips will be sending out letters to beneficiaries that are registered and giving them guidance. CMS will be educating the Beneficiary Contact Center (BCC) with these expectations after beneficiaries register on their website.
    • Noridian: We have passed this information on to CMS.
      • Member addition: One of the things BCC has been telling patients is that this is life sustaining equipment. Phillips has recommended beneficiaries contact their physician. The beneficiaries are expecting the supplier to replace the equipment. This is causing confusion. Beneficiaries don’t trust suppliers, etc.
        • Noridian: There should be more education coming out soon, continue to reference the published FAQ.
• National Home Infusion Association (NHIA): Will send Noridian an invitation to speak at the NHIA conference in March in Nashville. 
  • Any insight as to when 2019 utilization data will be released?
    • Noridian: Not currently
• Member comment: Regarding HIGLAS, more information is needed for suppliers to understand where payment reconciliation details come from. Where other funds are being allocated? Examples can be provided if needed. Any outstanding government amounts are being deducted from DME payments. It’s difficult to track down and reconcile where those payments are coming from.
  • Member addition: While in agreement, it is difficult, not sure what we can do. It’s all caught up in the Department of Treasury. There is no way to track it down. It is an issue for larger providers that work in multiple spaces.
  • Member addition: Agreed, let’s work together if it’s a big deal…have not had any luck with Department of Treasury thus far. May have more luck working together.
    • Noridian: There has been work with a group to see what we can do to help suppliers. When multiple Provider Transaction Access Numbers (PTANs) under one Taxpayer Identification Number (TIN) monies may be taken under the TIN. This workgroup is evaluating what we can do to alleviate this issue. The Noridian Medicare Portal is only by NPI/PTAN. 
• Member comment: In reviewing Q and A’s there seems to be a contradiction between 9 and 12. What is Noridian’s position on this?
  • Noridian: It is being cautiously stated if there is a need for a loaner for more than a month, it may be eligible for coverage, however, suppliers need to be careful not to change to a permanent loaner.
    • Member addition: Noted that there is a Florida physician group with patients unable to obtain a PAP, so physicians are starting to order oxygen.
      • Noridian: Oxygen coverage doesn’t change, but we’re in the middle of PHE so not enforced. 

Next meeting: October 20, 2021