Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - April 20, 2023

Attendees

POEAG Members: Wayne Bradberry; Glenn Closurdo; Nancy Froslie; Rosa Gomez; Dawn Jorgensen; Marsha Lawrence; Carolyn Koster

Noridian Attendees: Melissa Betts; Shelly Carlson; Stacy Dahl; Ashley Decoteau; Colleen Harryman; Amber Mertz; Kate Petersen; Ruth Reese; Mary Reineke-Ferguson; Kloe Roberts; Dan Schmidt; Tracy Schutt; Brenda Swancy; Cindy White

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

Standing Agenda Items

Follow-up from Previous Meetings

General

  • Joint POEAG to develop education for clinicians ordering DMEPOS
    • Five meetings have been held focusing on sleep
    • Great suggestions
      • Provide education during residency
      • More webinars for providers on DME requirements
      • Update clinician checklist
    • Newsletter
    • Looking for supplier volunteers for a similar Glucose meeting, willing to recruit practitioners
      • Tabled
      • Starting a project with Medical Policy
  • Collaborative MAC education
    • Knee Orthoses
      • February 2023
    • Oxygen
      • April 2023
    • Lower Limb Orthoses
      • June 1, 2023
    • Surgical Dressings
      • Quarter three
    • Therapeutic Shoes for Persons with Diabetes
      • Quarter four
  • Hospice and DME education
    • Webinar will be held April 26, 2023
  • Level 200 webinars
    • Please send scenarios you would like to see included

DME

  • Removal of Certificate of Medical Necessity (CMN) and DME Information Form (DIF)
    • January 2023
  • National Supplier Clearinghouse (NSC) is now National Provider Enrollment (NPE)
    • Effective November 7, 2022
    • East of Mississippi is NPE East
      • Novitas Solutions
    • West of Mississippi is NPE West
      • Palmetto GBA
  • New Medicare Part B immunosuppressant drug benefit

O&P

  • L200 webinar on Prior Authorization for Orthotics with a focus on surgery
    • Additional education has been added to current webinar
      • Including a focus on surgery

New Items

General

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

DME

  • New Oxygen Modifiers Required April 1, 2023
    • Required for initial claims with dates of service on or after April 1, 2023
    • N1- Group I oxygen coverage criteria met
    • N2- Group II oxygen coverage criteria met
    • N3- Group III oxygen coverage criteria met
  • KX or N1, Oxygen Modifiers N2, N3
    • Effective for new oxygen rental periods beginning on or after April 1, 2023
      • N1, N2, or N3 modifiers will be billed in place of the KX modifier
    • Initial claims for oxygen rental periods with dates of service on or after April 1, 2023
      • Rejected if billed with a KX modifier
    •  Oxygen rentals that began prior to April 1, 2023
      • May continue to be billed with KX modifier for remainder of rental period and for subsequent billing of oxygen contents or maintenance and service
  • Joint Oxygen FAQ
  • Voluntary Prior Authorization of Certain Power Mobility Device (PMD) Accessories
  • Revised Glucose Monitor Local Coverage Determination
    • Final LCD effective for dates of service on or after April 16, 2023
    • Removed three or more daily administration of insulin or continuous subcutaneous insulin infusion from CGM coverage criterion
    • Removed treatment regimen requiring frequent adjustment from CGM coverage criteria
    • Added initial coverage CGM criterion related to history of problematic hypoglycemia
    • Revised to include telehealth visits
    • Updated base with respective supply allowance monthly billing codes
      • Removed K0554 and K0553
      • Added E2103 and A4239
  • Insulin Coinsurance Limitation when furnished through DME
    • Effective July 1, 2023
    • Waives Part B deductible for insulin furnished through DME
    • Limits beneficiary coinsurance for insulin to $35 per month
    • Supplier payment adjusted as necessary to meet remaining amount for month’s supply
      • Supplier not responsible for balance of reduced coinsurance
    • For "from date of service" in May and June:
      • Do not bill a 3-month supply of insulin
    • Bill 1-month supply of insulin with JK modifier
    • For "from date of service" in July and later
      • JK modifier required for 1-month supply
      • JL modifier required for 3-month supply
    • CMS MLN Fact Sheet

O&P

  • Ten orthoses codes added to Required Face-to-Face and Written Order Prior to Delivery list

Suggestions from POE Advisory Members

  • There used to be a policy article about the use of the CG modifier with the L3923 and L3924 that was retired in May 2020. Is the CG modifier no longer used with these codes? Where can I find the updated policy?
    • The L3923 and L3924 are upper limb orthoses codes. There is not a policy for upper limb orthoses. Please utilize the Standard Documentation Requirements Article. There must be medical records that support the need for the upper limb orthotic.

Upcoming Meeting

  • Next Meeting: July 19, 2023, 12 p.m. CT/1 p.m. ET - First JA/JD combined meeting

 

Last Updated Apr 26 , 2023