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 

Member attendees: Carolyn Koster, Dan Vasilj, Dawn Jorgensen, Erica Rochelle, Japa Volchok, Jera Sitton, Kim Brason, Leonard Coulombe, Linda Lewis, Maria Sanchez, Michelle Wullstein, Pamela Fritz, Patty Donndelinger-Bogyo, Robin Nyberg, Ronda Buhrmester, Rose Gomez, Tanya Ward, Taylor Knox, Theresa McCrary, Tina Smith, Tracy Faust, Wayne Bradberry

Noridian Attendees: Cindy White; Colleen Harryman, Kate Petersen; Mary Reineke-Ferguson; Ruth Reese; Shelly Carlson; Tracy Schutt

Standing Agenda Items

• Coronavirus (COVID-19) Public Health Emergency (PHE)
  • Waivers and flexibilities in place
  • CMS resource pages
  • Noridian resource pages
  • Beneficiary Authorization of Benefits (AOB) - Needs signature prior to billing. Noridian sent CMS a formal request to have this removed; however, it was clarified that the waiver did not include the AOB. Electronic signatures are acceptable.
• Targeted Probe & Educate (TPE)
  • No update on resumption
• Post-Payment Clinical Review
  • Please follow the Medical Review page for added codes on review
    • Surgical dressings added December 2020 (A6010, A6496, A6197)
• Education for Practitioners
  • We continue to seek opportunities

Follow-up Information from Previous Meeting

General

• Physician based education for prior authorization
  • Pending
  • Supplier question: What information do you need from us and how do we contact you?
  • Noridian response: We would prefer to do this education in conjunction with the supplier. We would like to remind providers to enter the entire “story” in medical records.
• Text alert option for companies not allowing usage of other electronic options
  • Noridian unable to launch at this time, however suppliers may be able to change FB settings to allow notification when there is a new posting.
• Weekly listserv for upcoming webinars
  • Implemented August 2020
• Advertisement on NMP for upcoming webinars
  • Implemented August 2020
• Additional Standard Written Order (SWO) education requested
  • Monday Live Chat has been addressing
  • SWO specific webinar held December 30
• Specific training on telehealth
  • It is on our schedule for a collaborative webinar with Part B in November 2021
  • We are checking with Part B on the possibility of an earlier time

DME

• L200 Ventilator webinar
  • In process
  • Noridian continues to seek examples of scenarios from the supplier community for inclusion in the webinar
• Provide denial rate affirmation on prior authorization and conduct targeted training
  • Investigation remains on-going
• Suggestion for education on billing oxygen when beneficiary has commercial insurance primary and Medicare secondary
  • Project in progress
  • Update - Even if the primary paid 100%, Noridian would need a claim in our system to track the full history
  • Supplier comment: Our system may not generate a claim to the secondary insurance if there is no balance. Can Noridian initiate a modifier or narrative on the claim?
  • Noridian response: We are unable to initiate a modifier but can look into a solution
• Home infusion codes moving to Part B January 1, 2021
  • Webinar that was cancelled at the end of December is in process of being rescheduled
• Post COVID-19 PHE Guidance
  • Send questions and Noridian forwards to CMS
    • DMEPOS-POEAG@Noridian.com
• Patient owned equipment billing for supplies/accessories
  • Education being developed
  • Noridian requested examples from the member stating last meeting that denials for supplies are occurring when information on date of purchase is not on all subsequent claims even when Medicare purchased the base item?

O&P

• Competitive Bid
  • Webinars were held November 25, December 2, December 15 and January 6
• Lower Limb Prosthetic (LLP) Prior Authorization (PA) - Yes coding verification is required for LLP only. Medical review reports that suppliers are complying with this requirement.

New Items

General

• CMS transmittal clarifying use of PRN on orders
  • Frequency is no longer a required element of the order, so the PRN language is being removed
  • Medical records will be utilized to support the administration of the of the order and quantity provided
  • Supplier question: Can Noridian do a webinar regarding this?
  • Noridian response: The challenge is that Noridian cannot give suggested language because it is many times used word-for-word in medical records. Our suggestion is to be a bit more in-depth as to why a medication is not provided on a regular schedule.
• Noridian relocated our Pricing Data Analysis and Coding (PDAC) page of the website under the Policies section for greater visibility.
• Noridian is working on our partnership webinars with our A/B counterparts that match our jurisdictional states for 2021. The following topics are under consideration: Diabetic Shoes/Podiatry; positive airway pressure (PAP)/Polysomnography; Documentation requirements; Telehealth/Telemedicine
  • Are there other suggestions?
    • Orthotics to help providers understand the clarifications received over the past few months and with competitive bidding
      • Noridian suggests monitoring the schedule of events for education on these topics
• 2021 ACT schedule: February 11, May 13, August 12, November 11
  • All at 2 p.m. CT
  • All General DMEPOS
  • Suggestions from members?
    • Supplier question: Is there room to add additional ACTs because they are very valuable.
    • Noridian response: We offer Monday Live Chats every Monday for an hour but periodically we could do a Thursday Live Chat, similar to what we did with COVID-19, and make them policy specific.

DME

• Intravenous Immune Globulin (IVIG) demonstration - update - extended through December 2023

O&P

• Any concerns to date with competitive bid?
• Supplier question: Is another competitive bid webinar going to be given?
• Noridian response: Yes, the next one is scheduled for February 24th; however, it is not posted to the website yet.

Suggestions from POE Advisory Members

• Do you have any feedback on the contact center that could be provided to them?
  • Members are free to email DMEPOS-POEAG@Noridian.com after speaking with staff.

General Questions

• Are MLN Matters now being sent by MACs instead of CMS?
  • Noridian response: The only change is that the MAC will now be sending them. The timing is similar to our regular listserv, though the emails will be separate.

Next meeting: April 22, 2021