Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - September 10, 2019

Roll Call

Noridian Attendees

Claire Anderson, Kimberly Behrens, Carynne Godfrey, Lu Newell, Annessa Schjeldrup, Beth Sandeen, Julie Schroeder, Tana Williams

POEAG Member Attendance

Welcome New Members: Peggy Palmer- Arcidia CA, and Kimi Shintani- Honolulu HI
Wende Alfaro, Lynne Bautista, Cheryl Bradley, Tameka Island, Mitchel Kaye, Greg Labow, Susan LaPadula, Rick Lash, Diane Przepiorski, Dawn Silva,

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The June 11, 2019 meeting minutes were distributed to POEAG members and published to the website June 26, 2019.

Prior Suggestions and Recommendations

The POEAG meeting recommendations and/or suggestions from the prior event with updates are reflected below.

Suggestion Date Description Resolution
06/11/19 A provider addressed the address verification update on which Providers does it affect? Noridian's response: Provider Based Billing Facilities (PBB) are the only Providers affected. The date has been postponed until April 2020. See the attached special revised edition to learn more. CMS Medicare Learning Network (MLN) Matters Special Edition (SE)19007
06/11/19 Provider addressed high HMO denials in CA. Patients present their Medicare card and do not realize they have HMO. The RPM, a practice management system used by providers, has verification built in and shares the HMO carrier. Noridian will continue to promote the use of NMP for each patient encounter and remind providers that NMP provides HMO information.
06/11/19 A provider addressed a question regarding the legal input to change Medicare Secondary Payer (MSP) information what does Benefits Coordination & Recovery Center (BCRC) need? Noridian reached out to the BCRC and they will need the Attorney to complete several forms. One is Consent to release information approved by the beneficiary and the other is Legal proof of Representation. Contact the BCRC for additional information. 1-855-798-2627 and location of the forms.
06/11/19 A provider addressed the concerns of the transition to HETS away from CWF. Is CMS going away from DDE? Is there a schedule of functionality decommissioning? "At this time, Noridian has not been provided a specific date as to when ‘mid-fall' would be. We will reach out to our POEAG members and providers once we have that date."
CMS.gov generated information on March 27, 2019 discussing discontinued access and updated statement of fall 2019 to terminate access for CWF eligibility inquiries. CMS Change Request (CR)10983 per the CR the date of July 1, 2019 was rescinded but will still follow through in mid fall
Noridian provides the additional information: See "Health Insurance Query Access (HIQA) eligibility changes" article

 

New Agenda Items

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

  1. New Medicare Card / Medicare Beneficiary Identifier (MBI) Updates
    We are less than 16 weeks away from the end of the transition period to obtain the new MBI number. As of January 1, 2020 Noridian, can longer accept the Health Insurance Claim Number (HICN). Regardless of the date of service, the claim will require the new MBI number starting January 1, 2020.
    • Additional resources available when the Beneficiary is unable to provide a copy of their new insurance card.
      • MBI look-up tool is available through Noridian Medicare Portal (NMP)
      • Remittance advice (RA) will also provide new MBI when a valid HICN is submitted
    •  CMS New Medicare Card Open Door Forum: Completed September 11, 2019 2 p.m. ET
  2. Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Patient Driven Payment Model (PDPM)
    Get Ready for Implementation on October 1, 2019. The new PDPM is replacing the Resource Utilization Group, Version IV (RUG-IV) for the SNF PPS. PDPM improves the accuracy and appropriateness of payments by classifying patients into payment groups based on specific, data-driven patient characteristics, while simultaneously reducing administrative burden.
    • Changes to Assessment: Both RUG-IV and PDPM use Minimum Data Set (MDS) 3.0 as basis for patient assessment and classification, but assessment schedule under PDPM is more streamlined and less burdensome on providers. See presentation (starting on slide 52) to find out how your assessments will change
    • Billing for Services: Use Health Insurance Prospective Payment System (HIPPS) code generated from assessments with an assessment reference date on/after October 1, 2019, to bill under PDPM
    • Changes to Payment: Under PDPM, clinically relevant factors and patient characteristics are used to assign patients into case-mix groups across payment components to derive payment. Additionally, PDPM adjusts per diem payments to reflect varying costs throughout the stay
    CMS and Noridian has resources to help prepare:
  3. Provider Enrollment
    • Completed Conference: Optimizing Provider Enrollment with Noridian (OPEN) will be hosted in Anaheim California at the Anaheim Convention Center, September 18-19, 2019. Topics covered included:
      • Revalidation
      • I&A and PECOS
      • Common Errors and Medicare Resources
    • Website Update: Enrollment portion of the Part A website has been updated. To give the provider community an overview of what is needed to enroll, each specialty type has been added to the website. See the Part A Enrollment for Specialties webpage
    • New Report Card Process: The Provider Enrollment education department has started a report card process. We use providers enrollment application submission, development request per application, revalidation request and more to give them a full overview of their enrollment. We then give them pointers on how to improve their application submission and revisit them in six months and show them where they have improved. This data is sent to them via PDF. They also have the option for an e-visit to go over the data in PowerPoint form. Let us know if you have any enrollments that you think would benefit from this. Or if they have any questions, send us an email at PEeducation@noridian.com
  4. Noridian Medicare Portal (NMP) Education
    • Provider enrollment functions available within NMP
      The NMP has added the use of additional self-service tools for Enrollment functions. Users may enter a Tax Identification Number (TIN), Provider Transaction Access Number (PTAN), and National Provider Identifier (NPI) combination and it will list currently processing applications or the completed applications for either Individuals or Organizations within the past six months.
      • Part A: Organizations can only view their organizational applications
      • Part B: Providers can view Group and Rendering applications.
    The "In Process" applications section will display the application status along with any requests for information letters that have been sent to the contact listed on the submitted application. This information/documentation can be quickly uploaded to the application within NMP. The "Completed" applications section will display a listing of recently completed applications where the notification letter can be downloaded. View the Provider Enrollment section of the NMP User Manual.

Upcoming Events

Providers can view trainings and seminars available by visiting the "Education and Outreach / Schedule of Events" section of our website.

Webinars

Completed Enrollment Seminar - Optimizing Provider Enrollment with Noridian (OPEN) Anaheim, CA September 18, 2019 and September 19, 2019

New POEAG Suggestions and Recommendations

During each meeting, all POEAG members are asked to provide suggestions on ways to increase education, improve training methods, or elaborate on topics discussed during the meeting.

  • A provider thanked Noridian for the reminder on the MBI adoption, timeline, and resources available. Noridian stated this implementation will truly affect all providers and it is so important to remember that starting January 1, 2020 Noridian can only accept the MBI regardless of the claims date of service.
  • POEAG members shared their appreciation for the Provider Enrollment September in-person seminar in California. Providers requested the materials be made available for those unable to attend the event. Noridian's Provider Enrollment team members shared they plan to offer the event materials on their webpage and they plan to conduct a few webinars to cover materials presented at the event.
  • A provider asked will the remittance advise for Part A be coming to the Noridian Medicare Portal (NMP)? Noridian stated it is currently on the list of possible updates to the NMP, but at this time we do not have a timeframe.
  • A provider asked for more information on the appropriate use criteria (AUC) for diagnostic imaging and looking for more information. Noridian offered that in 2020 there will be an education and operations testing period and more than likely changes will not take place until 2021. Watch the CMS website for additional information. Also refer to CR11268

Upcoming Meeting

All meeting times 1-2 p.m. PT

2019

  • December 10

2020

  • March 10
  • June 9
  • September 8
  • December 8

Thank you for attending today's meeting, we look forward to working with all of you again.

 

Last Updated Sep 25, 2019