Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - June 11, 2019

Roll Call

Noridian Attendees

Claire Anderson, Elizabeth Barton, Kimberly Behrens, Tammy Ewers, Heather Langei-Watters, Beth Sandeen, Annessa Schjeldrup, Julie Schroeder, Tana Williams

POEAG Member Attendance

Teresa Cirelli, Lisa Davies, Timothy Downie, Dawn Davidson, Mindy Gale, Samantha Karpenko, Amber Krueger, Eva Stearns, Pam McCord

POEAG Mission and Goals

During each meeting, the Mission and Goals are reviewed.

Prior Meeting Minutes

The March 12, 2019 meeting minutes were distributed to POEAG members and published to the website April 5, 2019.

Below are the POEAG meeting recommendations and/or suggestions from the prior event.

Suggestion Date Description Resolution
5/17/2019 Email A member asked for information on the topic of targeted medical review for therapy beyond the cap. Specifically, does Noridian have a resource that addresses what is looked for during medical review in these cases? If the therapist believes the patient meets medical necessity, so an ABN is not given, but the case is ultimately put under medical review and denied, is the patient responsible for the balance, or since no ABN is the hospital on the hook? Noridian is updating the Outpatient-therapy services and ABN use webpage to include the limitation of liability (LOL) as it relates to thresholds. The article will include:
  • Mandatory Use of the ABN
  • KX threshold modifier examples
  • Transfer of liability for services not medically reasonable and necessary
Outpatient Therapy Billing webinars are scheduled in June to provide ABN and KX modifier threshold training along with billing time and untimed codes.

For a general overview of the targeted MR process, go to the Medical Review and Education or Target Probe and Educate (TPE) website.
3/12/2019 A member requested additional training occur on the topics of Part A to B Rebilling Guidance. Noridian provided a webinar last month for related events on this topic and a new page was added to the Noridian website. A to B Rebilling
3/12/2019 A member stated they have received a lot of requests from coding staff for 2019 CPTs, specifically interprofessional codes and virtual check-ins, remote codes. There has been limited AMA and/or CMS guidance on these codes. The group questioned how this will be marketed to the beneficiaries, so they are prepared to explain as questions are posed. Noridian is providing that CPTs G2010/G2012 has the status indicator of M "Services are not billable to fiscal intermediary/ MAC and are not payable under OPPS".
  • Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012)
  • Remote evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010)
3/12/2019 A member shared the Date of Death is an area they struggle and the NMP has limited information. Noridian shared, new information has been added to the NMP under Claim Status, Date of Death Denial Details. Providers may now obtain the Date of Death on File in the Social Security Administration (SSA) Record. To update the record, the beneficiary or legal representative must contact the Social Security Administration (SSA) In the resources section of the NMP claim status result, a CMS hyperlink reference is listed. Expanded Denial Details


New Agenda Items

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

  1. New Medicare Card / Medicare Beneficiary Identifier (MBI) Updates: Now that CMS has completed the beneficiary mailings of the new insurance card, Noridian wants to share that we are less than 30 weeks away from the end of the transition period to obtain the new MBI number. We want to remind providers of the importance of switching to the new MBI number. As of January 1, 2020, Noridian can no longer accept the Health Insurance Claim Number (HICN).
    • Additional resources available when the Beneficiary is unable to provide a copy of their new insurance card.
      • The MBI look-up tool via NMP
      • Remittance advice (RA) will also provide the new MBI when a valid HICN is submitted.
    • Provider Outreach and Education team is working on data analysis information on the percentage of MBI usage and reaching out to Providers with high percentages of claims not adapting the new MBI transition.
    • Monthly webinars for MBI information are available, please register through our website.
  2. CMS Medicare Learning Network (MLN) Matters Special Edition (SE)19007 - Address Verification Update: Part A Provider Bases Billing (PBB) Facilities Practice Address Verification Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations: This conveys the activation of systematic validation edits to enforce the requirements in the CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 1, Section 170, which describes Payment Bases for Institutional Claims. These requirements are not new requirements. CMS discussed these requirements in Change Request (CR)9613 and CR9907, both of which were effective on January 1, 2017.
    • What can providers do?
      • Verify claim submission
      • Verify PECOS enrollment address
      • Attend the upcoming DDE training, as CMS is adding a new option 1D for Provider Practice Address Query
        • Watch our site to sign up for training
      • Read more about provider-based facilities: Provider based facilities
      • SE19007    
  3. Ambulance Return Trip to Beneficiary's Home: Attention all skilled nursing facility (SNF) employees, registered nurses (RNs), dialysis centers, discharge planners, social services, physicians, hospitals, ambulance companies, etc. In most cases, Medicare does not cover ambulance trips when ordered by facilities or providers to return the beneficiary to their home (SNF, assisted living, residence, etc.). An ambulance transport must meet the medical necessity "if other means of transportation would endanger the beneficiary's health, whether or not it's available". The transport becomes the beneficiary's financial burden. Per the CMS Internet Only Manual (IOM), Publication 100-02, Chapter 10, Section 10.2.1, a 911 emergency call alone does not establish medical necessity.

    Many times, the SNF is responsible, under Consolidated Billing, for the transport. Other modes of transportation are to be utilized including a wheelchair van, cabulance, stretcher van, litter van, taxi, gurney van, transportation by a friend, neighbor or family member etc.

    These are non-covered services. To learn more, visit the Ambulance webpage.
  4. Self Service Education Opportunities: NMP Education
    • Upcoming Webinar: Completing an Appeal through the NMP- June 19, 2019
      • CR 11042, Publication 100-04, Chapter 29 - Appeals of Claims Decisions - Revisions incorporates the following updates:
        • The policy on use of electronic signatures
        • Timing of signatures on transfer of appeal rights and the appointment of representative forms
        • Tolling an adjudication timeframe when trying to cure a defective appointment form
        • Limiting scope of redetermination review in certain instances
        • Application of good cause for late filing involving beneficiary accessibility
        • Application of good cause where there is a declared disaster
  5. Provider Enrollment: We have two new enrollment focused education representatives, Beth Sandeen and Julie Schroeder. Any inquires that need Provider Enrollments attention will need to be sent to

Upcoming Events

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

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.

  1. A provider addressed the question, is the address change specific for Part A and is Noridian unaware of this coming for Part B. Noridian stated that currently the change is for Part A Provider Based Billed (PBB) facilities and at this time Part B has not been addressed for the address changes. SE 19007
  2. A provider questioned the new G2012 and G2010 codes; Noridian shared CMS is finalizing; the effective date of 01/01/2019 and is effective currently. Noridian is providing that CPTs G2010/G2012 has no payment rate defined, and it is finalizing with the status indicator of M. Services are not billable to fiscal intermediary/ MAC and are not payable under OPPS.
  3. A provider asked about clinical decision use and appropriate criteria for advanced diagnostic images in 2020. Noridian POE will research and watch for available references on this topic.
  4. A provider addressed the MSP Basics webinar for July 24, 2019 can this be repeated and/or recorded as the event is a UT holiday. Noridian shared at this time the webinar will not be repeated as its part of an all MAC workgroup: however, we will evaluate what training recording can be pursued. The member requested a training specifically on the MSP Questionnaire; we can entertain POE request form. Noridian stated that the completion of the MSP Questionnaire is not addressed in this presentation.
  5. A provider questioned the Provider Based attestations; they are working w/ different MAC for off-campus departments. That MAC had so much reference material and a contact for their communication in the preparation and attestation. They are now working on that for Noridian and can't find what they had hoped to base on what they need guidance on as they want that evidence of compliance gathered correctly. Those requirements and criteria are not stated specifically. They type of info we want to see to support the evidence of compliance. - Noridian shared Browse By Provider Type and it discusses samples but does not see a reference. While Noridian links to a Program Memorandum, it is not an example like the other MACs offer. Noridian will research other MAC material (i.e. list of 5 items) and contact members as we make progress to ensure we are on the right track. Our research will include partnering with Provider Enrollment and Part A Audit team members at Noridian.
  6. A provider stated she appreciates the call and feedback. To best understand how to make changes to code requirements, some registries and coverage w/ evidence are getting vague. It is important they do more services. Some condition, diagnosis, and NCD requirements are creating payments from Noridian on shadow clams which is the same as the clinical trials. How to make new coding rules for clinical trials vs. Transcatheter Aortic Valve Replacement (TAVR) and Coverage w/ Evidence Development. Some codes are used for dual purposes and maybe new codes need to be created. Noridian will investigate additional information.

Upcoming Meetings

Scheduled Meetings for 2019

  • September 10, 2019 1-2 PM CT
  • December 10, 2019 1-2 PM CT

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


Last Updated Thu, 08 Oct 2020 13:31:35 +0000