Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - September 8, 2020

Roll Call

Noridian Attendees

Reanna Doele, Tammy Ewers, Lu Newell, Lori Weber, Tana Williams, Kim Graham, Teresa Cirelli, Julie Schroeder, Tim Morrissey

POEAG Member Attendance

Mitchel Kaye, Kimi Shintani, Dawn Silva, Susan LaPadula, Wendy Alfaro, Nichole East, Greg Lablow, Alexis Christian-Abbott, CMS

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The prior meeting minutes were distributed to POEAG members and published to the website

JEA: https://med.noridianmedicare.com/web/jea/education/poe-advisory-group
JEB: https://med.noridianmedicare.com/web/jeb/education/poe-advisory-group

New Agenda Items

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

  1. Advance Beneficiary Notice of Noncoverage (ABN) Form Date Revised
    1. The ABN, Form CMS-R-131, and instructions have been approved by the Office of Management and Budget (OMB) for renewal. Due to COVID-19 concerns, CMS has expanded the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023). At this time, the renewed ABN will be mandatory for use on 1/1/2021. Reference: https://www.cms.gov/medicare/medicare-general-information/bni/abn
  2. Appropriate Use Criteria (AUC)
    1. The Educational and Operations Testing Period for the AUC Program has been extended through CY 2021. The ordering provider professional will be required now by 2022 to consult a qualified Clinical Decision Support Mechanism (CDSM) through an interactive, electronic tool. During the patient’s workup, the CDSM is used by the ordering provider to communicate AUC information to the imaging center and assists them in making the most appropriate treatment decision for a patient’s specific clinical condition. CDSM provides the ordering professional with a determination of whether that order a) adheres to AUC, b) does not adhere to AUC or c) not AUC applicable.
  3. Medicare Diabetes Prevention Program (MDPP) - Part B Only
    1. Medicare pays Medicare Diabetes Prevention Program (MDPP) suppliers to furnish group-based intervention to at-risk eligible Medicare beneficiaries:
  4. Portal Updates
    1. MSP Claim Denial Details provided: Offers the Insurer Type, Insurers Name, Address, Policy Number, Effective Date and Term Date, Phone number for Benefits Coordination and Recovery Center (BCRC) for updates, CMS Internet Only Manual (IOM) references, and reference to MSP topic page at Noridian Medicare.
    2. Reopenings - Part B: Effective October 1st, it will be mandated to use the self-service portal for these claim updates; changing the billed amount to correcting the wrong month or day of service, adding/changing diagnoses, place of service, etc. It’s great that providers can make most corrections via the portal and will save office administration time.
    3. Remittance Advice - Part A: There was a discussion with the Portal Team about the upgrade for Part A full remittance advices. The project has been prioritized as number one when all the mandatory upgrades are completed.
      • August deployment for Noridian Medicare portal. Noridian will retain the Facility Address information for Part A Prior Authorizations. One additional change made to Part A Prior Authorization is that the beneficiary information will be validated against HIPPA Eligibility Transaction System (HETS) during submission.
      • Implemented in August was the long-awaited change for Eligibility Inpatient Overlap. Previously Noridian pulled all the data from common working file (CWF). HETS has made a number of changes and added information for Inpatient Overlap. This information can be retrieved from the Noridian Medicare Portal. Discharge status codes are located in the Quick Reference Guide on the JEA/JFA Noridian web page.
         
        Location Billing NPI Admit Date End Date Discharge Status
        Hospital 10-digits 03/25/2020 03/25/2020 65
        Hospital 10-digits 12/2/2019 12/12/2019 01 - patient was discharged to a home
        Skilled Nursing Facility (SNF) 10-digits 12/12/2019 12/18/2019 07
  5. Noridian Outreach and Education Tutorial Recordings
    1. The educational tutorials available on the Noridian website will be taking on a different look. They are still accessible from the same location, but users will be directed to YouTube instead of BrainShark. With this change, users will be able to access the play lists directly from YouTube as well, without going through the website.
  6. Medical Review and Other Entities Information
    1. Comprehensive Error Rate Testing (CERT): Providers and suppliers are now able to submit medical records directly to the CERT contractor at CERTmail@nciinc.com. As a best practice, providers and suppliers are encouraged to password protect their documentation. Passwords should be submitted in a separate email to the CERT contractor. Have questions? Reach out to the CERT Contractor at CERTprovider@nciinc.com. They can assist with questions related to medical records requests, review status, and more. Noridian’s CERT team is also able to assist with questions regarding the CERT process.
    2. Noridian Medical Review: The MolDX Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels (L37301) LCD has increased the coverage of panels from three (3) to five (5) pathogens. Reference the Billing and Coding article (A57338) to view covered billing codes listed in Group 1 found in the link below. CPT codes 87632 and 87633 are listed in Group 2 codes as non-covered. The correct CPT is 87631 (Infectious agent detection by nucleic acid (DNA OR RNA); respiratory virus (e.g., adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe techniques, multiple types or subtypes, 3-5 targets), covered for up to five (5) pathogens.
    3. Recovery Auditor Contractor (RAC): Proposed New Issues and be found at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Proposed-RAC-Topics.
  7. Skilled Nursing Facility COVID-19 Tests: Skilled Nursing Facilities with a Clinical Laboratory Improvement Amendments (CLIA) Waiver Certificate can perform diagnostic laboratory tests. Special Editions 20011 page 11 has the COVID laboratory codes. On that page it specifies that G2024 is bundled on the SNF claim for Medicare patient in a Part A stay.
    1. If the resident is covered Medicare Part A, the COVID-19 test and specimen collection are included in the SNF PPS Prospective Payment System "bundled" and consolidated billing (CB) applies. Under the CB requirement, a SNF itself must submit all Medicare claims for the services that its residents receive (except for specifically excluded services).
    2. CLIA regulations require facilities to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests performed in certified facilities, each claim for an HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level.

Upcoming Events

Providers can view trainings and seminars available by visiting the "Education and Outreach/ Schedule of Events" section of our website.

Webinars

Part A: https://med.noridianmedicare.com/web/jea/education/training-events
Part B: https://med.noridianmedicare.com/web/jeb/education/training-events

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.

Comments:
The material was informative and will be dispensed within the organization. It is very helpful physician and facilities.

Suggestion:
Clarification on the National Correct Coding Initiative (NCCI) edits that were changed in January 2020 and in October 2020 will be reversed; specifically, the physical therapy combinations.

  • Noridian will have the change request (CR) listed in the Quarterly Provider Update webinar in October 2020. Review CR 111840, states Version 26.3 will include all previous versions and updates from January 1, 1996 to present. It will only be necessary to search the Column One/Column Two Correct Coding edit file for active or previously deleted edits. CMS no longer publishes a Mutually Exclusive edit file on its website for either practitioner or outpatient hospital services, since all active and deleted edits will appear in the single Column One/Column Two Correct Coding edit file on each website. Refer to the CMS NCCI webpage for additional information at https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.

Suggestion:
Any progress on Part A providers obtaining full remittance advices from the Noridian Medicare Portal. Added a date range for Medicare checks in the Noridian Medicare Portal (NMP). CMS has a hard cap of 1000 checks that can be added. This would improve internal processes for Part A providers.

  • CMS has given Noridian some mandatory updates for the NMP, once completed the Part A full remittance advice project will be prioritized including the capability to enter a date range.  Noridian Medicare Portal Team has been notified to ask CMS if it is possible to access viewing up to 1000 checks in the portal. This will help the providers to "look back" using the date range of the checks that were distributed.

Upcoming Meetings

Scheduled Meeting for 2020

Meeting times 1-2 PM PT

  • December 8

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

Last Updated Thu, 08 Oct 2020 13:15:30 +0000