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POE AG Meeting Minutes - December 14, 2021 - JF Part B

Provider Outreach and Education Advisory Group (POEAG) Meeting Minutes - December 14, 2021

Roll Call

POEAG Member or Other (CMS) Attendees

Dawn Davidson, Jamie Neill, Lisa Beyer, Mindy Gale and Trisha Anderson

Noridian Attendees

Teresa Cirelli, Elizabeth Barton, Katie Hove, Tim Morrissey, Val Cavett, Jan Ervin, Cheryl Hanson, Julie Schroeder, Daylann Robertson, and Sarah Gurule-Zietlow

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 Progress or Resolution
11/16/2020 Educate on Inpatient Transfers vs Leave of Absence 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.

12/14: Expected available date has been moved to January 2022.
12/10/2020 Add more information on how to bill unlisted codes 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.

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.
03/09/2021 Publish an Overlapping Facility Request for Assistance Form 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.

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.

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.
06/08/2021 Nurse Practitioner (NP) and Physician Assistant (PA) Edits 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.

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.

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.

Trisha had brought this to Noridian and appreciated the work being done as this impacts providers.
06/08/2021 Prior Authorization Updates 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.

12/14: Development to add the reason codes to the PA webpages has started. Plan to have webpages updated beginning of 2022.
9/14/2021 Donor Claim Denials 09/14: Previously worked with someone on donor claims denying as duplicate claims when Q3 modifier was appended. Tammy in POE is working on this issue and will reach out.

12/14: This was missed in the agenda and has been added. Tammy will work with Trisha to better understand the two claim denials she is working through.


New Agenda Items

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

  1. Back to Basics Tutorial Development
    Noridian had planned a webinar series and modified our 2022 approach to instead offer a tutorial series for new provider staff members to gain exposure and learn more about the basics of Medicare. Noridian shared examples of topics planned to include, beneficiary forms, claim submission, appeals, and documentation. POEAG members may also share any topics they find would be a good addition for the tutorial series.
    1. Dawn indicated this would be a valuable and beneficial tutorial series for Noridian to pursue.
  2. Prepay Targeted Probe and Educate (TPE) resumed in the Fall 2021 after being on pause during the Public Health Emergency in 2020 and part of 2021. Noridian has been providing education through webinars with the next one scheduled tomorrow, December 15.
  3. Providers utilizing outsourcing companies are responsible for the activity performed by these companies.
    1. Providers utilizing outsourcing companies are responsible for the activity performed by these companies. Noridian noticed an increased number of telephone inquiries and appeals; four times the normal workload volume and all is tied to outsourced company activities. The person hiring the outsourcing company to take calls, follow-up on claim denials, or submit an appeal are following up too soon, submitting appeals without rationale on what is being requested, and may be perceived as abusive behavior.
    2. Before contacting customer service, the Noridian Medicare Portal (NMP) or Interactive Voice Response (IVR) must be used by providers or individuals doing business on their behalf. They must review the self-service options and the remittance advice for details on the claim outcome. Reviewing denial reasons in the IVR, portal, and remittance advice and then fixing the issue could resolve many of the contacts received on claims.
  4. Ambulance Prior Authorization for Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT). Noridian indicated this is repetitive, not once or twice but recurring throughout the month.
    1. CMS is expanding prior authorization process for RSNAT
      • Specific criteria for the prior authorization program
      • Ambulance service may request a Physician Certification Statement (PCS)
      • Beneficiary weekly transports for ESRD, chemotherapy or radiation
    2. JF states will be implemented in August 2022.
    3. Noridian holding webinars and developing tutorials starting in January 2022.
    4. Ambulance requirements:
      • Beneficiary will be transported to nearest facility that can treat the condition
      • Any other method of transportation is contraindicated
      • Condition requires ambulance transportation
      • Condition requires the level of service provided and billed
      • Return trips rarely covered unless the beneficiary's health is endangered
  5. MAC Customer Experience (MCE) Satisfaction Survey Update
    Results for surveys collected September through November continues to show participants find the webinar informative. Requests for basic information to understand Medicare have been indicated in suggested future webinars. Opportunities throughout the year have identified participants would like to have the option to view a recording of the webinar.
  6. Recorded webinars are coming! We have been developing resources to start recording webinars in December to be available under the Education and Outreach section on our website. Webinars on Demand will be posted on the site for two months.

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

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.

  • January 25 (Ambulance), 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

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, or elaborate on topics discussed during the meeting.

  • Jamie Neill:
    • Surprise Billing effective January 1 will be a future general topic of interest.
    • Feel free to get to this when appropriate. There has been some confusion between providers and Gainwell about the Medicaid codes for booster shots and the 5-11 population. Can you address that?
      • This would be up to Gainwell as the Medicaid state contractor to work with their system team for their state-specific coding and related annual upload process and timing.
  • Dawn Davidson:
    • She appreciates the help and contacts she has received from CMS. She has a new team member joining and will use that as an opportunity to give Noridian feedback on the 'basic' Medicare resources we offer.
  • Lisa Beyer:
    • Thanked Noridian for all the information.
  • Mindy Gale: nothing additional shared; technical connection issues
  • Trisha Anderson:
    • In September she had asked about donor claims. She has been working with Tammy on her denials as the recipient and donor claims.
    • 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.
      • The Final rule for 2022 has information, we'll watch for guidance from CMS. We can add it to the Modifiers webpage.
  • Daylann Robertson:
    • Hospice, Medicare Advantage Plans, and Medicare Secondary Payer are areas for consideration based on denials received. Tammy shared there are select Medicare HMOs taking care of this type of effort. The Home Health and Hospice MACs are meeting with AB MACs (like Noridian) monthly and we are hoping they provide fact sheets and guides to assist with this topic. Tammy is hopeful a listing of HMOs involved will be made available.

Upcoming Meetings

Scheduled Meetings for 2022

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

  • March 8
  • 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, 07 Jan 2022 18:21:06 +0000