Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - March 14, 2023

Roll Call

POEAG Member or Other (CMS) Attendees

JE: Cheryl Bradley, and Susan LaPadula

JF: Anna Gauslow, Dawn Davidson (Sarah Robertson), and Jana Weis

CMS: Alexis Christian-Abbott

Noridian Attendees: Teresa Cirelli, Cheryl Hanson, Dani Aasen, Erin Swaidner, Jan Ervin, Katie Wik, Kim Phillips, Miriam Funderburk, Val Cavett, Daylann Robertson, Jennifer Joyce, and Julie Schroeder

POEAG Mission and Goals

The primary function of the POE Advisory Group is to assist Noridian in the creation, implementation and review of our provider education and training strategy and efforts. The input received from these groups will affect the way educational materials and correspondence are presented, the content contained in them and how Noridian can best provide resources for the provider community.

Prior Meeting Minutes

The prior meeting minutes were distributed to POEAG members and published to the website(s).

Prior POEAG Member Recommendations

Below are the POEAG member prior meeting recommendations and the progress or resolution for each item.

  1. 09/14/2021. Pre and Post-pay Medical Review Chart for Part A and B.
    1. 09/14: Providers are looking for instructions on how to respond, what timelines they have, where should the data be submitted in a reasonable time for processing. A chart could be helpful.
    2. 12/14: Chart is in development.
    3. 03/08: Chart was included with the agenda. Open discussion to review. Should there be separate charts for Part A and B; separate Jurisdiction? Member requested to define pre- and post-payment review. Intro paragraph, offer hyperlink to JE or JF website for pre-payment or post-payment review. This is fabulous; it really is terrific and thank you to all who worked so hard on this resource. It would be helpful to provide a sample or template of what the letter looks like to help the provider locate the correspondence in their office if it were delivered internally to the wrong department. Specific courier addresses for return documents if there is a courier or signature service should be included. Another member suggested the value to include recoupment 935 letters to the resource.
    4. 09/13: Updates to the chart are in process. The final version with comments received in March will be emailed to POEAG members by September 23.
    5. 12/13: Members were sent the material and will share feedback. There were no comments from members shared during the meeting.
    6. 03/14: February 16, the chart posted to Noridian’s Medical Review webpage: Documentation Requests: How, Who and When to Send
      If you receive request for medical records and are wondering what time frame you have, the address you need to send records to, and other information is listed in this chart. We want to make changes if needed. Feedback from members found the format was well done and easy to follow.
  2. 12/14/2021. Back to Basics Tutorials.
    1. 12/14: Noridian will offer a tutorial series for new provider staff members to gain exposure and learn more about the basics of Medicare.
    2. 03/08: Tutorial sessions are in development and will be available by early summer.
    3. 06/14: We are still on track with the goal of to begin publishing the basic tutorial series and will provide an additional update on our progress in September.
    4. 09/13: Due to an unexpected leave of absence, this program will be a top priority and expected to be coming out soon. Exciting News! The Medicare basics will be developed into a 2-day Symposium being planned for March 8 and 9 – March into Medicare.
    5. 12/13: We are excited to offer our March symposium. It is our plan to have the "Save the Date" announcements published soon. We are finalizing the session topics to prepare for a successful event. The original idea stemmed from POEAG, and we are proud to be able to meet your recommendations.
    6. 03/14: The two-day event was held March 8-9, 2023. The topics presented included enrollment, touring the CMS and Noridian websites, reviewing beneficiary notices for Part A, MSP, Part A bad debt, using the Noridian Portal, claims submission and reading the remittance advice, fee schedule indicators, appeals, preventive services, and review processes. Feedback received through the MCE surveys was very positive. The people who participated and submitting questions seemed to be the people we wanted to capture - those needing basic Medicare information. It was a good opportunity to come and get that education during those two days.
      One member asked if the POEAG group would be notified once all the Webinars on Demand from the Symposium are posted and if copies of the presentations could be provided. We will put a listing together and send it to the POEAG members.
  3. 9/13/2022. Skilled Nursing Facility (SNF) Demand Bill Education.
    1. Topic was not conducted in previous SNF Noridian education and outreach. Noridian will work to educate on the regulatory privileges for all Medicare beneficiaries, include the right to demand a bill to be sent to Medicare.
    2. 03/14: Noridian is producing an Education-on-Demand Tutorial. The tutorial was expected by the end of 2022 and has been moved to the end of March 2023. We apologize for the delay. Jan is hoping to have this information put together and get will request feedback from POE AG members.
  4. 9/13/2022. Evaluation and Management (E/M) translation of ‘prescription drug management’ meaning for the 2023 guidelines.
    1. People are getting hung up is on the translation of ‘management’ and that the MDM column three is now ‘risk of test or treatment to the patient management’. There is a mindset that because it says prescription (RX) management, if a provider prescribes, then they get credit for this area.
    2. Noridian’s Response: One drug is not the same as the next. Prescription drug management documentation would need to show the work and/or risk involved by the billing provider when managing a prescription. Is the prescription something that could be harmful to the patient’s health? Will it interact with other drugs the patient is taking? Is the prescription a non-complex drug for a patient with no allergies or complications? Example – a patient taking anticoagulants. Did the patient have a stroke? Is there a risk they may sustain a subsequent hemorrhage?
    3. POEAG recommended this would be one of the best topics for planning upcoming webinars. POE will take this to the Medical Directors to pursue with CMS or publish specific by Noridian. The member stated there should be more structure with managing these services.
    4. 12/13: POE is working with Medical Directors for educational opportunities.
    5. 03/14: POE is working with our Medical Directors to see how we can put together this educational opportunity. It may be an opportunity to put together another webinar or an article and include the Prescription Drug Management.
      One member thought this would be excellent to have more information on this topic.
  5. 12/13/2022. Education on billing high dollar injection claims larger than seven digits allowed on the claim.
    1. 03/14: Noridian developed educational guidance and posted on the Part B website under Drugs, Biologicals and Injections – High-Cost Injections Exceeding $99,999.99
      1. JEB - High-Cost Injections Exceeding $99,999.99
      2. JFB - High-Cost Injections Exceeding $99,999.99

New Agenda Items

Prior to the meeting, Noridian solicited agenda topics from members and evaluated significant program changes to discuss.

  1. Clinical Trials: Should claims for clinical trials and research studies be submitted to traditional Medicare or the Medicare Advantage organization for the patient’s enrolled plan?
    Noridian’s Response: On our website, we have a section under Browse by Topics for billing scenarios for clinical trials. Here is the information on Medicare Advantage plans:
    Patient has a Medicare Advantage (MA) plan. Who should providers bill?
    Medicare (traditional) will reimburse qualifying clinical trial claims on behalf of MA members and will waive the Part A and Part B deductibles. MA plans are responsible for remaining original Medicare coinsurance minus the plan's normal member copays for the incurred types of service, with exception to CEDs listed in CMS Change Request (CR)10238 ; in those instances, the MA plan is responsible.
  2. Request training sessions for End Stage Renal Disease (ESRD) Billing to include the use of modifiers. We and other dialysis providers are seeking clarification on the proper use of the various modifiers in and out of the bundle, outliers, TDAPA, etc. Of particular interest are the uses of the JW and JZ, along with any other modifiers commonly used. We also struggle with modifier AY and would like to know when the modifier is appropriate to use.
    • Noridian will check with the POE staff on the planned ESRD webinars for 2023.
  3. Common requests for education received through surveys:
    • 2023 Evaluation and Management Changes and Guidelines
      • Chronic Pain Management
        • Will include once CMS provides guidance
      • Critical Care Services
        • Provided end of January – recording available
        • Recently updated webpage
      • Split and Shared Services
        • Will include in next E/M
    • Behavioral Health
      • Provided in February – recording available
    • Bundling Surgery - May
    • Clinical Laboratory Billing
    • Clinical Trials
    • Documentation
      • Provided in April – recording available
    • End Stage Renal Disease (ESRD) Billing
    • Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC)
    • Skilled Nursing Facility and Demand Bills

One member requested Telehealth After PHE. This would be helpful and a good transitional webinar for facilities and clinics. SNFs will lose their three-day acute stay waiver. Is that something that can be discussed? Perhaps SNFs should have a PHE wind-down event as well.

CMS has been issuing information, on their website. POE will look at putting a webinar together. For the SNF suggestion, which has been considered and a webinar could be revamped from last year to include the latest updates. We agree this webinar is important.

MAC Customer Experience (MCE) Satisfaction Survey Update: Surveys reflect the webinar presentation content is informative. We review the survey comments and look for opportunities to improve educational topics, webinar materials and presentation skills. Here are a few comments from recent webinars:

    • Participants continue to appreciate the knowledge they receive from our events.
    • Including polling questions or web site tours are always a favorite to be engaged during the webinar. Showing how to locate information on the website.
    • Opportunities to consider the timeframe scheduled and allowing time for questions and answers.

These three bullet points are a compilation of a few similar comments we frequently receive. We are happy to see these positive comments. Some of our presenters like to do a polling "challenge" at the beginning and end to gauge how the attendees learn, or how they felt about the knowledge they received. We have others who do polling throughout their presentation. Attendees always appreciate the activity to allow participation during the webinars. Website tours are always a favorite to see how to navigate and do a live demonstration. We have opportunities to extend our timeframe and will be considerate of attendee’s time. We try to complete the webinars during our scheduled time period and not go over.

Upcoming Education and Training Events

Providers can view Ask the Contractor Teleconferences (ACTs), webinars, and related training opportunities by visiting the "Education and Outreach/ Schedule of Events" section of our website.

Webinars and Schedule of Events

2023 ACTs

CMS requires quarterly ACTs. Noridian offers a question-and-answer portion within each webinar to help streamline applicable topics, audience, and questions for experts.

  • March 22 (Part A), April 19 (Part B), August 30 (Part A), and October 11 (Part B) from 3-4 p.m. CT, 2-3 p.m. MT, and 1-2 p.m. PT
  • Submit questions in advance through the Pre-Question Process on our website

Please share recommendations for any timing, frequency, size, topics, and provider type(s) for the 2023 ACT schedule.

Upcoming Meetings

Meetings for 2023

We continue to meet four times per year.

When: All meeting times 2-3 p.m. CT, 1-2 p.m. MT, and 12-1 p.m. PT

  • June 13
  • September 12
  • December 12

 

Last Updated Dec 09 , 2023