Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - October 15, 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.

Member attendees: Wayne Bradberry, Ronda Buhrmester, Leonard Coulombe, Patty Donndelinger, Dan Fedor, Pamela Fritz, Sherry Givens, Dawn Jorgensen, Carolyn Koster, Linda Lewis, Theresa McCrary, Robin Nyberg, Jan Palmer, Erica Rochelle, Kimberlie Rogers-Bowers, Maria Sanchez, Lesleigh Sisson, Jera Sitton, Barb Stockert,

CMS attendee: Alikia Mack

Noridian attendees: Cindy White, Colleen Harryman, Courtney Willis, Diana Duchscherer, Jessica Bennett, Mary Reineke, Melissa Kuznia, Tracy Schutt

Standing Agenda Items

  • Coronavirus (COVID-19) Public Health Emergency (PHE)
    • Waivers and flexibilities in place
    • CMS resource pages
    • Noridian resource pages
    • Beneficiary Authorization of Benefits (AOB) - Needs signature prior to billing
      • Suppliers expressing concern because AOB is a part of proof of delivery and signature requirement is waived on this. This question is with CMS currently.
      • Member Question: What date was the PHE extended to?
      • Noridian Response: In general, it is extended three months at a time but a specific date has not been published.
  • Targeted Probe & Educate (TPE)
    • Results on Noridian website (Medical Review > Medicare Review Results)
    • Suspended during COVID-19 PHE
      • No update when it will resume
    • Letters are available in Noridian Medicare Portal (NMP)
  • Post-Payment Clinical Review
    • Post-payment review initiated in August
      • Urological (A4351 and A4352)
      • Knee Orthoses (L1833 and L1851)
  • Member Question - Regarding the post pay review, if we receive a request for date of service after March 1, 2020, should we reach out to you?
    • Noridian Response - Other contractors are reviewing claims as well and we don’t have control over dates of service they review; however, if you do receive a post pay review from Noridian with a date of service after March 1, 2020, call the Contact Center so it can be looked into.
  • Education for Practitioners
    • We continue to look for opportunities
    • Suggested emphasis on dictation of medical records which Noridian incorporates into all practitioner education opportunities
    • Noridian partners with A/B for global education opportunities
      • Noridian held oxygen webinar end of July with Jurisdictions E and F, which went very well. Another webinar was held nationwide the end of September and again had very positive survey comments.

Follow-up Information from Previous Meeting

General

  • Physician based education for prior authorization
    • Pending
  • Text alert option for companies not allowing usage
    • Pending
    • Member Question - Has Noridian considered implementing an app? I use CGS’ apps quite often.
      • Noridian Response - This is in discussion. Continue adding your suggestion to our surveys and send an email to DMEPOS-POEAG@Noridian.com
  • Weekly listserv for upcoming webinars
    • Implemented
  • Advertisement on NMP for upcoming webinars
    • Implemented

DME

  • Oxygen webinar with A/B MACs held September 29
    • Very positive survey results
  • L200 Ventilator webinar
    • Continues in process
    • Noridian continues to seek examples of scenarios from the supplier community for inclusion in the webinar
  • Provide denial rate affirmation on prior authorization and conduct targeted training
    • Prior Authorization Request (PAR) resumed in August, so will return to investigation
  • Suggestion for education on billing oxygen when beneficiary has commercial insurance primary and Medicare secondary
    • Project in progress
  • Home infusion codes moving to Part B January 1, 2021
    • Collaborative webinar scheduled October 21 at 1 p.m. CT
  • Post COVID-19 PHE Guidance
  • KU Modifier Education
    • Article published June 10
    • Webinars provide guidance
    • Association meetings received article information

O&P

  • O&P Training Program for Competitive Bid
    • Webinars and educational materials are being prepared
    • Dates to be announced soon
  • Ask the Contractor Teleconference (ACT) O&P specific
    • November 12 at 2 p.m. CT

New Items

General

  • GoToWebinar not supporting Internet Explorer
    • Utilize alternative web browsers

DME

  • Retirement of Enteral Nutrition and Parenteral Nutrition Local Coverage Determination (LCD) announced October 8, effective November 12
    • Correct coding and billing articles
  • Intravenous Immune Globulin (IVIG) demonstration ends December 31, 2020
    • Date of service (DOS) driven
    • Article published October 7

O&P

  • L1686 Prefabricated Hip Abduction Orthosis - Correct Coding
    • DMD article published September 17

Suggestions from POE Advisory Members

  • Member Question - We have patients that are post-COVID-19 and physicians are putting diagnosis codes not related to this; there should be a post-status COVID-19 diagnosis code. Since we don’t know how long this pandemic will last or how long we will have repercussions from the pandemic, should a post-COVID-19 diagnosis be established?
    • Noridian Response - During the PHE, the items affected by waivers need to be billed with the CR modifier. It is not a requirement that the beneficiary have a COVID-19 diagnosis. For those policies where the coverage criteria are not being enforced, the practitioner will determine the diagnosis and document the medical necessity.  When the beneficiary does not have COVID-19, the claim will still be billed with the CR modifier because they are impacted by the waivers and flexibilities.
    • Follow-Up Question - Should the CR modifier be used on everything?
    • Noridian Response - No, only on those items where CMS has issued a waiver or flexibility. This would include proof of delivery signature, ABN signature, use of telehealth and cases where the coverage criteria are not being enforced, however the item is prescribed with medical necessity documentation.
  • Member Question - Telehealth versus F2F dates on prescriptions: We receive prescriptions, and some don’t have a visit date. I’ve gone back and asked for the F2F or telehealth date. Is that correct?
    • Noridian Response - Yes, there needs to evidence of an encounter with a beneficiary.
    • Follow-Up Question - Does Noridian have any quick reference information on these types of questions?
    • Noridian Response - Our website offers a grid on waivers and flexibilities
    • CMS has a fantastic Q&A and they include the date the questions were added.
  • Member Comment - There still must be an order date on Standard Written Orders (SWOs) but on many of them, the patient contacts the physician after seeing an advertisement, for example, but the item was never really ordered. Can additional education on this be provided to suppliers?
    • Noridian Response - We’ve been discussing another SWO webinar series. We will fast track this to get this information out there. We held SWO webinars early this year but when the PHE began, education related to waivers and flexibilities became the priority.
  • Member Question - Which DME Medical Director (DMD) was in charge of retiring the enteral/parenteral nutrition LCDs?
    • Noridian Response - The medical directors for all four jurisdictions were involved in the decision and we are hoping all four will attend the upcoming enteral/parenteral nutrition webinar.
  • Member Question - I have received a number of questions regarding patient owned equipment. I know this has been discussed in the past but maybe a refresher to suppliers would be good. Claims are being denied for supplies when information on the date of purchase etc., is not listed on all subsequent claims even if Noridian purchased the equipment. Does this information need to be listed on each line of the supply claim? Suppliers are receiving denials if it is not on there.
    • Noridian Response - We are aware of this issue and we are putting education together.
  • Member Question - A patient has glasses after cataract surgery, and they are broken beyond repair. Does the CR waiver mean they can get new glasses without seeing a doctor? Does patient pay for non-covered items that were on first pair out-of-pocket as they did previously? This assumes glasses are out of warranty.
    • Noridian Response -If the glasses are broken beyond repair as a result of something related to the COVID-19 PHE, this would warrant the CR modifier and the COVID-19 narrative. If they were simply broken beyond repair, the RA modifier would be utilized as this is the standard modifier used for replacement when items are lost, stolen or irreparably damaged. The covered items would be the same.
  • Member Comment - I think some specific training on the various telehealth options; video vs. telephonic, etc., would be very beneficial.
    • Noridian Response - We appreciate this suggestion; this is one we can consider doing collaboratively with Part B.
  • Member Question - Where does CR modifier appear on the claim?
    • Noridian Response - It is appended to the claim line for the item.
  • Noridian Question - How can Noridian improve our education on complex issues?
    • Member Response - Have all in one spot as a quick reference; Frequently Asked Questions (FAQs)

Next meeting: 2021 dates will be announced soon

 

Last Updated Thu, 12 Nov 2020 20:15:22 +0000