Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - June 8, 2021

Roll Call

POEAG Member or Other (CMS) Attendees

Cheryl Bradley, Dawn Silva, Kimi Shintani, Molly Martin, and Susan LaPadula

Noridian Attendees

Elizabeth Barton, Teresa Cirelli, Andrew Matson, Tammy Ewers, Katie Hove, Kelly Garlinghouse, Reanna Doele, Tim Morrissey, Crystal Mercer, Karlotta Dixon, Jan Ervin, Valerie Cavett, and Julie Schroeder

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 Resolution
09/10/19 Part A full remittance advice functionality added to the Noridian Medicare Portal 06/08/2021: A version of the remittance advice was previously offered on the portal for those providers who received the Standard Paper Remittance Advice (SPRA). The project to offer a full remittance advice for those providers receiving Electronic Remittance Advices (ERAs) started design and development in June. We plan a July launch and will provide an update before our September POEAG meeting.
03/09/21 HMO and Medicare Advantage Plan denials 06/08/2021: Noridian researched data analysis for Part A HMO denials and existing CMS Medicare Advantage inpatient claim billing requirements. A member shared the California Medi-Cal website Frequently Asked Questions webpage where “proof of denial from Medicare” is expected from providers. On June 3, we published the Medicare Advantage Inpatient Claim "Shadow Billing" webpage with examples and CMS resources.
03/09/21 Prior Authorization Training 03/09/2021: Noridian shared our outreach including the Prior Authorization for Certain Hospital Outpatient Department (OPD) Services webpage, promotion of the CMS OPD Operational Guide (PDF), the Prior Authorization Look-up Tool, Noridian Medicare Portal Prior Authorization status and submission functionality, and the Ask the Contractor Teleconference (ACT) specific to OPD Prior Authorization minutes.
06/08/2021: We have webinars scheduled for June, July, and August. We are recording Education on Demand tutorials.
03/09/21 Evaluation and Management 06/08/2021: Noridian updated our Evaluation and Management webpage on May 20 and produced the below Education-on-Demand tutorials. We are scheduling an additional webinar this year and have shared the updated American Medical Association (AMA) CPT errata & technical corrections webpage.
03/09/21 Telehealth webinars 06/08/2021: Noridian conducted Telehealth and Virtual Services webinars in January and March. An RHC and FQHC Telehealth Services webinar was held in May. Additional telehealth webinars will be scheduled for July, September, and November. In March we extended an offer to partner with the POEAG member if they would like outreach to their employees and/or association members.

 

New Agenda Items

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

  1. Insight from Noridian’s Medical Review team
    1. Prepay Targeted Probe and Educate (TPE) continues to be in a suspension status per CMS direction due to public health emergency (PHE); Noridian will inform providers if any changes occur to the TPE status. CMS has directed Medical Review (MR) to continue claim reviews via widespread service specific post-payment reviews. MR will post notice of any post-payment review topics that are implemented or under review on our Noridian Provider website under the Medical Review/Post-Pay Reviews tab. Additionally, if your facility is part of the widespread review you will receive an individual provider notice letter which includes the claim(s) involved in the selected sample. If a response is not received by Noridian within 45 days from the date of the individual provider letters, your entire claim will be adjusted for denial of non-response. The CMS MLNConnects dated Thursday, June 3, “MACs Resume Medical Review on a Post-payment Basis” announces post-payment reviews may occur for dates of service after March 2020.
    2. Additional Documentation Request (ADR) Non-responders: Although pre-pay TPE activities were paused, our post-pay Medical Review activities are occurring. Part B has a high volume of non-responders and we are learning one large factor may be provider’s displacement of job site.
      • Members requested to learn more about the provider types most impacted and services not being responded to by providers.
      • Communication of the postal addresses used for documentation request obtained during the provider’s enrollment such as the pay-to or billing addresses could be communicated to providers. This would help providers watch for the ADR requests. Providing the non-responder providers with the address we mail the ADR letter to may assist in provider interoffice coordination. Ownership within PECOS for provider enrollment communication by the provider will assist with ADR coordination.
      • Noridian was asked to create an article or promotional document for POEAG members and associations to distribute. Content recommended included portal features, delivery addresses, Noridian recommendations, CMS guidance, and pre- and post-pay activities occurring.
    3. Prior Authorization
      • CMS added two new services to the Hospital Outpatient Department (OPD) Prior Authorization program. For dates of service beginning on or after July 1, 2021, the following additional hospital OPD services will be required as a condition of payment.
        • Cervical Fusion with Disc Removal; CPT codes 22551 and 22552
        • Implanted Spinal Neurostimulators; CPT code 63650
      • These two services will be in addition to the existing prior authorization services, which include blepharoplasty, botulinum toxin injection, rhinoplasty, panniculectomy, and vein ablation. Our website is being updated to include information regarding the program expansion. Our Noridian Medicare Portal functionality is being programmed to ensure it accepts requests and inquiries for all Prior Authorization codes. Webinars and tutorials are being scheduled to provide educational resources.
        • One member had experience with Prior Authorization and has had no issues with the process.
        • A member solicited peer input and shared turnaround times have taken more than 10 days to process, they have experienced long hold times when trying to speak to a representative, and the representatives have a lack of knowledge for clarifying information when talking with Noridian. Noridian will reach out to this POEAG member to investigate and improve our services and knowledge.
  2. Insight from Noridian’s Claim/Adjudication team
    1. For common issues or general opportunities for provider improvement to help with processing, we usually educate through the website with our FAQs, articles, and the Denial Code Resolution. Internal partnership with claims, education, enrollment, and our call center occur based on trends and necessary education or training. General reminders for providers on scenarios that we continually see are below.
      • Ensure the name submitted on the claim matches the Medicare card exactly
      • If appending a modifier, ensure that modifier is appropriate for the procedure code billed. The incorrect use of the QW modifier is a recurring concern; it has been incorrectly billed with Evaluation and Management codes.
      • If billing a date span, ensure the procedure code is allowed a date span.
      • Ensure all fields on the CMS-1500 claim form are filled out correctly, including Item 5 (Patient’s Address).
  3. Provider Enrollment
    1. Members were asked to share any concerns they are experiencing regarding communication from the Enrollment team (i.e., outbound notification letters or requests for information).
  4. Noridian Medicare Portal (NMP)
    1. NMP Response Time: Noridian upgraded our portal platform and added a new server to support the capacity of users and transactions in March. We apologize for the prior impact the slow response time had on our provider’s daily activities.
    2. Functionality Input Survey: An email will be sent to each member containing questions on the topics of your favorite feature, issues experienced and their significance to you, and ideas for additional functionality. The email will be sent from Noridian’s Portal team. We will consolidate and review responses received and provide an update during the September meeting on how POEAG member input is used to pursue and prioritize portal activities.
  5. Medicare Diabetes Prevention Program (MDPP)
    1. The MDPP program was developed as a group-based structured lifestyle intervention that includes dietary coaching and moderate physical activity. The goal is preventing the onset of diabetes in beneficiaries who are pre-diabetic. This clinical intervention consists of 16 intensive “core” sessions of a curriculum, classroom-style setting and then less intensive monthly follow-up sessions. Providers need to receive recognition from the Centers for Disease Control and Prevention (CDC). Eligible providers then enroll with their Medicare contractor (Noridian). Providers identify pre-diabetic patients and provide clinical intervention to earn between $600 - $700 per beneficiary by meeting the billing criteria with procedure codes G9873-G9890. Details are available on our Noridian MDPP webpage. CMS offers a Medicare Diabetes Prevention Program (MDPP) - Frequently Asked Questions webpage. Members were asked if they are involved with the two-year MDPP, and if so, would they share their experience with our MDPP trainer.
  6. MAC Customer Experience (MCE) Satisfaction Survey Update
    1. Results for surveys collected March through April indicate providers appreciate when polling is used in our webinars, the question and answer portion of events, any website or tool demonstrations offered, and having material delivered prior to the event. Opportunities identified are recommendations for longer events or less content and adding examples or scenarios in the outreach material.
  7. POEAG Solicited Response to Innovation Station Update
    1. Noridian emailed the POEAG members on May 11 to obtain feedback on Noridian’s potential creation of an Innovation Station for our providers to recommend innovations to Noridian on how to improve the Medicare Program. We have received a great number of responses and are taking all feedback into consideration. The feedback we have received has been sent to our Innovations Team and we are looking into moving forward with this idea. Thank you to everyone who contributed to the feedback.

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.

During the upcoming round robin portion of the agenda, members share what recommendations they have for CSR training topics.

Electronic Mailing List (Listserv)

Noridian’s email list is distributed weekly with a CMS-authored MLNConnect sent out each Thursday. Noridians 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.

  • A member indicated their colleague’s prior provider enrollment inquiries have been addressed and there are no outstanding concerns for this topic.
  • Information regarding post-payment review activities was appreciated.
  • Members indicated they would watch for Additional Documentation Request outreach materials to share with members.
  • The Noridian Medicare Portal improvements were complimented as they have an impact on provider’s experience working with Noridian.

Upcoming Meeting

Scheduled Meetings for 2021

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

  • September 14
  • December 14

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

 

Last Updated Thu, 15 Jul 2021 12:17:00 +0000