POE AG Meeting Minutes - April 25, 2019

POE Advisory Group Mission and Goals


  • To determine the best methods of providing quality education and training to our supplier community.


  • 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.

Noridian Attendees: Trina St Ours, Cindy White, Diana Duchscherer, Jessica Gaddie, Kathileen Stelljes, Tanya Gillies, Athena King, Colleen Harryman

POEAG member Attendees: Michelle Wullstein, Noel Neil

Standing agenda items

  1. Medicare Beneficiary Identifier (MBI)
    • Nothing new to report from Michelle or Noel
  2. Targeted Probe and Educate (TPE)
    • Assessment remains same – it's difficult to compare rates from quarter to quarter
    • Education will continue to work with medical review to determine any additional information can be shared with supplier community
      • Members primary questions:
        • Are the errors from suppliers who have been educated already or those that are in round one?
        • Can a breakdown of how many suppliers are in each round be provided?
    • Members noted that it will be interesting to see what the impact will be to error rates based on recent fraud case for O&P
Review Criteria Error Rate July meeting Error Rate October
(April - June 2018)
Error Rate January
(July - September 2018)
Error Rate April
(October - December 2018)
Ankle Foot/Knee-Ankle-Foot Orthosis (AFO/KAFO) TPE Reviews 40% 34% 34% 34%
Knee Orthosis TPE Reviews 73% 57% 61% 61%
Spinal Orthoses: TLSO and LSO TPE Reviews 42% 51% 51% 47%
Therapeutic Shoe TPE Reviews 25% 33% 36% 28%


Follow up information from previous meeting

  1. Business track to be offered to O&P masters programs which will provide guidance on Medicare coverage requirements
    • Noridian is holding work on this until we get new training curriculum finalized and published. At that time, we can look at enhancements
  2. Training curriculum status
    • Currently in review with Noridian Communications team
  3. Quick link to supplier manual
    • Available in left hand navigation of Education and Outreach page
  4. Noridian DME has begun a project with Part B for a collaborative webinar on telemedicine

New Items

  1. RT / LT Modifiers
    • Members reported they haven't heard of any issues related to this change since transition from billing on one line with units of service (UOS) two to billing on separate lines with UOS of one apart from secondary insurance
      • Secondary insurance generally requires combination on one line, so claims are requiring rework
    • At this time, Members noted that they did see need for additional education on topic

Suggestions from POE Advisory Members

  1. Member (Noel) expressed interest in education that discusses the IOM/National Coverage Determinations (NCD) and inter-relationship with how they are used for reference purposes of claims processing and approval of documentation
  2. Member (Michelle) suggested targeted education/discussions with Competitive Bid Implementation Contractor (CBIC) about next competitive bid round. Targeted education is desired for orthotic suppliers since it is completely new to that industry
    • Noridian noted that CBIC just started talking about new bid recently and we will start working with them again soon. Right now, we are fielding questions regarding GAP period
  3. Discussed impact of competitive bid on fraudulent suppliers (like recent scam). Same codes that are proposed for competitive bid are those that were recently impacted by "Operation Brace Yourself"
  4. Discussion occurred regarding beneficiaries that were subjected to fraud for same/similar issue and how they will get a truly medically necessary item
  5. Member (Michelle) mentioned that it was brought to her attention that suppliers are trying to circumvent edits by billing for opposite side of what is already on file, so claim doesn't deny for same/similar. (wrist, ankle, bi-lateral knee etc.) Noridian staff have not previously heard of this practice but may be something to monitor

Next scheduled meeting: July 25, 2019 at 3 p.m. CT


Last Updated Wed, 12 Feb 2020 09:33:52 +0000