Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - December 13, 2022

Roll Call

POEAG Member or Other (CMS) Attendees

Avery Malate, Candice Kahue-Antone, Chelsey Kekahuna-Kalaukoa, Mitchel Kaye, Susan LaPadula, and Mindy Gale (JF)

Noridian Attendees

Teresa Cirelli, Elizabeth Barton, Cheryl Hanson, Dani Aasen, Erin Swaidner, Jan Ervin, Tammy Ewers, Tim Morrissey, Val Cavett, Daylann Robertson, Jennifer Joyce, Chad Helgedalen, and Tanisha Barnhardt

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.
  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. Topics include beneficiary forms, claim submission, appeals, documentation, and locating information on websites.
    2. 03/08: Tutorial sessions are in development and will be available by early summer. POEAG suggested topics include over payments and options for providers, ADRs, Pre and Post Pay Medical Review. POEAG feedback: Wonderful. Thank you to the whole team. Unfortunately, our industry has a tremendous turnover so having it on-demand will be critical.
    3. 06/14: Tutorial sessions continue to be in development.
    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 two-day Symposium being planned for March 8 and 9 - March into Medicare.
    5. 12/13: We are working on tutorials as well as our two-day symposium in March. We are setting this time aside for new staff or refresher training for Part A and Part B on appeals, enrollment, claims and related Medicare basic topics. We will have our ‘Save the Date’ advertisements published in late December with topics and registration made available in the new year.
      1. A member asked if education would be focused on Skilled Nursing Facility (SNF) and related resources that are an extension of resources from basics through the details including covering the IOM. Noridian shared we plan to do a multi-part SNF webinar series and will work with Mitch, Avery and Susan for additional ideas to ensure the topics providers need to learn about are being included and addressed.
      2. There will be a new nursing home Minimum Data Set (MDS) effective October; these data elements will correlate to claims.
  3. 9/13/2022. Skilled Nursing Facility (SNF) Demand Bill Education.
    1. This 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. 12/13: Noridian is producing an Education-on-Demand Tutorial and is planned to be available by the end of 2022. We are working with the POEAG member on what the education may be (webpage or a tutorial) and a tutorial would better fit the need to hear the information and see the slides. Member feedback for topics and venue recommendations is always welcome.
  4. 9/13/2022. Extending Recorded Webinars on Demand Availability.
    1. Requests received to extend recorded Webinars on Demand from two months to six months.
    2. 12/13: Noridian listened to the suggestion and implemented a change in October to allow recorded webinars to be available for six months on our website. We have streamlined our process and the recordings are being published approximately one week after the event. Material is sent to attendees prior to the event and is available if requested.

New Agenda Items

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

  1. CMS and Consumer Financial Protection Bureau (CFBP) Joint Letter.
    1. A member shared there is a press release regarding Protecting SNF residents and families for admission processes and proper protection under the Nursing Home Reform Act (NHRA), Fair Debt Collections Practices Act (FDCPA), and Fair Credit Reporting Act (FCRA). Beneficiaries are being charged at time of admission which differs from the "bad debt". This is a front-end issue and concern.
      • CMS Joint letter: Nursing facility debt collection practices
      • A member shared this correlates to the SNF demand billing webinar that Noridian is developing. What providers, patients and families are seeing is helpful information for members to bring to Noridian’s attention for outreach opportunities.
  2. Appeal Issues
    1. Noridian has used data analysis to identify unnecessary appeals; too late, too often resulting in duplicates. This effort adds more workload to Noridian as well as providers. There may be 200 or more appeals per day that are to be dismissed. Providers do need to allow time for Noridian to process the initial appeal instead of resending. Providers have hired offshore billing companies to reduce their accounts receivables. We find these companies are submitting multiple unnecessary appeal requests. Some are duplicate appeals sent within days of each other.
    2. Surgical modifiers - Collaborative webinar scheduled in March 2023. Most of this focus has been on Part B and duplicate services.
    3. They are seeing some timely filing issues as well as rebilling denied claims as a new claim. These result in dismissals.
    4. Following recent Facet changes, we allow two levels, and this has been an increased focus in appeals.
  3. Common requests for education received through surveys:
    1. 2023 Evaluation and Management Changes and Guidelines
      • Chronic Pain Management - this is a new management section beginning in 2023.
      • Critical Care Services - we will be hosting this event in January.
      • Billing for Time - this is an area where several MACs are preparing an educational article to address time-based billing.
    2. 503B Pharmacies and How Drugs Should be Billed - this is being researched by Noridian.
    3. Facility Based Education - we will be researching potential Part A basic training topic.
    4. Data on Denials, How Many Overturned Through Appeals Processes - this is a great topic for POE to pursue.
    5. Various specialty requests are being addressed. Gastrointestinal endoscopies (12/15), Eye care (11/22), Radiation oncology (5/22, event is being evaluated for 2023), and research for additional training on Shoulder debridement, and Iron Infusion therapy.
  4. 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:
    1. Participants continue to appreciate the knowledge they receive from our events.
    2. Providers are pleased with having the Webinar-on-Demand recordings.
    3. Including polling questions or web site tours are always a favorite to be engaged during the webinar.
    4. Opportunities to consider the timeframe scheduled and allowing time for questions and answers. Requesting examples instead of reading from slides.
    5. POEAG member input for 2023 specific webinar topics are requested to avoid the "repurposed" webinars each year.
    6. Please know we truly value each survey completed as every survey and the comments are reviewed by reps, leadership, management. This is for webinars, webpages, tutorials, event recordings. Your voice drives our education plan.

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. Please share recommendations for any timing, frequency, size, topics, and provider type(s) for the 2022 ACT schedule.

  • Subject to change: March 22 (Part A), April 19 (Part B), August 30 (Part A), and October 11 (Part B) from 3-4 p.m. CT.
  • Submit questions in advance through the Pre-Question Process on our website. Having the pre-submitted questions helps ensure Noridian has the proper experts from our teams (medical review, contact center, medical directors) available to assist.

Provider Contact Center Training

CMS approves training for Customer Service Representatives (CSRs) for up to eight hours per month. The training improves consistency and accuracy, understanding of issues, and knowledge retention. POE participates in training Customer Service Representatives each month. POEAG member recommendations for PCC training topic or related recommendations are welcome.

Electronic Mailing List (Listserv)

Noridian’s email list is routinely distributed Friday mornings with a CMS-authored MLN Connect sent out each Thursday. Noridian’s providers will benefit by seeing outreach opportunities with an ability to register as those events are available.

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 member provided suggestions regarding the physical therapy request for medical records from the SMRC review. The request is looking for a specific date of service but the plan of care for the therapist’s treatment may not have been done on the same day. Medical necessity may be established on a different day.
    • The recommendation is to include examples of what is being requested beyond a single date of sentence be inserted in the additional documentation requests (ADRs).
    • We can share that recommendation with the SMRC on behalf of Noridian’s POE AG. For the evaluation being signed, depending on what date, the therapist notes may stand up to scrutiny but when written in the initial evaluation, it will not be included with each treatment. Noridian shared we can encourage a hyperlink for documentation tips for resource sections.
    • Suggested including a checklist of resources when requesting therapy records.
  • Other members appreciated the six-month expansion for recorded webinars to be available on Noridian’s website.
  • Gratitude and respect was shared for the whole team.

Upcoming Meetings

Proposed Meetings for 2023

We continue to meet four times per year. New in 2023 based on feedback received from membership, we will combine into one meeting to include both Jurisdictions E and F.
When: All meeting times 2-3 P.M. CT/12-1 P.M. PT

  • March 14
  • June 13
  • September 12
  • December 12

Thank you for attending today’s meeting. We look forward to working with all of you again.


Last Updated Dec 09 , 2023