POE AG Meeting Minutes - April 21, 2022 - JD DME

POE Advisory Group Mission and Goals

Attendees

Members: Glenn Closurdo, Dawn Jorgensen, Carolyn Koster, Carlota Martinez, Theresa McCrary, Noel Neil, Robin Nyberg, Charles Robinson, Erica Rochelle, Maria Sanchez, Barb Stockart, Mary Stone, Jami Tharp, Dan Vasilj, Tanya Ward, Donald Weschler, Kim Brummett
Noridian: Ruth Reese, Kelsey Slettebak, Kloe Roberts, Shelly Carlson, Amber Mertz, Brenda Swancy, Cindy White, Colleen Harryman, Kate Petersen

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
  • Last extension expired April 2022
    • Has been extended to July 16, 2022
• 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%
• Education for Practitioners
  • Continue to seek opportunities

Follow-up from Previous Meetings

General

• Joint POEAG to develop education for clinicians ordering DMEPOS
  • First meeting held focusing on sleep
  • Great suggestions
    • CGM and glucose is a suggestion for future development
• Collaborative education with A/B MACs
  • Documentation
    • May 26, 2022
  • Surgical Dressings and Supplies CERT Taskforce
    • June 15, 2022
  • Glucose Monitors and Supplies
    • August (TBD)
  • Respiratory
    • November (TBD)
  • Pneumatic Compression Devices CERT Taskforce
    • TBD
• 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
  • PAR webinars have been scheduled
  • Orthotics
    • April 26 and May 12, 2022
  • PMD
    • May 11, 2022

DME

• 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, 2021
  • Frequently Asked Questions (FAQ) posted on Noridian website
  • No updates
• Noridian is aware of the oxygen decision memo
  • Webinar May 19, 2022

O&P

• PAR emergent situations
  • CMS released additional information on emergent situations
    • The ST modifier should be utilized by suppliers when a beneficiary requires a brace on the same day. If the health or life of the beneficiary is jeopardized without the use of the orthic device. And the beneficiary’s emergent need cannot wait for the two-day turnaround time.
      • These claims will be subject to prepayment review
  • Providers under the competitive bid exception
    • Should continue to utilize the KV modifier
      • These claims may be subject to prepay review

New Items

General

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

Suggestions from POE Advisory Members

• There was an article posted about when a beneficiary has a face-to-face (F2F) exam in the 31–91-day period stating another F2F is required if they need to switch to respiratory assist device (RAD). This article was confusing, and we do not understand what it is meant to convey. The article was emailed to the POEAG email address. Can you help explain the article?
  • Education will follow up on the article and its source.
    • The article has been removed from the Noridian website.
• Are Targeted Probe and Educate (TPE) results posted on the Noridian Medicare Portal?
  • Yes, we confirmed that the claim review results letters and the findings letters with the round results are all posted to the Noridian Medicare Portal
• A supplier billed a positive airway pressure (PAP) device with the CR modifier, but it denied with a CO50 denial code because it was not billed with a diagnosis of obstructive sleep apnea (OSA), is this a correct denial? We contacted the supplier contact center and we were told to appeal the denial.
  • This is a diagnosis driven policy, but it is included in the public health emergency (PHE) waivers and flexibilities. Medical necessity must still be met and documented.
    • Education agrees that the claim should be appealed.
• Is it required to have the height and weight on the Certificate of Medical Necessity (CMN) for the Pneumatic Compression Devices?
  • The patient’s date of birth (MM/DD/YY) and sex (male or female); are required but the height in inches and weight in pounds says, "if requested". If you have that information, we recommend completing those fields.
    • Would the claim be denied if it is missing?
      • We do not believe it would be denied but cannot guarantee it. If it does, we recommend sending in for an appeal with the medical records that show the height and weight.
• A member indicated that they know there are no updates on the Phillips Respironics recall. However, manufacturers are having issues with shipping shortages. Most options available are non-modem devices. Is Medicare looking at a reprieve regarding compliance requirements?
  • A manufacturer recall does not change the coverage requirements in place for Medicare.
• Has Medicare decided how they are going to resolve the public health emergency (PHE) on the back end?
  • CMS has not provided any guidance about the steps that will be taken at the end of the public health emergency (PHE).
    • The public health emergency (PHE) was extended on April 16, 2022, for another 90 days.
• Is there any guidance on the face-to-face (F2F) requirement post compliance for new positive airway pressure (PAP) beneficiaries? The telehealth option during public health emergency (PHE) has been very helpful. Do you have any insight on whether this will continue after the public health emergency (PHE)?
  • CMS has not provided any guidance on what will be implemented after the public health emergency (PHE) ends. Once Noridian has more guidance from CMS, we will educate.
• A few months ago, there was a surgical dressing webinar for physicians. Is there another one being scheduled?
  • There is not another surgical dressing webinar for physicians planned at this time.
    • There is a DME webinar planned in June for suppliers.
• Is there a simple Comprehensive Error Rate Testing (CERT) online tool available on the Noridian Portal? I have been using the CERT tab that is available after logging into the Noridian Portal. However, MyCGS has an online tool that allows the supplier to enter the claim identification number (CID#) for a status check.
  • The Noridian Medicare Portal (NMP) CERT tab is the best resource for a CERT status check. The CID can be used to find a specific claim, or a listing of all CERT claims can be found by entering the supplier details.
• I wanted to mention that I do enjoy the pre and post questions being by asked the presenter during the webinars. I believe it is an easy way to know your audience. A very nice change for audience participation. Thank you.
  • Thank you for this feedback

Upcoming Meeting

Next Meeting: July 21, 2022