Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - April 16, 2020

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.

Member attendees: Wayne Bradberry, Kim Brummett, Allen Clark, Boualay Crow, Pamela Fritz, Sherry Givens, Rose Gomez, Sara Iseman, Dawn Jorgensen, Taylor Knox, Carolyn Koster, Linda Lewis, Joni Moore, Noel Neil, Robin Nyberg, Erica Rochelle, Maria Sanchez, Lesleigh Sisson, Jera Sitton, Mary Stoner, Mina Uehara, Katie Workman, Michelle Wulletein.

Noridian attendees: Cindy White, Colleen Harryman, Jessica Bennett, Melissa Kuznia, Megan Schrock, Courtney Willis, Tana Williams

Standing agenda items

  1. Medicare Beneficiary Identifier (MBI)
    • Removing as a standing item
  2. Targeted Probe and Educate (TPE)
    • Suspended during the COVID-19 Public Health Emergency (PHE)
  3. Education for Practitioners
    • Addition as we look for opportunities

Follow up information from previous meeting

General

  1. Increased Fraud & Abuse education
    1. More to come in the future - other projects took priority
  2. Tool that encompasses codes that are not covered/allowed
    1. The scope of this project is too large at this time and would be very difficult to maintain
  3. CERT following SWO guidelines - yes confirmed with CERT for dates of service on/after 1/1/2020

DME

  1. L200 for Ventilators
    1. In Process
    2. Noridian is still seeking examples of scenarios from the supplier community for inclusion in the webinar
  2. Provide denial rate affirmation on prior authorization and conduct targeted training
    1. Under investigation
    2. PAR voluntary during PHE
  3. Clarification of short-term oxygen need
    1. Covered under PHE
    2. Following PHE will resume work on topic
  4. More detailed education on CGM / update DME on Demand
    1. DME on Demand updated on April 7 to include the KF modifier

O & P

  1. O & P Training Program for Competitive Bid
    1. In process of preparation, but will be deployed closer to implementation of CB
  2. List of same and similar tips to avoid unnecessary denials
    1. Remains in process
    2. Supplier inquired if there had been DMD discussion on changing same/similar edits, specifically for ankle/foot orthoses (AFO)? Additionally, has there been discussion on a change in reasonable useful lifetime (RUL) for AFO or Spinal orthoses?
      • Noridian response was that no there has not for either question
      • We are however, working on same/similar for upper limb orthoses
      • Noridian offered to provide a link to PDAC ability for reporting Q4 HCPCS crosswalk - able to sort by policy group name
        https://www.dmepdac.com/palmetto/PDAC.nsf/DID/43Z2ZKZ02X
  3. Off the shelf coding more visible/training
    1. Plan to include in Q2 quarterly email to Associations
    2. Attempts to schedule individual education for suppliers experiencing denials did not result in suppliers agreeing to education
  4. Upper Extremity orthotic training
    1. Webinar held March 24

New Items

General

  1. Documentation Checklists
  2. Disasters and Emergencies
  3. DME on Demands (SWO updates)
  4. Extended Monday Live Chat
  5. Thursday Live Chat - Special Edition

DME

  1. Current use of CR modifier for COVID-19 PHE

O & P

  1. Lower Limb Prosthetics Prior Authorization
    1. Postponed due to the COVID-19 PHE

Suggestions from POE Advisory Members

  • Suppliers had questions on when and how TPE would resume
  • Suppliers suggested more practitioner education
    • Suggested emphasis on dictation of medical records
    • Noridian noted that suppliers need to be involved as well for two reasons:
      • Creates cohesive partnership between practitioners and suppliers
      • DMEMAC expectations from CMS are to provide education to the supplier community
  • Supplier requested education on handling oxygen beneficiaries acquired through acquisition of another company
    • What rights does the previous company have to contact that beneficiary?
    • Noridian suggested consulting a healthcare attorney as this is out of the DMEMAC purview
  • Same/similar edits discussed once again
  • It was noted that the COVID-19 webinar efforts are appreciated while recognizing that not all answers are known at this time
  • Supplier suggesting education on billing oxygen when the beneficiary has a commercial insurance primary and Medicare secondary
    • Good opportunity for DME on Demand
    • Example: Primary pays 100% on 85% of claims submitted
      Results in 36 months not showing as paid by Medicare
      Processed as Break in Service/Break in Medical need
      Should $0 have been billed on months where commercial insurance paid 100%
       

Last Updated Wed, 06 May 2020 20:22:14 +0000