Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes – December 12, 2017

Noridian Attendees

Claire Anderson, Elizabeth Barton, Wade Carlin, Tammy Ewers, Monica Miller

POEAG Member Attendance

Angela Amey, Lynne Bautista, Davina Caraveo, Fatma Girit, Mitchel Kaye, Greg Labow, Susan LaPadula, Greg Labow, Rick Lash, Gail Nickerson, Diane Przepiorski, Rob Sikorski, Dawn Silva, Lauri Tan (CMS)

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The September 12 meeting minutes were distributed to POEAG members and published to the website October 12, 2017.

Prior Suggestions and Recommendations

There were no outstanding POEAG meeting recommendations and/or suggestions from the prior event.

Suggestion Date Description Resolution
09/12/17 SNF electronic document submission Request for Skilled Nursing Facility providers on how to submit documents electronically. Noridian currently educates on this topic within existing SNF webinar presentations. As additional documentation submission features become available through the portal, Noridian will have an outreach campaign to promote the new functionality. At this time, there is not a date available for this feature.
09/12/17 Electronic Submission of Medical Documentation (esMD) promotion Request for details on esMD usage vs other submission methods to assist with identifying when to promote esMD. The usage of esMD compared to fax and postal submission is minimal. Noridian has information on esMD under Browse by Topic / Claim submission withour our website in addition to a reference under Medical Review / How to Submit ADRs on our website.
09/12/17 Policy and Article Change Clarity More detailed information about policy changes was suggested as the current announcements do not contain the needed detail and require providers to review the article/policy in full.  "The 21st Century Cures Act requires Medicare Administrative Contractors to release more information within our LCDs such as a summary of evidence, responses to comments submitted,  a bibliography of sources, and an explanation of the rationale that supports such determination." If there are examples of articles regarding policies that lacked clarity, having those examples would/could be further shared with our Policy team for process improvements.
09/12/17 In-Person Seminar Details Noridian indicated spring 2018 will be the planned timeline and we are hoping to partner with hospitals to host the events in order to increase provider collaboration and attendance. One member offered their facilities in Tacoma, Irvine, and Los Angeles for hosting the in-person seminars.
Topics have been identified for a Noridian Part A/B single-day presentation (portal, Audit / Cost Reports, Enrollment, Medical Review (including RAC, SMRC, CERT), top claim errors, Incident to, Telehealth, signatures and documentation (including examples), national editing, Chronic Care management, E/M, Policies, modifiers, and significant program changes. Our cities and tentative dates will be going to hospitals in the area to solicit their hosting capabilities in December. We anticipate events occurring April through September in approximately 9 continental cities in addition to Hawaii and Alaska; which all details would be published and all providers could go to whichever location fit their needs to get the same information.
09/12/17 ACO Detail Availability in DDE and Portal A member is looking for information regarding Accountable Care Organizations (ACOs). There is information within the Common Working File and there is needed information regarding risks for the beneficiary. The request is to have additional details displayed in portal or DDE inquiries. Conversations with the POEAG member and the External Relations manager at Noridian are occurring.
09/12/17 New Medicare Card Letter and Fact Sheet Email Receipt A POEAG member asked for the CMS letter and fact sheet to be emailed to POEAG members. CMS approved the request following the meeting and Noridian emailed the information 09/20/17.  Additional details are on the CMS webpage titled, "What do the new Medicare cards mean for providers?"
09/12/17 New Medicare Card Distribution Approach A POEAG Member shared their organization has begun to prepare for this change and would like to receive more guidance regarding if the cards will begin to be issued based on Social Security Numbers, geographic region, or other criteria.  Following the September meeting, Noridian researched CMS' Website and found the cards will be issued based on geographic location beginning April 2018. An additional request was to know if  Noridian will be communicating through our portal as the cards are issued to people with Medicare. Noridian shared that within the CMS Open Door Forum June 8, 2017 [PPTX] presentation (slide 13), CMS plans to have the eligibility inquiry responses provided through the Medicare contractor portals begin to include an indication if that beneficiary's new card had been mailed.
09/12/17 Cost Report Submission Portal Functionality Training Members indicated the portal user manual containing the provider audit (cost report) instructions needs to be clear on what is required to submit cost reports, especially for Rural Health Clinics with outreach offered. Noridian has published the instructions and conducted webinars for providers in November.
09/12/17 Cost Report Submission Portal User Account Inactivity Consideration There was a concern regarding annual usage vs. account inactivity which Noridian will research. After the September meeting, Noridian received the following guidance from the User Security manager who oversees portal accounts and decommissioning due to inactivity, "The systems are designed with the utmost security to protect not only the users but also Noridian as it relates to PHI/PII information. It is always helpful for the user to maintain their own reminder system (such as a re-occurring task reminder in Outlook). Noridian's portal delivers a series of emails to the user's email informing them of inactivation, prior to occurrence (at 45 days of non-usage and again 7 days prior to deletion of the account. If a user is deleted from the portal (at 90 days due to non-usage), their email is removed and can be used again in the future. This will be helpful for those that need limited access."
09/12/17 California Association of Rural Health Clinics Conference A POEAG suggested Noridian participate in the event as to focus on the importance of Rural Health Clinics as more beneficiaries are retiring to rural, underserved areas. Noridian received the presenter invitation and was approved by CMS to participate in the 06/25-06/27/2018 event in Folsom, CA.

 

New Agenda Items

  1. Self Service Enhancements
    1. Website Changes
      1. New webpage added for Disasters including the recent California wildfires.
        1. JEA: https://med.noridianmedicare.com/web/jea/enrollment/emergency-applicaton-hotline
        2. JEB: https://med.noridianmedicare.com/web/jeb/enrollment/emergency-applicaton-hotline
      2. New webpage added for Disaster Recovery
        1. JEA: https://med.noridianmedicare.com/web/jea/topics/emergencies-disasters
        2. JEB: https://med.noridianmedicare.com/web/jeb/topics/emergencies-disasters
    2. Social Media Update: We are pursuing Facebook and a YouTube channel for webinar announcement and to draw attention to hot topics. Social Media, when ready, will be advertised through our website and listserv. We look forward to the two-way exchange social media provides.
    3. Eligibility Enhancements – Our portal offers dual eligible Medicare/Medicaid information (aka QMB), hospital period, and expanded preventive information (cardiac and related rehab sessions).
    4. Cost Report Usage – Providers have begun using the new functionality for submission of their time-sensitive reports. Training events were completed on this new feature.
    5. Upcoming Portal Enhancements – In the next six months, we plan to offer secure messaging, Medical Review enhancements, and eligibility-specific claim denial details (i.e., incarceration, HMO, etc).
      1. Two way secure messaging clarity was requested. This is similar to a mailbox and allows for claim-specific inquiry submission containing Protected Health Information in a secure manner.
    6. Self Service Reopenings continues to increase with monitoring and capacity expansion occurring to accommodate the provider adoption rate of this feature.
    7. Redetermination submission now permits 70 MB per attachment; an increase from the prior 10 MB per attachment limitation.
  2. QMB Remittance Advice Liability Issue
    1. On October 2, Change Request 9911 modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to identify QMB patients and reflect zero cost-sharing liability. This change resulted in unanticipated issues for providers, states, and other secondary payers who are used to seeing Medicare deductible and coinsurance amounts in specific fields on the RA. Beginning December 8, CMS systems will revert back to the previous display of patient responsibility for QMBs on RAs. You may want to hold QMB claims and submit them after December 8. See the QMB Program webpage for more information.
    2. This information was published by in the CMS MLN Connects dated November 16, 2017. Noridian has published the information on our homepage and "Fees & News" webpage under Alerts.
  3. New Medicare Card
    1. Within the CMS MLN Connects dated November 9, 2017, CMS is offering free, color educational posters, tear-off-sheets, and fliers available they are hopeful providers will order to help educate patients of the upcoming change.
    2. CMS hosts Open Door Forums with the upcoming events and historical event minutes available on their website, https://www.cms.gov/Medicare/New-Medicare-Card/Open-Door-Forums.html.
  4. Provider Enrollment
    1. The Provider Enrollment team will be hosting a series of 2018 webinars. The topics for six months are being solicited from POEAG members. Scheduled topics per select months were shared during the meeting.
      1. Revalidation Refresher: January, April, July, and October
      2. PECOS: February
      3. March: Collaboration with the Enrollment Call Center
  5. PCC Inquiries and Education's Role
    1. POE representatives have seen an increase in general inquiries directly asked to them, mostly via email. General inquiries are handled through the PCC and staff will be referring any questions to the PCC first. We have a tiered contact center to escalate inquiries to the next level if necessary. Inquiries can level up to a Provider Research and Relations Specialist (PRRS) who will, if necessary, will work and coordinate with other departments for resolution to the inquiry. If an inquiry is not answered to a provider's satisfaction, they can call back in to the PCC and provide the inquiry identification number for further research.
  6. Inquiry Reduction Initiative
    1. At a prior meeting we had discussed the issues and concerns we've had with the increase in outsourced calls. We've been able to implement an internal tracking for these calls to pull some reports. We have begun making calls to provider offices and facilities that are outsourcing to notify them we are receiving these calls that typically can be answered using self service options such as the remittance advice, IVR, NMP and web site.
  7. Recovery Auditor Contractor Monthly Review Item Publication
    1. Effective November 9, 2017, CMS is publishing a list of review topics that have been proposed, but not yet approved, for RACs to review. These topics will be listed, on a monthly basis, on CMS' Medicare Fee For Service Recovery Auditor Program / Provider Resources webpage along with details about the proposed reviews. CMS also indicates questions or comments about the Recovery Audit Program can be emailed to RAC@cms.hhs.gov (do not email Personal Health Information).

Upcoming Events

Providers can view training available by visiting the "Education and Outreach / Schedule of Events" section of our website.
Part A: https://med.noridianmedicare.com/web/jfa/education/training-events
Part B: https://med.noridianmedicare.com/web/jfb/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.

  1. A recommendation to use the "track change" feature on final and/or draft policies to best highlight what changes occurred was received and discussed. This would potentially impact CMS' Medicare Coverage Database and would be a supplement to the revision log and existing summary of change in the policies. The recommendation will be shared with Noridian's Contractor Medical Directors.
  2. A suggestion was received to provide more information on the discharge status from Home Health providers for outpatient physical therapy and rehabilitation beneficiaries. This information is not always readily available in the current systems and more communication is needed between MACs so that consistent information is available to providers.
  3. Multiple POEAG members advised that more education on Targeted Probe & Educate (TPE) from the Noridian Medical Review department would be helpful to ensure providers are aware of the program.
  4. A request to have information provided for using the JG modifier when billing for 340B drugs was received. There is information currently available on CMS' website, https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Downloads/Billing-340B-Modifiers-under-Hospital-OPPS.pdf
  5. A POEAG member advised that having past Part A remittance advices available would be helpful to California providers affected by the wildfires. The member asked about the process for reporting any eligibility discrepancies with the Noridian Medicare Portal vs. the Common Working File (CWF) through the DDE system. In the rare case (less than ten times in a month for every eligibility inquiry received), Noridian reports identified discrepancies to CMS' HIPAA Eligibility Transaction System (HETS) Help Desk with the results almost always being the portal/IVR was current and CWF was delayed by a few days.
  6. A POEAG member suggested that Provider Enrollment conduct training for provider specialty 31 (intensive cardiac rehab) in the areas of credentialing, adding a supplier, TIN, new PTAN, and assignment of benefits. The method suggested was a webinar with information on how groups can best handle situations of qualification vs. finalized discharge and system entry.
  7. Noridian was asked to consider hosting events November through February to help providers prepare and be familiar with annual Medicare program changes. In-person seminars or webinars would be valuable; however, there is value in periodic in-person meetings when they are conveniently located to the majority of providers.
  8. Holiday months, year-end activities and second suggestion for doing year-end efforts; webinars for annual changes. May-mania for AAPC and webinars.

The next scheduled meeting is March 13, 2018.

Last Updated Nov 27, 2018