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

Roll Call

Noridian Attendees

Claire Anderson, Elizabeth Barton, Kimberly Behrens, Reanna Doele, Tammy Ewers, Heather Langei-Watters, Beth Sandeen, Julie Schroeder, Tana Williams

POEAG Member Attendance

Wendy Alfaro, Cheryl Bradley, Mitchel Kaye, Greg Labow, Susan LaPadula, Dawn Silva

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The September 10, 2019 meeting minutes were distributed to POEAG members and published to the website September 25, 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
9/11/2019 A provider asked for more information on the appropriate use criteria (AUC) for diagnostic imaging. Noridian offered that in 2020 there will be an education and operations testing period. Watch the CMS website for additional information. Please also refer to CR11268.
11/12/2019 Provider email A provider asked for more information on the PDPM process issue. CMS provided guidance on 11/22 that the issues have been fixed and providers should no longer be experiencing claim processing delays. More information can be accessed at: CMS PDPM

 

New Agenda Items

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

Part B:

  1. New Medicare Card / Medicare Beneficiary Identifier (MBI) Updates: Time is running out. Noridian wants to share that we are less than 20 days away from the end of the transition period to obtain the new MBI number. We want to remind providers of the importance of switching to 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.
    1. Additional resources available when the Beneficiary is unable to provide a copy of their new insurance card.
      1. The MBI look-up tool is available through the Noridian Medicare Portal (NMP).
      2. The remittance advice (RA) will also provide the new MBI when a valid HICN is submitted. This feature will end on December 31, 2019.
         
  2. 2020 Annual Benefits Part A/B: Here are that latest updated premiums and deductibles. For more information see CR11542.
    Part A:
    1. Annual inpatient hospital deductible
      1. $1,408 per benefit period - Day 1-60
      2. $352 Coinsurance per day - Day 61-90
      3. $704 per day Lifetime Reserve (LTR) Coinsurance - Day 91-150
    2. Psychiatric hospital
      1. Same as hospital deductible
    3. Skilled Nursing Home (SNF)
      1. Paid in full - Day 1-20
      2. $176 Coinsurance per day - Day 21-100
    1. $144.60 - Standard monthly premium
      1. Held harmless beneficiaries will have a Part B premium increase in 2020
    2. $198.00 - Annual deductible
    3. Coinsurance 20%
  1. Noridian Medicare Portal (NMP) Education:
    1. November 1, 2019, Part B Deductible, Hospice, and Medicare Diabetes Prevention Program (MDPP) Response Expansion: NMP information returned within the eligibility inquiry responses has been updated to include expanded deductible information for multiple years, more comprehensive hospice episodes, and MDPP service periods. Learn more Response Expansion.
       
  2. Provider Enrollment: Provider enrollment gives the option of a Report Card. A report card is an overview of the enrollment. We let them know the areas of improvement and what resources are available online. Below, is a snap shot of what the report card entails. Please reach out to PEeducation@noridian.com if you know an enrollment that would benefit from it.

Enrollment Statistics

Calls to Enrollment Contact Center March April May June July August September Total
Number of Calls 1 0 1 0 0 1 1 4
Reason for Calls Wrong Dept. Sent to PCC NA Re-send RFI NA NA Enrollment Status Enrollment Status  

 

Application Information March April May June July August September Total
Number of Received Web Applications 0 0 0 0 3 6 2 11

 

  1. External Collaboration: We wanted to share our external collaboration events over the past year and the upcoming plan for 2020.
    1. Home Health and Hospice - All A/B MACs and the Home Health and Hospice MACs continue to partner to educate clinicians in their role in the care of patient certification, recertification and related care. We are working through a national tutorial as well as evaluating the common areas of concern to produce educational material in 2020.
    2. A/B All-MAC National Collaboration - We have historically worked on national consistent messaging regarding preventive services. This year we shifted gears and focused on conducting six Medicare Secondary Payer (MSP) webinars on the different aspects of MSP. With our webinars completed, we will be evaluating the common areas of concern based on the questions received during the webinars and work to produce MSP educational material in 2020. Because of Noridian's routinely high volume of lab redeterminations, we have suggested that the AB MACs produce a national lab-specific appeals webinar.
    3. A/B and DME MAC National Collaboration - Quarterly webinars were held in 2019 to educate clinicians on the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) they order for beneficiaries. Their documentation, interactions and frequency of patient care, and partnerships with the DME suppliers is a large impact on the Comprehensive Error Rate Testing (CERT) error rate. Having clinicians educated on the requirements for the DMEPOS they order is important to CMS.
      1. 2019: Positive Airway Pressure (PAP) 03/21, Lower Limb Orthoses (6/20), Spinal Orthoses (09/19), and Surgical Dressings (12/12)
      2. 2020: Nebulizers (03/2020), Diabetic Shoes (06/2020), Oxygen (09/2020), and Documentation Requirements (12/2020)
    4. CERT - We are working with the CERT contractor for a cohosted event to better explain the program and process in 2020; this will be our first event with the CERT.
    5. Supplemental Medical Review Contractor (SMRC) - We co-hosted our first event with the SMRC this fall. It is our plan to pursue this partnership each year.
    6. Recovery Auditor Contractor (RAC) - We've previously hosted RAC an annual webinar with the RAC to describe the process and our roles in the decisions, recoupment, and related discussions or appeals. We hosted two events this fall and plan to continue this annual partnership.

Upcoming Events

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

Webinars

Part A: https://med.noridianmedicare.com/web/jea/education/training-events
Part B: https://med.noridianmedicare.com/web/jeb/education/training-events

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 stated: I have no suggestions at this time. My usual issues normally focus on Enrollment. Provider Enrollment has been working really hard to personally connect with her and this has been a big success story!
  • A provider stated - I work with a lot of Physical/Speech/OT therapists and they are all preparing for the new (NIST) codes they will need to bill. It would be nice to have specific training for rehab and the new requirements being put into place. Also, if you could offer educational training specific to what the reviewers are looking at in regard to rehab would go a long way in addressing the paranoia the providers are experiencing. The final ruling indicating they would produce new scenarios which we are waiting to be receiving. The other thing I see a lot of, is people are discharging their patient when they reach the $3000 threshold; which is a disservice to the patients for the premature discharge.
    • Noridian shared we have some information on the modifiers in our upcoming quarterly webinars. We have a presentation planned for early 2020. The threshold and reviewing process differences and the bell-curve selection process.
    • Tammy suggested we may be able to partner with Mitchel and the associations he is involved with in CA! (I'm excited for this).
  • A provider stated - Complete Part A Full Remittance Advice should be made available on the NMP.

Upcoming Meeting

Scheduled Meetings for 2020

All meeting times 1-2 PM PT

  • 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 Jan 27, 2020