Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - October 11, 2018

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: Leonard Coulombe, Carolyn Koster, Patty Donnelinger, Noel Neil, Jan Palmer, Barb Stockert, Mary Stoner, Alicia Tippets, Kelly Troutman, Shannon Truman, Katie Workman, Kim Brason, Sharon Briggman, Jan Palmer

Noridian attendees: Cindy White, Diana Duchscherer, Jessica Gaddie, Tanya Gillies, Mary Reinke, Chuck Cassada

Standing agenda items

  1. Medicare Beneficiary Identifier (MBI)
    • No additional discussion
  2. Targeted Probe and Educate (TPE)
Review Criteria Error Rate July meeting Error Rate October (April 2018 June 2018)
Diabetic Supplies TPE Reviews 66% 65%
Enteral Nutrition TPE Reviews 14% 20%
Hospital Bed TPE Reviews 34% 72%
Immunosuppressive Drug TPE Reviews 14% 18%
Manual Wheelchair TPE Reviews 43% 32%
Nebulizer TPE Reviews 15% 19%
Oxygen TPE Reviews 37% 40%
Parenteral Nutrition   100%
Positive Airway Pressure (PAP) TPE Reviews 7% 12%
Surgical Dressing TPE Reviews 93% 86%
Urological Supplies TPE Reviews 33% 40%

 

Follow up information from previous meeting

  • Flow chart for dentists for steps in providing Oral Appliances
    • Pending
    • The plan is early 2019.
  • Request for DME and Part B joint webinar on Oral Appliance
    • Remains pending
    • The plan is to schedule for early 2019 as well.
  • A request was made to have E0486 (oral appliance for OSA) added to the same/similar resource tools.
    • The same/similar chart is not all-inclusive by design and as such because E0486 is specific only to PAP for OSA it will not be added to the chart.
    • Using Option 2 on the Noridian Medicare Portal (NMP) and searching a HCPCS range should show if E0486 has been paid by Medicare i.e. E0470 – E0601
  • Training Curriculum status
    • Planning complete
    • Presentation by POE
    • Roll out date TBD
    • Suppliers inquired about links in the bullets of the training curriculum and that is not the plan at this time. This document is intended as the roadmap only.
    • It was also suggested that we consider bundled groups of training which will be considered.
  • Noridian Medicare Portal
    • Same/similar available for all HCPCS codes coming soon
    • Suppliers questions reasons for inability to link to all payment history in same/similar and it was explained that the payment history is proprietary to the DME MAC processing the claim for payment. While the information is stored in the common working file, it cannot be distributed through individual portals.
  • Clinician's Corner
    • Continue to promote to increase awareness.
  • Noridian led the effort to provide the first ALL MAC collaborative web tutorial on Documentation needed for DME
    • At the last meeting members indicated they were unaware of this tutorial so Noridian requested that everyone view it prior to the next meeting to provide feedback.
    • https://www.youtube.com/watch?v=nhsJnGnuI5M
    • One supplier had reviewed and expressed positive comments regarding the content and 12-minute length.
  • Template for Detailed Written Orders (DWO) on Clinician's Corner
    • pending
  • Liter flow tool to identify oxygen modifiers using calculation of averages
    • pending
  • Collaborative webinar or ACT with CGS on Q modifiers. Show scenarios
    • Noridian requested questions/scenarios
      • None received to date
      • Pending
  • Joint webinar with CBIC
    • Most likely will not happen
  • CERT error rate on refractive lenses requested
    • JD data, November 2018 report (claims DOS July 2016 - June 2017), claims completed prior to September 1, 2018
      • 24 claims pulled in review
      • 12 denied claims
      • 12 no error claims
        • Note: 9 of claims were denied by MAC and CERT agreed with denial
      • Out of claims reviewed, there is a 50% error rate with a finding on 12 out of the 24 claims
    • National Data, from November 2017 report (claims DOS July 2015 - June 2016)

CERT Improper payment rates identified at a national level for refractive Lenses.

Suggestions from POE Advisory Members

  1. Additional education is needed regarding the reasons for liter flow to be in the medical record. Noridian will increase education explaining the need for documentation to support the liter flow billed.
  2. Suggestions for enhanced training include:
    • Continuous Passive Motion (CPM)
    • Non-invasive ventilation
    • Respiratory Assist Devices (RAD)
  3. It was suggested that Noridian look at ways to assist in tailoring education more individually. Not all educational opportunities may be available when a new employee is being on-boarded. Think about how to make critical information more easily accessible. For example: Information on webinars and ACTs, how could that be in the hands of new employees more quickly through Noridian provided education? DME on Demand?
  4. More options for pre-claim review were expressed again as needed by the supplier community.
  5. Education needed on fragmented billing. Suppliers believe that DME MACs are interpreting differently.

Last Updated Tue, 11 Feb 2020 16:04:22 +0000