Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - March 9, 2021

Roll Call

POEAG Member or Other (CMS) Attendees

Cheryl Bradley, Kimi Shintani, Marija Cerelli, Nichole East, Susan LaPadula, Tameka Island, and Wendy Alfaro

Noridian Attendees

Elizabeth Barton, Reanna Doele, Tammy Ewers, Lu Newell, Tim Morrissey, Annessa Schjeldrup, Julie Schroeder, Lori Weber, Teresa Cirelli, Janel Aamold, Kathryn Grueneich, Katie Hove, Kelly Garlinghouse, Jan Ervin, and Cheryl Hanson

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
09/10/19 Part A full remittance advice functionality added to the Noridian Medicare Portal 03/09/21: NMP recently completed an upgrade, had 1099 tax forms for 2020 loaded, and and we are working on a project that could allow reconsiderations to be submitted through NMP. The Part A Full Remittance Advice project is scheduled to kick-off by June 2021 as our prioritized project.
12/10 Provide education to Physical/Speech/OT therapists for the new (NIST) codes, new requirements, what Noridian reviewers would be looking for when reviewing claims, and service provided beyond threshold amount 03/09/21: The quarterly release webinars facilitated in January included information on the therapy changes which outlined the maintenance expansion and threshold increase. We educate on therapy changes in the telehealth webinars and address the delay in the PTA/OTA modifier with affect on payments. The TPE reviews have been suspended at this time due to the Public Health Emergency. Noridian has tentatively scheduled webinars in 2021: Outpatient Rehabilitation Therapy Services (April), Outpatient Therapy Certification and Recertification (June), and Outpatient Therapy Maintenance Billing (October).
02/22/21 Assignment violation 03/09/21: Noridian received a request and is currently working with the POEAG member on the resources available for recommendations on improved outreach opportunities.

 

New Agenda Items

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

  1. SNF Benefit Period Waivers (claim guidance, certification/recertification)
    1. CMS MLN Matters Special Edition (SE20011), “Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)”, provider should work with their MACs to submit any documentation needed to establish the COVID-19 emergency applies to the benefit period. It is recognized that some SNF providers may not yet have submitted the PPS assessments for the benefit period waiver. In these circumstances, providers may utilize the Health Insurance Prospective Payment System (HIPPS) code that was being billed when the beneficiary reach the end of their SNF benefit period. You must abide by all other SNF guidelines. Claims need to follow sequential billing. All SNF benefit period waiver claims should include the condition code DR, condition code 57, and include “COVID100” in the remarks. For all admissions under the benefit period waiver, complete a 5-day PPS assessment, follow all SNF PDPM assessment rules, include the HIPPS code derived from the new 5-day assessment on the claim, and the variable per diem schedule begins from Day 1. To qualify for the benefit period waiver, a beneficiary’s continued receipt of skilled care in the SNF must in some way be related to the PHE.
  2. COVID-19 Vaccines & Roster Billing for Mass Immunizers
    1. Noridian has created tutorials for coverage and billing and for mass immunizer enrollment, conducted webinars, published CMS resources, updated our preventive webpage with monoclonal antibody information, and updated our Public Health Emergency webpage with vaccine and roster information.
  3. Noridian Medical Review TPE Activities
    1. MACs have not received direction from CMS to resume TPE audits. Currently MACs are conducting service specific claim reviews. More information can be found on Noridian’s Medical Review webpage under Post-Pay Reviews. Individual providers will be notified if they have an open, pending TPE file when we have direction from CMS to resume TPE activities. ADR requests for TPE and post-payment audits are available on the Noridian Medicare Portal within the Claim Status functionality with options to securely submit the requested documentation directly through the portal as a benefit to providers. More information is available on our ADR Status and Submission webpage.
  4. CERT Published Errors and Noridian Activities
    1. CMS has published the 2020 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF). Noridian’s POE and Medical Review team partner for our Improper Payment Reduction Strategy to prioritize policy groups and services each year. If there is a vulnerable CERT area in need of expanded education, Noridian welcomes those recommendations.
  5. Home Health
    1. Providers have expressed there are issues with home health and hospice facilities not closing files accurately and/or not timely.
    2. If this is an impact to you, would you be interested in joining a national home health and hospice teleconference to speak about these issues? If you think this is a good idea and would like to participate, please send a confirmation email with the name of the contact person for future communication (which will come from CGS) as they arrange the call.
    3. If you prefer, you can send your questions or issues to the AB/HHH workgroup to help associations prepare for the conversation.
  6. MAC Customer Experience (MCE) Satisfaction Survey
    1. Beginning March 15, Noridian will use the MAC Customer Experience survey to solicit provider feedback on POE’s website content, tutorials, and our live events (webinars). The survey allows Noridian to identify improvements on the content, presenter, description, duration, and gain input on what providers find valuable or what needs to change. They live-event surveys replace our GoToWebinar surveys. This also replaces the MAC Satisfaction Insight prior, annual surveys CMS had coordinated.
  7. Provider Enrollment Education
    1. During 2021, our Provider Enrollment education team members will conduct live chat webinars each month. Providers may submit questions in the registration for Noridian to cover during the live chat event before opening the lines for impromptu, open-forum questions. Also, a virtual classroom on topics such as electronic funds transfer agreements, how to set up surrogacy in Identity and Access and how to sign the application in the Provider Enrollment, Chain and Ownership System will be demonstrated. The focus will be on questions the team has received ahead of time. The goal of these outreach options is to assist the provider/supplier community reduce burden associated with the enrollment process.
  8. Data Analysis: Top reason for claim denials is the patient is on a Health Maintenance Organization or Medicare Advantage Plan. POEAG members previously shared it is a matter of having the claim on file and a business pattern to bill Fee-for-Service, Traditional Medicare regardless of the HMO information they may have. Is there improved outreach Noridian can offer regarding timely filing and how primary insurance company claim denials or correspondence can assist with appeals if needed?
    1. Members shared that California has the highest number of HMOs and Medicare Advantage (Mas) in the country. Members shared they have heard that some HMOs are asking/requiring providers to bill traditional, fee-for-service Medicare to obtain the denial before they can bill the patient’s HMO or MA 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

2021 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 2021 ACT schedule.

  • January 20 (Part A), March 10 (E/M), April 14 (Part B), September 15 (Part A), and October 13 (Part B) from 1-2 ET / 3-4 CT.

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.

  • Noridian website / Contact Us / Provider Contact Center Training Closures (JEA, JEB)

During the upcoming round robin portion of the agenda, please share what recommendations you would like to share for CSR training topics.

Electronic Mailing List (Listserv)

Noridian’s email list routinely is distributed Tuesday and Fridays morning with a CMS-authored MLNConnect sent out each Thursday. Noridian’s providers will benefit by seeing outreach opportunities and 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.

  • A request was received for education regarding billing COVID-19 related to clinical trials.
  • Noridian was asked to research the data analysis for Part A to see if there is a trend in the HMO denials primarily occurring for ESRD and SNF providers.
  • With the Evaluation and Management event efforts, Noridian was asked to produce a question and answer resources or an Education-on-Demand tutorial.
  • Noridian was asked to offer additional Telehealth webinars. Although more events are scheduled, Noridian shared we are able to partner with groups and offer education to their members.
  • Education on the topic of prior authorization was requested. Noridian welcomes recommendations for additional global education from our POEAG members.
  • We maintain resources within the Medical Review / Pre-Claim Review / Prior Authorization for Certain Hospital Outpatient Department (OPD) Services webpage (JEA, JEB).
  • We promote the CMS OPD Operational Guide (PDF) through our website, Latest Update articles and related email list distributions.
  • A Prior Authorization Look-up Tool was created to assist our providers.  
  • Our Noridian Medicare Portal allows providers to check the status of their Prior Authorization Request and securely submit new requests as defined within the NMP Inquiry Guide.
  • We hosted an Ask the Contractor Teleconference (ACT) specific to OPD Prior Authorization on September 16, 2020 with the minutes published to our website.
  • Noridian is hosting webinars in June, July and August to educate providers on Prior Authorization.

Upcoming Meetings

Scheduled Meetings for 2021
All meeting times 3 - 4 P.M. CT / 1 - 2 P.M. PT

  • June 8
  • September 14
  • December 14

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

 

Last Updated Tue, 23 Mar 2021 18:41:57 +0000