POE AG Meeting Minutes - January 20, 2022 - JD DME

POE Advisory Group Mission and Goals

Attendees

POEAG Members: Wayne Bradberry; Ronda Buhrmester; Glenn Closurdo; Todd Dodds; Nancy Froslie; Angie Fyfe; Crissy Hill; Dawn Jorgensen; Paull Kesselman; Carolyn Koster; Noel Neil; Erica Rochelle; Maria Sanchez; Lesleigh Sisson; Barb Stockert; Dan Vasilj; Japa Volchok; Tanya Ward; Donald Eschler; Michelle Wullstein

Noridian: Shelly Carlson; Stacy Dahl; Amber Mertz; Ruth Reese; Tracy Schutt; Kelsey Slettebak; Brenda Swancy; Cindy White

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 look for update soon
  • Last extension expired October 2021
  • Effective January 16, 2022, extended another 90 days
• Post COVID-19 PHE Guidance
  • Send questions to DME POEAG email (DMEPOS-POEAG@Noridian.com) and Noridian forwards to CMS
• Sequestration suspension extended to March 31, 2022
  • Effective April 1, 2022 - June 30, 2022, adjustment will resume at 1%
  • Effective July 1, 2022, adjustment will increase to 2%
• Targeted Probe & Educate (TPE)
  • Resumed
• Post-Payment Clinical Review
  • Ended
• Education for Practitioners
  • Continue to seek opportunities
  • PEN education after checklists are updated
    • DME Enteral webinar January 19, 2022, 11 a.m. CT
    • DME Parenteral webinar January 26, 2022, 1 p.m. CT

Follow-up from Previous Meetings

General

• Suggestions for engaging audiences
  • Working on implementing “pop quizzes”

DME

• Level 200 Ventilator Webinar
  • Three scenarios completed, looking for two more
    • Asked for more scenarios for vents
• L200 Respiratory webinars
  • Oxygen placed on hold due the upcoming policy changes
  • PAP May 25, 2022, 1 p.m. CT
  • Nebulizers placed on hold
  • Continue to look for scenarios
• Frequently Asked Questions – Philips Respironics Respiratory Products Recall – Revised
  • Initially published June 25, revised July 16
  • Frequently Asked Questions (FAQ) posted on Noridian website
  • No updates
• Noridian is aware of the oxygen decision memo and more education will be forthcoming.
• Joint POEAG to develop education for clinicians ordering DMEPOS
  • In progress

O&P

• Nothing pending

New Items

General

• Ask the contractor teleconference (ACT)
  • Scheduled for 2022 - February 10, May 11, August 9, and November 10
  • General - all topics
• 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

Suggestions from POE Advisory Members

Really glad Noridian is looking at F2F and prior auth requirements, the office has been inundated with calls and questions. Suggest full forged education to suppliers on this because they don't understand the differences between the Master and Required Lists. Two other members stated the importance of education on this.

It will be in all webinars starting soon and specific education also be provided closer to implementation. Noridian was notified at the same time as suppliers.

Concerns with CR modifier; Suggestion to educate everyone on the proper use. Many are adding this because they thought it was ok but concerns if there are audits. One other member had the same comment

The CR modifier usage was also brought up in the Jurisdiction A POEAG meeting. Noridian has stated during webinars not to add it to everything. For those of us around this at the beginning, we went over and over the CR modifier in depth and when it should be used. If there are new billers, it's possible they don't recognize these discrepancies. We will review this and get additional information out as soon as possible.

Suggestion to add the TPE process to the resources in webinars but since nothing changed, it doesn't need to be focused on.

What, if any, education has been provided so far on the inclusion of five orthosis codes to prior authorization since the first implementation is to begin in April?

Our orthotics and prosthetics team is working on education that will be provided at least in March, general information is being put together regarding the overall prior authorization process as well.

One member has a global view of claim denials and denial CO-261 for prosthetics has had a huge impact. Has this been shared with the POE team and has education been discussed? Maybe information could be given in an upcoming LLP webinar because mixed resolutions are being given by the Contact Center or maybe a DME on Demand could be created.

CO-261 is a code that was discussed recently and are currently looking into this. There are a number of Medically Unlikely Edits (MUEs) that are published and unpublished. If it's unpublished, Noridian cannot talk about it. Is it enough that suppliers understand that Medicare publishes some and others they don't publish? If they are unpublished, they can't be talked about. Will that help suppliers understand?

Yes it can be helpful to talk about published and unpublished MUEs. With this denial, it's not related to frequency or a numeric limitation for the code. They are struggling to identify what the problem is and how to correct it. With Noridian, these denials are not appealable because they are unprocessable.

Can there be a L200 webinar on continuous glucose monitors? It can get confusing on the proof of delivery and the number of units. How do we monitor the usage when it's exempt from the refill requirement?

An L200 Glucose Monitors and Supplies is scheduled for February 1, 2022.

Do you know when the DME MACs will update the Oxygen LCD to by in synch with the NCD?

No, we are working on it with CMS. As an NCD is updated, LCDs must follow. The decision memo was published so we know it is coming; however, CMS has not provided DME MAC implementation instructions. This is what we are working on now. We have education prepared and are waiting for CMS to ensure nothing has changed. We are aware there are some changes that may cause the need to update to supplier systems, this has been shared with CMS. In general, there is lead time prior to implementation so education will be given as soon as possible prior to CMS releasing a date.

Upcoming Meeting

Next Meeting: April 21, 2022