Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - June 10, 2025

POEAG Member and Noridian Attendees

JE: Angela Amey, Avery Malate, Candice Kahue-Antone, Cheryl Bradley, Chrystina Ingram, Luci Hendrickson, Mitchel Kaye, Sara Jasper, Susan LaPadula and Tameka Island

JF: Anna Gauslow, Carol Self, Dawn Davidson, Jana Weis, Mindy Gale, Mollie Brooks, and Sarah Luther

Noridian Attendees: Teresa Cirelli, Cheryl Hanson, Val Cavett, Julie Schroeder, Stephanie Aalund, Marci Eckroth and Tracy Schutt

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. 9/12/23: Suggested Evaluation and Management (E/M) education articles
    1. Copy and paste in Electronic Health Record (EHR) - Some providers copy and paste the history and exam since it is no longer required to choose the E/M level. Old habits are hard to change, and this is not discussed in the current E/M guidelines. Suggestion to develop article with the Noridian Medical Directors.
    2. On-line digital E/M services - 99421-99423
      • There is specific language within AMA CPT about on-line evaluation and management within seven days of a previous E/M for same problem is not reportable. Would the same problem mean same diagnosis as reported on the claims? The CPT book states same or related problem. The diagnosis code would not be the only determining factor.
      • The CPT code book states that all professional decision making and assessment or subsequent management by physicians or qualified health professionals in the same group practice contribute to the cumulative time of the digital on-line E&M. Would this include same provider and provider specialty? It doesn’t state one way or the other and CMS is silent on this.
      • Lastly, would the date of service be the date the on-line inquiry was initiated by the patient? Sometime the messages can span over multiple days so keeping track of the seven days is critical.
    3. 12/12: Those discussions will be had with our CMDs. I couldn’t find all the answers, so it may be something we need to bring to CMS.
    4. 9/10: Discussions have taken place and a final draft version is not ready currently.
    5. 12/10/24, 3/11/25, 6/10/25: Remains an open item without guidance at this time.
  2. 12/10/24: Pulmonary Rehabilitation Services in a Skilled Nursing Facility (SNF)
    All of the CMS guidelines state pulmonary rehabilitation cannot be reimbursed when performed in a SNF. If there is a claim example, we can look to see how it processed through our system.

    6/10/25: We received one claim example regarding pulmonary rehab services performed in a SNF.
      • The claim did not include pulmonary rehab (PR) codes, 94625 and 94626. The codes on the claim example were 94060, 94760, 94664, are for pulmonary diagnostic testing, pulse oximetry services, inhaler education, etc. and are not under the pulmonary rehab. These services are respiratory therapy codes, which would be services allowed in a SNF.
      • Pulmonary rehab includes:
      • 94625 - Physician or other qualified health care professional services for outpatient PR; without continuous oximetry monitoring (per session) or
      • 94626 - Physician or other qualified health care professional services for outpatient PR; with continuous oximetry monitoring (per session)
      • Vendors are visiting SNFs, selling that their program is endorsed by Medicare. They provide diagnosis codes, CPT codes, and it doesn't seem correct.
      • Suggestion: XXXX  22X Type of Bill (TOB) or 23X TOB, 0460 Revenue Code
      • Suggestion: Follow-up with CMS and once providers have all of the information, MACs can release a Local Coverage Determination (LCD).
      • Teresa will work with another team to gather data
      • Member Question: If a physical therapist visits a SNF and performs therapy, which codes would they bill?
        Noridian Response: They should bill the code for the service they are providing.
  3. 3/11/2025: Marriage and Family Therapist (MFT)
    1. MFT providers are receiving letters from Noridian regarding their enrollment status. Letters are sent when Noridian receives a claim from a beneficiary, and the provider is not registered as being able to provide these services. Due to Mandatory Claims Submission, aside from opt out providers, if services are provided to a Medicare beneficiary, the provider is required to submit a claim. If a provider is not enrolled with Medicare, that person is not allowed to see Medicare beneficiaries. Payment needs to be refunded. Noridian may add to an upcoming newsletter or schedule a 30-minute webinar and will reach out to the member as they are looking for next steps to take after receiving the letter. Noridian will look into options of adding information to the letters to assist providers.
    2. How many MFTs have applied to Noridian? The total number of Marriage and Family Therapist in JE and JF is 7,638 and Mental Health Counselor for JE and JF is 6,185. Currently, the pending application for MFT and MHC is 607 total.
  4. 6/10/25: Issue has quieted down
    1. Noridian: When marriage and family therapists (MFTs) and mental health counselors were rolled out as a provider type, they weren't included in PECOS. We are finding that we are unable to update the specialty from Other to MFT or mental health counselor. We are working on a resolution.

New Agenda Items

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

  1. CMS moving short stay reviews to Medicare Administrative Contractor (MAC)
    1. Reviews will be performed by the MAC starting September 1, 2025 and will follow the Targeted Probe and Educate (TPE) process that can be found under Medical Review on our website.
    2. CMS updated their website with available information. It covers the effective dates, and the approach of the reviews will follow TPE probe approach if data supports the necessary review of their facility.
    3. The Quality Improvement Organization (QIO) will continue oversight of their workload related to Hospital-Issued Notices of Noncoverage (HINN) review, higher weighted DRGs, and quality of care concerns after September 1.
    4. CMS link about this change of oversight: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/medical-review-and-education/hospital-patient-status-reviews
    5. Member Question: Will there be a change in the number of records reviewed? We normally receive extremely low volumes and going to 20-40 claims would cause a large workload for providers and MACs.
      Noridian Response: We do not have information on the number of records that will be reviewed, only that it will follow the usual TPE process.
    6. Member Question: Is this for all providers?
      Noridian Response: This is for providers who have patients admitted to the hospital for a short stay (less than two midnights).
  2. Skilled Nursing Facility (SNF) CMS Mandatory Off-Cycle Revalidations
    CMS Extends Mandatory SNF Off-Cycle Revalidations to August 1, 2025. On April 17, 2025, CMS formally announced an extension for the mandatory off-cycle revalidation deadline for skilled nursing facilities (SNFs). Noridian updated our website and published an article on May 1, 2025.  There has been no additional information provided by CMS.
  3. Outpatient End Stage Renal Disease (ESRD)
    Repeat laboratory tests on the same date of service. Should modifier 91 be appended to the subsequent billing when the lab code is the same?
  4. Eligibility on Noridian Medicare Portal (NMP)
    Provider starting to provide Advanced Primary Care Management (APCM). Would a Medicare Advantage Dual Eligible Special Needs Plan (DSNP) patient qualify as a Qualified Medicare Beneficiary (QMB) when the patient is eligible for both Medicare and Medicaid coverage?
    • Eligibility for QMB can be verified through the NMP. If the patient has a Medicare Advantage Plan, check with that plan to verify if the patient would qualify for the APCM service that can be billed as higher complexity patient using HCPCS code G0558.
  5. New Provider New Biller (NPNB) Education Series
    We need your guidance to develop the topics that would be beneficial for new providers, billers and staff to learn about Medicare. What is important for those that are new to Medicare to learn about? Please email topics to POEAG@noridian.com by the end of July.
    • Suggestions:
      • "Welcome to Medicare" letter: Noridian sends an email to new providers during the month they become a new provider.
    • Include information on this series in the new provider emails: Yes. This will be included.
    • Topic suggestion: Understanding the benefit period

Top five inquiries to Provider Call Center (PCC)

  • Part A

    Missing or Invalid Code
    Payment explanation or calculation
    Days
    Incomplete information provided
    Claim overlap

  • Part B

    Coding errors or modifiers
    IVR/NMP referral
    Missing or invalid codes
    Duplicate
    Payment Explanation or calculation

Upcoming Education and Training Events

Providers can view Ask the Contractor Meetings (ACMs), webinars, and related training opportunities by visiting the "Education and Outreach/ Schedule of Events" section of our website.

Webinars and Schedule of Events

Virtual Two-day Symposium Coming in October

We have started planning our fall Symposium that will be scheduled in October. Registration will be available at our September POEAG meeting.

2025 Ask the Contractor Meetings (ACMs)

CMS allows Medicare contractors to hold ACMs (formerly ACTs) to provide a way for providers to ask questions. Noridian offers a question-and-answer portion within each webinar to help streamline applicable topics, audience, and questions for experts.

  • Part A: February 27 and July 17
  • Part B: May 7 and December 3
  • Submit questions in advance through the Pre-Question Process on our website under the Education and Outreach section.

Please share recommendations for any timing, frequency, size, topics, and provider type(s) for the 2025 ACM schedule.

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 and 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, CSR training topic recommendations, or elaborate on topics discussed during the meeting.

  1. Member Question: MolDX claims for episodic testing and a new DEX Z code appear to be causing claims to develop for additional information. Emailed the specifics on combination coding for pricing.
    Noridian Response: Noridian will follow-up with Medical Policy team and work directly with the member.
  2. Member Suggestion: We are still seeing SNFs having trouble submitting documentation through NMP so they end up submitting manually.
    Noridian Response: We are offering SNF webinars in the near future and we will look into adding NMP information. Teresa will also take back to NMP team as well.

Upcoming Meetings

Meetings for 2025

  • We continue to meet four times per year.
  • When: All meeting times 2-3 p.m. CT, 1-2 p.m. MT, and 12-1 p.m. PT
    • March 11
    • June 10
    • September 9
    • December 9

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

Last Updated Dec 04 , 2025