Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - June 14, 2022

Roll Call

POEAG Member or Other (CMS) Attendees

Dawn Davidson, Jana Weis, Lisa Beyer, and Trisha Anderson

Noridian Attendees

Teresa Cirelli, Elizabeth Barton, Ashley Decoteau, Jan Ervin, Katie Hove, Tammy Ewers, Tim Morrissey, Val Cavett, Julie Schroeder, Sue Bennett-Coyne, and Brittney Beck

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. 11/16/2020. Educate on Inpatient Transfers vs Leave of Absence.
    1. Noridian is producing an Education on Demand tutorial on "Transfers, Interrupted Stays and Leave of Absence" that is expected to be available the end of October. It is currently under review.
  2. 12/10/2020. Billing Unlisted Codes.
    1. 09/14: A member requested to have more visibility to the internal listing the call center uses for unlisted codes. POE continues working with the call center and our claim processing teams on this possibility. A webpage is under development to assist with unlisted codes and is anticipated to be published early-2022. This topic will be shared with our Contact Center as a Customer Service Representative (CSR) education opportunity so they may avoid referencing internal-only resources.
    2. 12/14: Developing a table to indicate "Top Unlisted CPT" and paring it with "Preferred Description" (if documentation supports). Ongoing discussions on details are taking place with Medical Review, Adjudication and Appeals teams. The group identified the code with the most errors as 33999.
    3. Trisha had brought this issue to Noridian’s attention and appreciates the work being done as this impact’s providers. Customer Service Reps (CSRs) at Noridian continue to reference an internal list when answering calls for unlisted codes.
    4. 03/08: Work continues with internal departments. Members appreciate the updates and work on this recommendation.
    5. 06/14: Internal workgroup members have changed but activities continue, and an update is expected at the September meeting.
  3. 06/08/2021. Prior Authorization Updates. 
    1. 09/14: The webinar series for Prior Authorization for Certain Hospital Outpatient Department Services was completed in August. Based on frequently asked questions during the webinars, the presentation was updated throughout the summer. One suggestion was to add the reason codes to the PA webpages; this is in the works with the Provider Contact Center.
    2. 12/14: Development to add the reason codes to the PA webpages has started. Plan to have webpages updated beginning of 2022.
    3. 03/08: The webpage updates continue to be in progress.
    4. 06/14: We are looking to add the reason codes to the PA webpage and anticipate an update during the September meeting.
  4. 09/14/2021. Donor Claim Denials.
    1. 09/14: A POEAG member previously worked with someone on donor claims denying as duplicate claims when Q3 modifier was appended. Noridian will contact and work with the POEAG member through the example claims and training opportunities internally or externally.
    2. 12/14: Contact from Noridian with the POEAG member to better understand the two claim denials in question and potential larger impact.
    3. 03/08: Noridian is working on the system edits, NCCI edit bypass options, and claim processing for claims billed with modifier Q3 to determine if there are gaps in the implemented claim processing solution.
    4. 06/14: Awaiting guidance Noridian and will ensure POEAG member is contacted as her claims are still not paying. Will be included on future agenda as a follow up and will work with Noridian’s edit team to provide progress.
  5. 12/14/2021. Back to Basics Tutorials.
    1. 12/14: Noridian will offer a tutorial series for new provider staff members to gain exposure and learn more about the basics of Medicare.
    2. 03/08: Tutorial sessions are in development and will be available by early summer.
    3. 06/14: We are still on track with the goal of to begin publishing the basic tutorial series and will provide an additional update on our progress in September.
  6. 03/08/2022. PT modifiers and ASC.
    1. 03/08: Noridian was asked to update the ASC webpage to include the PT modifier information.
    2. 06/14: PT modifier is available on the Modifier webpage. as it is not specific to ASCs.
      1. POEAG member indicated a prior meeting indicated PT was not appropriate in an ASC. The reference received indicated the deductibles did not apply, not that the ASC does not allow the PT modifier. There still may need to be changes made. They’ve not had claim denials but they did receive direction from a PCC indicating it is inappropriate to use the PT in the ASC. They had planned to use this with 33; it did pay. This may require PCC education.
        1. Teresa will return to the call center and research the resource, the webpage, our guidance, and claim processing. If we are not allowing it in an ASC, the POE AG member requested communication be published.

New Agenda Items

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

  1. Nerve block LCD and Policy Article A52725: Denials prompted this request for education on LCD L38803- Facet Joint Interventions for Pain Management and clarity on the expected intervals (evaluation of pain level upon discharge and follow up in a week, month, two months, or upon discharge and before the next procedure is scheduled).
    • Webinar for Facet Joint Intervention - July 12
    • A POEAG members specific questions have been sent to Noridian’s MR and will determine if the questions will be part of the July webinar or if a separate, individualized provider call will be needed.
    • The LCD is an area of concern at the Idaho Medical Association and throughout Idaho. More questions on policy and clarification exist so they feel the webinar that is scheduled will be great.
  2. The ability to delete line items in the DDE system is no longer working. Was this communicated to providers? Is this a system or a vendor issue? We are always talking about communication and how to improve.
    • We researched the information with a POEAG member prior to the call. It appears to be an issue with re-entering lines, and they were unable to perform the task how they previously were doing this. The addition of a line prompted RTP but then a change could be made and was not accepted. Noridian has not been able to replicate this situation in our test environment. We have submitted a ticket to the system maintainer to investigate and resolve. Noridian is interest to learn if others have this challenge, and if so, who is their service provider?
    • One member indicated 1V didn’t work but 4Vs does allow the line deletion.
    • Another member uses a clearinghouse and not having any issues.
  3. Sequestration adjustments returned. April 1 through June 30, started with one percent adjustment. The full two percent adjustment returns July 1.
  4. Welcome New Medicare Part B Provider Packet: Noridian has emailed the contents of what is mailed to newly enrolled Medicare Part B groups or solo practices and requests input from members on the materials and value in a postal mailing as opposed to an email.
    • Teresa will work with Elizabeth to send PDF.
  5. MAC Customer Experience (MCE) Satisfaction Survey Update: Surveys reflect the webinar presentation content is informative. We did have a few webinars in May that experienced technical issues and we either rescheduled or re-recorded those sessions. we have received comments:
    • When the duration of the event, with questions and answers, goes over scheduled time this impacts attendee’s ability to attend the entire webinar. Noridian is aware of the concern and working to stay within the scheduled time.
    • Participants appreciate when Noridian uses the polling tool to engage the audience when the content and presentation duration have time available. Strategic use of polling and alternative ways to engage the audience continues to be used.
    • Providers have sent technical issue concerns to Noridian which resulted in Webinar-on-Demand recordings being pursued and published.
    • Webinar-on-Demand communication is occurring to everyone registered, regardless of attendance, when published. This should increase access to the recordings.
    • POEAG member input for 2023 specific webinar topics are requested to avoid the "repurposed" webinars each year.
    • Please know we truly value each survey completed as every survey and their comments are reviewed by reps, leadership, management. This is for webinars, webpages, tutorials, event recordings. Your voice drives our education plan.
  6. Two-Day Virtual Symposium Returns - Save the Date for September 21 and 22 will be posted in July. Guest speakers will include CMS, Carrier Medical Director, Provider Enrollment, RAC, and DME. Additional Noridian topics from Education Representatives will be presenting and the data-driven topics are being finalized.

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

2022 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.

  • March 23 (Part A), April 20 (Part B), September 28 (Part A), and October 19 (Part B) from 3-4 p.m. CT.
  • Submit questions in advance through the Pre-Question Process on our website

Please share recommendations for any timing, frequency, size, topics, and provider type(s) for the 2022 ACT 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 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, CSR training topic recommendations, or elaborate on topics discussed during the meeting.

  • There is a struggle with RTP, LTR, benefit max, and three-day qualifying stay processing and this may be an opportunity for training. The last training was 02/2021.
    • There is an inpatient benefit period webinar in the fourth quarter, 2022.
  • Questions regarding upcoming changes for Evaluation and Management (E/M) services and if CMS will adopt 2021 guidelines for other E/M services. There is not a lot of information from CMS or AMA.
    • Teresa shared we do not have the 2023 changes for codes or topics and have heard discussion is occurring. We are awaiting the proposed rule and then subsequent guides from CMS; often received in July/August.
  • Providers are reaching out regarding telehealth involving state lines or neighboring states. Noridian may want to educate on this. At this time, Teresa shared that during the PHE it is based on state guidelines. This may not be common knowledge on how the law works and where to look for guidance. Teresa indicated we are also receiving many questions on what will occur when the pandemic ends; we anticipate published guides from CMS as changes develop. Beneficiaries will see neighboring state providers, but they use telehealth services to avoid driving. There are concerns and desires to still allow telehealth as it has been allowed during the pandemic. Going to medical associations to learn more of state guides is where providers are being directed.
    • Provider Enrollment - Unbroken rule and the pandemic as well as what makes sense is being discussed and will be communicated.
  • Noridian new vs. established patient claim processing is showing an increase in denials although the NPs are of different specialties. There are several calls with the call center.
    • Teresa indicated new patient submissions for NP and MD of different specialties should not be denying. The claims are submitted with two-digit NPP practicing specialty. The callback she received from Noridian indicated Noridian wasn’t looking at the specialties - which was questioned. It was Noridian’s goal to decrease the denials, not increase denials.
    • The member does use the NMP to research claims being hit against and some are six years not three years in history.
  • Where is the best place to go for LCD questions? Part B is denying claims and the LCDs are the same - you cannot have a nerve conduction study without EMG? Unless ruling out carpel tunnel. Part A is paying. Part B upholds denial at appeal level. Is this MR or Appeals MR education needed?
    • Teresa will work with POEAG member on the examples to have MR involved in the specific claim
  • Multiple Procedure Reduction - When the same doctor does the same service on the same day, the reduction is appropriate. They are hearing about denials when it is a different doctor in the same specialty that is resulting in the payment reduction. Two doctors performed different procedures on the same day; not in the same session. They are of the same specialty.
    • Noridian staff researched and provided the resource for this reduction justification
    • Allowed Amount Reductions
    • 30.6.5 - Physicians in Group Practice (Rev. 1, 10-01-03) Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one Evaluation and Management (E/M) (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one E/M service may be reported unless the E/M services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf
    • POEAG member thought if the evaluation and management services are for unrelated problems, a second E/M would be allowed.
    • Noridian will review.

Upcoming Meetings

Scheduled Meetings for 2022

When: All meeting times 1-2 P.M. CT

  • September 13
  • December 13

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

 

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