Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - December 14, 2021

Roll Call

POEAG Member or Other (CMS) Attendees

Cheryl Bradley, Mitch Kaye, Rob Sikorski, Susan LaPadula, Tameka Island, and Wendy Alfaro

Noridian Attendees

Teresa Cirelli, Elizabeth Barton, Sarah Rikhus, Tim Morrissey, Tammy Ewers, Jan Ervin, Cheryl Hanson, Julie Schroeder, Marci Eckroth, Sarah Gurule-Zietlow, and Daylann Robertson

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.

Suggestion Date Description Progress or Resolution
09/10/2019 Noridian Medicare Portal
  1. Part A full remittance advice functionality added
  2. Portal survey
06/08/2021: NMP's Part A Full Remittance Advice Expansion: A version of the Part A remittance advice was previously offered on the portal for those providers who received the Standard Paper Remittance Advice (SPRA).

09/14: a) Effective July 2021, the portal now offers full remittance advices for providers receiving Electronic Remittance Advices (ERAs). As of July 30, Part A claim status inquiry reason codes provide guidance of denials or edits for each line of the claim. Hyperlinks are provided to the reason code narrative. b) Survey results were emailed to all POEAG members on August 6. JE providers liked the accuracy and functionality provided but shared concerns about Portal stability. Two suggestions were forwarded: 1) Provider would like to talk directly to Medical Policy. Noridian's call center tracks all incoming calls and triages issues that need additional information. 2) Requested current 45-day timeline to allow a longer time frame, maybe 180 days, to respond to documentation requests. This has been forwarded to Medical Review.
03/09/2021 Prior Authorization Training 06/08: We have webinars scheduled for June, July, and August. We are recording Education on Demand tutorials. We will reach out to a member regarding their experience with our Prior Authorization process and responsiveness.

09/14: Webinars for Prior Authorization for Certain Hospital Outpatient Department Services wrapped up in August. We updated the presentation based on questions received during the webinars to improve our education each time it was delivered. In response to a request received, our Education and Call Center team members are working to add the applicable PA reason codes to the PA webpage.

12/14: Development to add the reason codes to the PA webpages has started. Plan to have webpages updated beginning of 2022.
09/14/2021 Expand Noridian Medicare Portal (NMP) 09/14: Expand NMP to offer 120 days and/or last 100 ADR letters for providers to access on demand.

12/14: Sarah shared these are only the ADRs from Medical Review and there are CMS-defined timelines (45-days) for the providers to access and respond. When the timeline expires, they can no longer use the portal for the ADR. Due to this time-specific requirement, we are unable to offer ADRs for a longer timeline.
09/14/2021 Pre and Post-pay Medical Review Chart for Part A and B 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.

12/14: Chart is in development

 

New Agenda Items

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

  1. Noridian Medicare Portal (NMP) - Request improvements to increase reliability and stability for users.
    1. Sarah shared historically had been challenges but we have had a stable year. Although there may have been a challenge specific to one type of functionality, the technical reports for transactions and performance are reflecting the portal is stable and performing. In the first two weeks of December, Noridian's Part A claim functionality had transitioned to an API logic to retrieve the content to display. This is new and the issues have been worked through and corrected.
    2. Rob indicated they are challenged as a larger provider with many provider numbers and clinics in the best way to use the portal. We have put together a comparison listing comparing what functionality in different portals they like best. Rob will send this listing to Teresa and Noridian's NMP team. Portal eligibility verification is frequently used by their office.
      • This is wonderful. Although Noridian' NMP team members do evaluate other MAC functionality, we acknowledge there are other inquiry options to pursue.
  2. Suggestion to include bullet points on changes included in the October 14, 2021 Advance Beneficiary Notice of Noncoverage (ABN). Mitch indicated the bullet points were helpful beyond the view of the form so he knows what to present and a clearer view of the changes.
    • Most changes were language updates such as adding the word 'healthcare' before provider.
    • ABNs are now mandatory or optional, in the past it was mandatory or voluntary.
    • Situations when an ABN is not required for services that are cosmetic or statutorily excluded - language changed from voluntary ABN to "CMS strongly encourages healthcare providers and suppliers to issue the ABN for care that is never covered." This change relates to a best practice to notify the beneficiary they will be responsible for payment.
    • Dual covered under Medicare and Medicaid - ABN will need to be adjusted by marking through Option 1 on the ABN form. The beneficiary cannot be charged until the claim has processed through both Medicare and Medicaid. The beneficiary can only be charged the amount remaining on the remittance advice after Medicaid processes the claim.
    • Must include two copies of the signed ABN, one for the notifier and one for the beneficiary.
    • The ABN must only be one page, in specific font and size.
    • Period of Effectiveness - defined as the ABN will remain in effect after a valid delivery if there have been no changes in care, treatment or coverage guidelines.
    • ABN Special Considerations - described in section 50.17 for dually eligible individuals, ambulance transports, hospice, comprehensive outpatient rehabilitation facilities, and home health agencies.
  3. Back to Basics Tutorial Development: Noridian will be doing a series of tutorials to assist providers train their new team members. We feel the topics could include Beneficiary Forms, Claim Submission, Appeals, Documentation understanding Medicare language, and locating information on websites.
    1. Susan - Overpayments and options for providers is a great addition to this series.
  4. Prepay Targeted Probe and Educate (TPE) resumed in the Fall 2021 after being on pause during the Public Health Emergency in 2020 and part of 2021. Noridian has been providing education through webinars with the next one scheduled tomorrow, December 15.
  5. Providers utilizing outsourcing companies are responsible for the activity performed by these companies.
    1. Before contacting customer service, the Noridian Medicare Portal (NMP) or Interactive Voice Response (IVR) must be used
    2. Reviewing the self-service options and the remittance advice is required
    3. Activity has increased in customer service calls and appeals
      • Reviewing denial reasons and fixing the issue could have resolved many of the contacts received on claims
  6. Ambulance Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT). Noridian indicated this is repetitive, not once or twice but recurring throughout the month.
    1. CMS is expanding prior authorization process for RSNAT
      • Specific criteria for the prior authorization program
      • Ambulance service may request a Physician Certification Statement (PCS)
      • Beneficiary weekly transports for ESRD, chemotherapy or radiation
    2. JE states will be implemented in February 2022.
    3. Noridian holding webinars and developing tutorials starting in January 2022.
    4. Ambulance requirements:
      • Beneficiary will be transported to nearest facility that can treat the condition
      • Any other method of transportation is contraindicated
      • Condition requires ambulance transportation
      • Condition requires the level of service provided and billed
      • Return trips rarely covered unless the beneficiary's health is endangered
  7. MAC Customer Experience (MCE) Satisfaction Survey Update
    Results for surveys collected September through November continues to show participants find the webinar informative. Requests for basic information to understand Medicare have been indicated in suggested future webinars. Opportunities throughout the year have identified participants would like to have the option to view a recording of the webinar.
  8. Recorded webinars are coming! During our last POEAG meeting, a member provided this recommendation. We have been developing resources to start recording webinars in December to be available under the Education and Outreach section on our website. Webinars on Demand will be posted on the site for two months.
  9. 2022 ACT Date and Topic Recommendations
    1. Recommend topic specific POEAG meetings
    2. Members will share any suggestions regarding topics and frequency with Noridian's POEAG leader; poeag@noridian.com.
  10. POEAG Meeting Frequency: Once every three or every four months
    1. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/com109c06.pdf, Section 20.6.1, "The POE AG shall generally convene quarterly but, at a minimum, shall meet three times per year."
    2. Members prefer quarterly, as it is currently scheduled. Meeting four times per year allows proactive information sharing and recaps.

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

2022 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.

  • January 25 (Ambulance), March 23 (Part A), April 20 (Part B), September 28 (Part A), and October 19 (Part B) from 3-4 p.m. CT.
  • Submit questions in advance through the Pre-Question Process on our website

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 benefit by seeing outreach opportunities with an ability to register as those events are made 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. Noridian request of members to make recommendations of others who represent diverse locations and specialties.

  • Cheryl Bradley: Thank you for the process improvements and communication. Does Noridian see anything for revalidation for providers? Enrollment has a lot of education planned for January.
    • Enrollment is receiving information and there is a phased process currently for all Part A with select Part B providers being selected for revalidation. They know CMS is working through a Cycle 2 to stagger the work to not impact providers all at once. Noridian will follow CMS' guidelines as information is made available and can be released with providers. Data.cms.gov is a database for revalidations and there is an 'adjusted date' under the provider's name. If they provider had been previously selected in the prior quarter, the can research the new due date.
  • Mitchel Kaye: Really happy about the tutorials being available. He's referred others to them and used them himself; a wealth of information.
  • Rob Sikorski:
    • Overpayments and credit process as there are many options providers have to refund what they perceive to be an overpayment due to credit balance reporting or other venue. A tutorial or event is something he would like to recommend.
      • An overpayment webinar is scheduled for February 2022
      • Jan at Noridian will pursue the credit balance tutorial
    • In Part A, they have not taken advantage if there is disagreement among overlapping services, how can the MAC be brought into the discussion to educate those involved.
      • Noridian will research
  • Susan LaPadula: Thank you for continuing quarterly meetings into 2022. It will be great to recap every three months. It was a joy to collaborate with your team.
  • Tameka Island: Complimented Noridian and the POEAG involvement.
  • Wendy Alfaro: Happy Holidays! You guys have done a wonderful job in 2021.
  • Amanda Selman: We've been seeing flu vaccine admin has been reimbursed at 2021 rate when they were to be reimbursed at the 2019 rate. Examples may be needed.

Upcoming Meetings

Scheduled Meetings for 2022

When: All meeting times 3-4 P.M. CT / 1-2 P.M. PT

  • March 8
  • June 14
  • September 13
  • December 13

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

 

Last Updated Fri, 07 Jan 2022 18:20:16 +0000