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

Roll Call

POEAG Member or Other (CMS) Attendees

Amber Krueger, Carol Self, Dawn Davidson, Jamie Neill, Lisa Beyer, Lisa Davies, Anna Goslow, and Lucretia Knight

Noridian Attendees

Elizabeth Barton, Teresa Cirelli, Andrew Matson, Reanna Doele, Tim Morrissey Crystal Mercer, Karlotta Dixon, Julie Schroeder, Val Cavett, and Jan Ervin

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
11/16/2020 Educate on Inpatient Transfers vs Leave of Absence 06/08/2021: We are working to prepare an Education on Demand tutorial on “Transfers, Interrupted Stays and Leave of Absence.”
12/10/2020 Add more information on how to bill unlisted codes 03/09/2021: A member clarified the request is to determine what internal listing the call center uses for unlisted codes to determine if that may be published externally.
06/08/2021: POE has been working with the call center and our claim processing teams. Noridian is working with the member on this request.
03/09/2021 HMO “Shadow” Claim Requirements 06/08/2021: Data analysis identified a high volume of claim denials due to the patient having elected a Health Maintenance Organization/Medicare Advantage Plan. On June 3, we published the Medicare Advantage Inpatient Claim "Shadow Billing" webpage with examples and CMS resources.
03/09/2021 Publish an Overlapping Facility Request for Assistance Form 06/08/2021: Our contact center leadership is evaluating other MAC Dispute Request for Assistance forms and our current workload. We are working with other departments to determine if adding a dispute form to our website is feasible. We are aware providers may feel a 45-business day written correspondence response timeline is less customer-service focused than the current processes which allows telephone inquiries. Your input to the following will help our efforts.
How is a form more beneficial than calling the PCC?
What information could or would help them bill their claim correctly to avoid a claim overlapping from another facility?
When there is another facility with an overlap denial, what is the best way to get the original facility’s claim corrected?

 

New Agenda Items

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

  1. Nurse Practitioner (NP) and Physician Assistants (PA) Editing
    1. There are a large volume of claim denials and appeals surrounding NP and PA services occurring a) on the same day as another NP or PA service or b) as a new patient visit in a three-year period when the beneficiary is seen by another NP or PA in the same group. Noridian listened to providers, evaluated data for these situations, and we are reviewing options. Noridian’s Medical Director, Education, System Editing, Appeals, and Claim Processing teams are working together to implement editing that could offer improvements. This may allow the review of comments or specialty departments a PA or NP works in to create claim editing based on the area of focus of the rendering PA or NP rather than solely by their assigned specialty, which is generic for PA and NPs. While informally this is occurring at the appeals level, it is our goal to improve the initial claim processing editing to decrease administrative burden and improve claim processing without the need for appeals.
  2. Provider Enrollment
    1. What concerns are members experiencing regarding communication from the Enrollment team (i.e. outbound notification letters or requests for information)?
      • A member shared they have not heard of any challenges with enrollment or the related communication.
  3. Noridian Medicare Portal
    1. 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). The poral project that will offer full remittance advices 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.
    2. 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.
    3. 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.
  4. Prepay Targeted Probe and Educate (TPE)
    1. 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. 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. MR will post notices 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. If your facility is part of the widespread review you will receive an individual provider notice letter which includes which claim(s) are 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.
  5. Additional Documentation Request Nonresponders
    1. Although pre-pay Targeted Probe and Education (TPE) activities were paused, our post-pay Medical Review activities are occurring. Part B has a high volume of nonresponders and we are learning one large factor may be provider’s displacement of job site. We are looking for your insight as to how to improve education on the importance and potential long-term impact if providers elect or are unable to respond with documentation requested.
      • A member shared the portal really provides great ADR information. They expressed interest in having the Medical Review examiner’s findings letter available in the portal.
  6. Prior Authorization
    1. 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
    2. 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.
  7. 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. As finalized in the CY 2018 Medicare Physician Fee Schedule, MDPP suppliers began enrolling in Medicare on January 1, 2018, and could begin furnishing MDPP services and billing Medicare for MDPP services on April 1, 2018. 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) prior to enrolling with their Medicare Administrative Contractor (i.e., 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
      • One member shared they have recently experienced MDPP challenges with reporting codes, supplemental Medicare plan involvement, reporting of their participation, and transferring MDPP details onto the claim. Noridian will reach out to this provider to seek global education opportunities for improvement and to offer individualized MDPP support.
  8. 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.
  9. 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 that contributed to the feedback.

Upcoming 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 3-4 p.m. 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, please share what recommendations you would like to share for CSR training topics.

Electronic Mailing List (Listserv)

Noridian’s email list is distributed weekly 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.

  • Group members expressed they appreciated Noridian is working on prior recommendations.
  • Noridian was asked to determine if a historical procedure-to-device edit spreadsheet could be made available. An older example is being provided by the member for Noridian to research.

Upcoming Meetings

Scheduled Meetings for 2021

All meeting times 1 - 2 P.M. CT

  • 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 12:17:17 +0000