Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - January 19, 2023

Attendees

POEAG Members: Barb Stockert; Carlota Martinez; Carolyn Koster; Crissy Hill; Dan Vasilj; Dawn Jorgensen; Glenn Closurdo; Irene Velarde; Jan Palmer; Kelly Troutman; Kim Brason; Lesleigh Sisson; Maria Sanchez; Marsha Lawrence; Mary Stoner; Melody Romero; Michelle Wullstein; Nancy Froslie; Patty Donndelinger-Bogyo; Rebecca Erickson; Ronda Buhrmester; Rosa Gomez; Sonia Olmos-Sura; Tanya Ward; Wayne Bradberry

Noridian: Ashley Decoteau; Brenda Swancy; Colleen Harryman; Dan Schmitt; Kate Petersen; Kelsey Slettebak; Kloe Roberts; Mary Reineke-Ferguson; Ruth Reese; Shelly Carlson; Stacy Dahl; 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

Standing Agenda Items

  • Coronavirus (COVID-19) Public Health Emergency (PHE)
    • Waivers and flexibilities remain in place
    • Extended January 11, 2023
  • Post COVID-19 PHE Guidance
  • Education for Practitioners
    • Continue to seek opportunities

Follow-up from Previous Meetings

General

  • Joint POEAG to develop education for clinicians ordering DMEPOS
    • Four meetings have been held focusing on sleep
    • Great suggestions
      • Provide education during residency
      • More webinars for providers on DME requirements
      • Update clinician checklist
    • Looking for supplier volunteers for a similar Glucose meeting, willing to recruit practitioners
      • Meetings to start 2023
  • Collaborative MAC education
    • Knee Orthoses
      • February 2023
    • Oxygen
      • Quarter two
    • Surgical Dressings
      • Quarter three
    • Therapeutic Shoes for Persons with Diabetes
      • Quarter four
  • Hospice and DME education
    • Webinar will be held in April 2023
  • Level 200 webinars
    • Please send scenarios you would like to see included
  • Considering 2023 in-person event
    • Held centrally for JA and JD
  • Quarterly updates
    • DME highlights from weekly email
    • Hot topics
    • New format
    • Is this beneficial?

DME

  • Philips Respironics Respiratory Products Recall
    • On going
    • Medical director discussions
      • During the PHE, if there is documentation from the treating provider that states the beneficiary’s medical condition has not changed since the previous sleep study and the evaluation by the treating physician is within a year of the DOS for initial issue of a CPAP, then DME MACs will accept this documentation in lieu of a repeat sleep study to meet the timely documentation requirement.
  • Removal of Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
    • January 2023

O&P

  • L200 webinar on Prior Authorization for Orthotics with a focus on surgery

New Items

General

  • Ask the Contractor teleconference (ACT)
    • Scheduled for 2023
      • February 9, 2023, 2 p.m. CT
      • May 11, 2023, 2 p.m. CT
  • General - all topics

DME

  • National Supplier Clearinghouse (NSC) is now National Provider Enrollment (NPE)
    • Effective November 7, 2022
    • East of the Mississippi is NPE East
      • Novitas Solutions
    • West of the Mississippi is NPE West
      • Palmetto GBA
  • Continuous Glucose Monitors (CGM) HCPCS code update
    • Effective January 1, 2023
    • New HCPCS Codes
      • A4239 Supply allowance for non-adjunctive, non-implanted CGM, includes all supplies and accessories, 1month supply = 1 unit of service
      • E2103 Non-adjunctive, non-implanted continuous glucose monitor or receiver
    • Deleted HCPCS codes
      • K0553 Supply allowance for therapeutic CGM device
      • K0554 CGM receiver/monitor
  • New Medicare Part B immunosuppressant drug benefit

  • Suggestions from POE Advisory Members

  • Thank you for adding CGM information to the website, it is very helpful
  • Intermittent catheters are very heavily audited, some beneficiaries have orders for over 200 (the max for a month); Targeted Probe and Educate (TPE) nurses could not approve over 200; is it possible the Medical Directors could add information about documenting the need for more than 200 in the Urological Dear Clinician Letter?
    • Noridian will submit a request
  • What are Level 200 seminars?
    • These webinars review specific billing and documentation scenarios our medical review staff has encountered, or suppliers have submitted for education on resolution. Anyone can attend of course but these are more advanced webinars that really require a basic knowledge of the policy.
  • It would be very interesting to see successful examples in the Level 200 orthotics webinar and we will sign up as soon as it's available
  • At the in-person meeting, having an in-person POEAG would be great.
  • Are there any publications on CO-261 denials? AOPA reached out to the Medical Directors, and they responded in a letter with a resolution. Was there a plan to provide this direction publicly?
    • There is no plan to publish anything, but Noridian will provide the feedback that the supplier community is looking to have something published.
  • When is the CGM collaboration occurring?
    • We do not have a date set because we haven't received any recommendations yet.
      • If you are interested in participating and have practitioners you would like to recruit, please reach out the DME POEAG email address.
  • Regarding same or similar and replacement criteria on O&P, a lot of claims are overturned on upper levels of appeals for valid reasons of change in medical condition. Is there training that can be done with staff at the redetermination level to see a higher level of overturns?
    • The redeterminations level must follow the Local Coverage Determination (LCD) while the upper levels of the appeals process have more flexibility with their reviews; however, we can pass these concerns on.
  • We can send the beneficiary a 90-day CGM supply but can only bill once every 30 days. Can this be changed to align more with other supplies in other product categories?
    • This is not something Noridian can change. Suppliers have a bigger voice than us; keep working at requesting the change and maybe it will happen in the future. 
  • Is there a way to see if a beneficiary was shipped a 90-day supply? We are struggling to make it efficient and are looking for suggestions.
    • The Noridian Medicare Portal displays this information.
  • Has anyone else received Additional Documentation Requests (ADRs) from Safeguard and Qlarant?
    • Attendee peer responded: If there was an impact due to natural disasters, now there's an influx of TPE and other types of audits.
  • What was the reason for the removal of Enteral DIFs? The new process of adding modifiers and narratives on each claim takes more time than just a DIF when there is an order change. This is so much more time consuming for our billers.
    • The decision to remove CMNs and DIFs was to reduce supplier and provider burden. Originally, CMS required the CMNs and DIFs to help document medical necessity and other coverage criteria for select DME. Through stakeholder outreach, CMS received feedback that CMNs and DIFs are burdensome and duplicative of information already available on the claim or in the medical record.
  • Is there any chance that the DIFs will return in the near future? That is what I am looking forward to, at least for enteral.
    • There has not been discussion of CMNs and DIFs returning.
  • Does the POEAG plan on having any in depth discussions regarding the changes with the enteral policy in regard to the elimination of the DIFs as well as the new requirements for modifiers and narratives as well as the changes with same or similar on the feeding pumps?
    • We are continuing to update our enteral education with all of the most up-to-date policy changes with the DIF removal. If you have any specific questions, please feel free to ask them now, attend an enteral nutrition webinar, or Monday Live Chat every Monday at 2 p.m. CT and we can cover those for you.
  • How does the group feel about combining Jurisdiction A and D POEAGs into one meeting?
    • There were no objections.

Upcoming Meeting

Next Meeting: April 20, 2023

 

Last Updated Feb 01 , 2023