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POE AG Meeting Minutes - March 08, 2022 - JF Part B

Provider Outreach and Education Advisory Group (POE AG) Meeting Minutes - March 08, 2022

Roll Call

POEAG Member or Other (CMS) Attendees

Dawn Davidson, Lisa Davies, Mollie Brooks and Trisha Anderson

Noridian Attendees

Teresa Cirelli, Elizabeth Barton, Ashley Decoteau, Cheryl Hanson, Jan Ervin, Katie Hove, Karlotta Dixon, Reanna Doele, Tammy Ewers, Tim Morrissey, Val Cavett, Julie Schroeder, Daylann Robertson, Brittney Beck, Marci Eckroth, and Jennifer Joyce

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. 09/14: 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.
    2. 12/14: Expected available date has been moved to January 2022.
    3. 03/08: Tutorial is under review.
  2. 12/10/2020. Add more information on how to bill 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 possible 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. Trisha had brought this issue to Noridian’s attention and appreciates the work being done as this impacts providers. Customer Service Reps (CSRs) at Noridian continue to reference an internal list when answering calls for unlisted codes.
    3. 03/08: Work continues with internal departments. Members appreciate the updates and work on this recommendation.
  3. 03/09/2021. Publish an Overlapping Facility Request for Assistance Form.
    1. 06/08: 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.
    2. 09/14: A member shared a) the form would be trackable and provide clear documentation, b) would confirm discharge location with the patient, and c) have Noridian recoup payment from other facility to track correction to discharge patient status code. The feedback received has been shared with Provider Contact Center (PCC) leadership for discussion and consideration.
    3. 12/14: Guidance to resolve claim overlapping denials has been developed. The logistics to create a form will require input from different departments. We will publish the guidance that was developed and monitor the feedback. The efficacy of implementing the form will continue in internal discussions.
  4. 06/08/2021. Nurse Practitioner (NP) and Physician Assistant (PA) Edits.
    1. 06/08: Providers are experiencing 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.
    2. 09/14: Noridian has scheduled an internal project to review system edits. A member indicated they contacted Noridian’s PCC and were informed the PA would need a different specialty; however, there isn’t a different specialty they can receive. PCC leadership will research this topic as a PCC CSR training opportunity.
    3. 12/14: Claim examples have been reviewed and edits identified that are causing denials which are upheld in appeals. Reviewing internal processes, system support and CMS policy to develop education. The member who raised this topic shared they appreciated the work being done as this impacts providers.
    4. 03/08: The, “Nonphysician Practitioners (NPPs): Evaluation and Management (E/M) Services” article was published on February 10 provides changes in processing of claims effective March 1, 2022. Members were excited to see the changes and are looking at how to ensure they add subspecialty information for the NP or PA.
  5. 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 under development 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: Progress continues on the webpage updates.
  6. 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.
  7. 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.

New Agenda Items

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

  1. Noridian New Provider packets are mailed out each month to providers that have recently enrolled in Medicare. We are looking for feedback if providers would prefer these packets via email vs mail.
  2. Members shared they prefer emails as postal mail does not arrive at the correct department. Having the packet go to the person conducting the actual enrollment would be better than the provider being enrolled as they most likely are not involved with those resources.
  3. Surprise Billing became effective January 1, 2022. Requirements do not apply to beneficiaries in federal programs (Medicare, Medicaid, Indian Health Services, Veterans Affairs, or TRICARE) since these programs already include protections against high medical bills. CMS published the, “What You Need to Know about the Biden-Harris Administration’s Actions to Prevent Surprise Billing (September 2021)” a fact sheet on September 30, 2021.
  4. Information on the PT modifier for ASC and which codes it applies to would be needed. Colonoscopy is the place where they can find some guidance.
    1. Modifier PT has been created and providers and practitioners should append the modifier to the diagnostic procedure code that is reported instead of the screening colonoscopy or screening sigmoidoscopy code.
    2. The Medicare policy is that the deductible is waived for all surgical procedures (CPT code range of 10000 to 69999) furnished on the same date and in the same encounter as a colonoscopy, flexible sigmoidoscopy, or barium enema that were initiated as colorectal cancer screening services.
    3. The final rule for 2022 added a phased schedule to reduce the beneficiary coinsurance from 20 percent to zero by 2030 for planned colorectal cancer screening tests resulting in additional procedures during the same clinical encounter.
      1. 2022: 20 percent
      2. 2023-2026: 15 percent
      3. 2027-2029: 10 percent
    4. Modifier PT was added to the JEB Modifiers webpage.
    5. 100-04 Chapter 14 Section 40.2 includes coinsurance and no deductible when provided in an ASC so the PT modifier would not remove copay responsibility of the patient.
    6. A POEAG member recommending having the guidance pertaining to PT modifier not being applicable within an ASC added to the ASC webpage.
  5. CMS and Noridian want to remind Part B providers that Cognitive Assessment & Care Plan (CACP) Service is available to perform via Telehealth. In January 2021, CMS introduced a Medicare-covered, possible additional visit to assess a beneficiary that meets the requirements. For example, if a physician, or other clinician, that’s eligible to bill an Evaluation and Management (E/M) or Annual Wellness Visit (AWV), finds a patient is showing signs of cognitive impairment during that routine visit, Medicare now covers a separate visit (CPT 99483) to thoroughly assess that patient’s cognitive function and develop a written care plan.
    1. Noridian Jurisdiction F Part B (JFB) Mental Health
    2. CMS Change Request (CR) 12247, Cognitive Assessment & Care Plan Services, dated April 26, 2021
  6. Sequestration adjustments will be returning in phases. April 1 through June 30, there will be a one percent adjustment. The full two percent adjustment returns July 1.
  7. MAC Customer Experience (MCE) Satisfaction Survey Update: Results for surveys collected in January and February continues to show participants find the Noridian webinars informative. We frequently receive requests to include more examples during webinars, however, many of the topics would be determined by individual patient documentation and the complete history. A wide variety of suggested topics are suggested with webinars planned for the majority of the recommendations.
  8. Recorded webinars are now available. POEAG members were asked for their input on Webinars-on-Demand being posted on the site for two months. We do offer long-term education-on-demand tutorials outside of the webinar recordings. Members shared a lot can change quickly so two months seems appropriate.

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. Please share recommendations for any timing, frequency, size, topics, and provider type(s) for the 2022 ACT schedule.

  • March 23 (Part A), April 20 (Part B), September 28 (Part A), and October 19 (Part B)
  • Hosted 3-4 p.m. CT.

Submit questions in advance through the Pre-Question Process on our website

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 eveants 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.

  • A question was received regarding Date of Death corrections. Providers need to contact the funeral home and then get a hold of Social Security. Is there a different way to get a date of death corrected?
    • As a Medicare Administrative Contractor, Noridian is unable to directly update the national beneficiary file(s).
  • This is our first meeting. We will poll office members for future topics or outstanding questions. We appreciate this opportunity.
  • Email regarding an LCD and outreach on the topic of nerve blocks in policy article A52725.

Upcoming Meetings

Scheduled Meetings for 2022

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

  • June 14
  • September 13
  • December 13

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


Last Updated Fri, 08 Apr 2022 17:37:15 +0000