Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - January 17, 2019

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.

Education comments/ideas may be directed to: DMEPOS-POEAG@noridian.com

Member attendees: Wayne Bradberry, Kim Brummett, Leonard Coulombe, Rosa Gomez, Dawn Jorgensen, Carolyn Koster, Terry McCrary, Noel Neil, Robin Nyberg, Jan Palmer, Debra Silvers, Barb Stockert, Mary Stoner

Noridian attendees: Cindy White – Facilitator, Elizabeth Barton, Diana Duchscherer, Kathileen Stelljes, Tracy Schutt, Trina St Ours, Colleen Harryman, Megan Schrock, Athena King

Standing agenda items

  • Medicare Beneficiary Identifier (MBI)
  • Targeted Probe and Educate (TPE)
    • Discussion and confirmation of a new pilot exploring 10 claim review occurred.
    • Confirmed for supplier questioning that the nebulizer itself is not being reviewed at this time. The codes on review are the inhalation medications.
Review Criteria Error Rate July meeting Error Rate October (April 2018 June 2018) Error Rate January (July to September 2018)
Diabetic Supplies TPE Reviews 66% 65% 61%
Enteral Nutrition TPE Reviews 14% 20% 53%
Hospital Bed TPE Reviews 34% 72% 72%
Immunosuppressive Drug TPE Reviews 14% 18% 39%
Manual Wheelchair TPE Reviews 43% 32% 58%
Nebulizer TPE Reviews 15% 19% 19%
Oxygen TPE Reviews 37% 40% 45%
Parenteral Nutrition   100% 59%
Positive Airway Pressure (PAP) TPE Reviews 7% 12% 10%
Surgical Dressing TPE Reviews 93% 86% 69%
Urological Supplies TPE Reviews 33% 40% 36%

 

Follow up information from previous meeting

  1.  Flow chart for dentists for steps in providing Oral Appliances
    • Pending
    • The plan is early 2019, however there is no established time line.
  2. Request for DME and Part B joint webinar on Oral Appliance
    • Oral Appliance will be included in the January 24 Collaborative webinar
    • Polysomnography, PAP and Oral appliances are included in this presentation
    • It has been advertised as Positive Airway Pressure Devices & Polysomnography, however oral appliance information was added due to the increase in same/similar occurrences
  3. Training Curriculum status
    • Expect publication to the website in the next few weeks
    • Curriculum is currently in the final approval stages with Noridian's internal communications team
  4. Template for Detailed Written Orders (DWO) on Clinician's Corner
    • Remains pending
  5. Liter flow tool to identify oxygen modifiers using calculation of averages
    • Completed and published November 30
    • Named Oxygen Modifier Decision Tree
  6. Collaborative webinar or ACT with CGS on Q modifiers. Show scenarios.
    • Noridian requested questions/scenarios
      • None received to date
      • Pending
  7. Request for more education on the provision of DMEPOS in collaboration with Part B for ambulatory services, for example total hip replacement with a one-day hospital stay and the prescription of walkers, canes and CPM machines.
    • Pending for 2019
    • Member offered to ask the Nevada association (NAMPS) members if anyone has ideas and respond back to Noridian.
  8. Suggestions for enhanced training include:
    • Continuous Passive Motion (CPM)
    • Non-invasive ventilation
    • Respiratory Assist Devices (RAD)
  9. Education needed on fragmented billing. Suppliers believe that DME MACs are interpreting differently.
    • Will address in 2019

Suggestions from POE Advisory Members

  • In response to member questioning, Noridian was able to confirm that the government shutdown is not affecting business operations at Noridian.
  • Member expressed concern for billing power wheelchair code K0822. The condition of payment prior authorization program only offers prior authorization for the base item. Requesting enhanced education on condition of payment prior authorization and advanced determination of medical necessity (ADMC).
    • Noridian will take this as an action item to improve education to stress that only base can be pre-approved and what is needed for the approval of accessories.
  • Member suggested that Noridian evaluate prior authorization condition of payment for suppliers in states where this is new. It may be beneficial to look at their results and the overall success/approval rate. Member noted that CMS used to publish this information, however supplier hasn't seen it published since January 2017. Request made to see these results on a quarterly basis to assist with additional education efforts.
    • Noridian will take this as an action item to identify whether we can publish this information.
  • Member would like to see the published statistics on prior authorization. It was stated that it is believed some suppliers are requesting prior authorization knowing that the beneficiary doesn't qualify but it's submitted for denial. Is there a way to note the ones that were submitted for denial to segregate from true denials? Member noted that numbers will be skewed otherwise. Possibly document something on the front of request to indicate it's only being submitted for denial (beneficiary request vs. physician request).
    •  Noridian will take this as an action item and research.
  • Noridian inquired about understanding of the new the multi-function ventilator. There was a short discussion resulting in information shared that no one on the call is providing them yet.
  • Member inquired about SMRC reviews and educating the supplier and clinical community about documentation requirements. Noridian noted that there are several webinars coming up that will target the Part B physicians to heighten awareness of documentation requirements. Clinician's Corner has some letters directed towards the provider community as well.
  • Member noted that now that the National Mail Order competitive bid contracts have expired there should be additional education to suppliers. Noridian stated that this will be included and emphasized in Glucose training webinars.
  • Member asked question about digital impressions for oral appliances. Noridian responded that the LCD for oral appliances in the treatment of obstructive sleep apnea must be followed. At this time the LCD specifies that a positive model of plaster or equivalent material must be made.
  • Member noted that the supplier community needs more education on telemedicine visits and how they are authorized for DME equipment. If they are being encouraged, DME suppliers need to be more prepared for that.
    • Noridian reviewed CMS guidelines at a high level which require the beneficiary to be in an originating site. If that is not occurring, it is not authorized telemedicine. Member suggested including in education how DME suppliers can recognize if the DWO is a result of a valid telemedicine encounter.
    • Possibly also do a shorter webinar or DME on Demand
      • EVERYONE LOVES DME ON DEMANDS
  • Member inquired whether Noridian was aware of any delay in processing claims. Some customers are complaining about delays. Noridian noted that the education team was not aware of any delays, however examples should be brought to the attention of the Noridian contact center.

Next meeting: April 11, 2019

 

Last Updated Tue, 11 Feb 2020 16:20:44 +0000