POE Advisory Group Details

12/7/2023 Part A and FQHC POE Advisory Group Meeting

Meeting Minutes

Meeting Time: 10:30 a.m. ET

Member Attendees: Mary Altieri, Todd Bergstrom, Louise Bertrand, Kim Bischel, Melissa Black, Kate Brewer, Kafi Cook, Matthew Felton, Sherri Hampton, Luci Hendrickson, Jacqueline King, Sara Luther, Catherine Nolin, Larisa Orlando, Nancy Richman, Liz Saulnier, Joanne Shade-Boyce, Kay Senesac and Kimberly Soares

National Government Services Associates: Charity Bright, Laura Brown, Martha Castle, Adela Deal, Michael Dorris, Toni Dunn, Emily Fox-Squairs, Andrea Freibauer, Alison Hamilton, Christine Janiszcak, Linda Klug, Julia Meehan, Kathy Mersch, Cheryl Papalia, Jean Roberts, Paul Root, Brittany Small, Susan Stafford, Michelle Vannatter-Johnson and Christine Warshel

Agenda

  1. Welcome/Introductions/Approval of Minutes from Previous Meeting
  2. Updates
  3. Review of Educational Material
  4. POE AG Members Suggestions for Education and Open Forum
  5. Upcoming Events and Additional Information
  6. 2024 POE AG Meeting Schedule

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I. Welcome/Introductions/Approval of Minutes from Previous Meeting

Jean Roberts, POE Consultant, NGS

Jean welcomed everyone and reviewed Handout 1 (Agenda). She noted we revised Handout 6 on Provider Enrollment since it was distributed to members via an email with the hidden link.

Jean asked attendees who did not register for the meeting to email their attendance to her or Christine. She explained we email members to advise when we post the meeting minutes to our website (by the 30th business day after the meeting). She asked the members to review the minutes then and to email us corrections and/or questions. Jean asked for approval of the 8/3/2023 minutes. When she did not receive a response, she approved them.

Jean advised everyone she is unmuting the phone lines (except for those who joined by microphone), asked everyone to self-mute if not speaking and noted the question box is open.

Jean introduced our new POE manager, Emily Fox-Squairs. Emily greeted the members and explained she has been with the company for 23 years, eight of which were in POE, and she is glad to be back in POE.

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II. Updates

Michelle Vannatter-Johnson BSN, RN, Clinical Review Nurse Lead, Clinical Operations, NGS

Prior Authorization Updates

Michelle Vannatter-Johnson BSN, RN, Clinical Review Nurse Lead, Clinical Operations, NGS

Michelle reviewed Handout 2 “J6/JK Part A and FQHC POE AG meeting, PA OPD for December 2023” and provided the following information:

  • On slide 2 (2023 Exempt Providers), there are 40 J6 and 37 JK providers exempt from PA. There were 17 J6 and 12 JK providers withdrawn from 2024 exemption due to ADR review.
  • On slide 3 (2024 Exempt Providers), there were four J6 and three JK providers continued from 2023 as well as ten J6 and nine JK providers newly qualified for PA exemption.
  • On slide 4 (Quarterly Trends), there is data for July, August and September of 2023 on the percentage of claims with affirmation, non-affirmation, partial affirmation and rejection.
  • On slide 5 (Reminders and Tips)
    • For reminders:
      • After a non-affirm decision, providers have an unlimited number of times to resubmit a PA request to obtain an affirm decision.
      • Each request must stand alone with all required elements to process the PA request and required documentation to support medical necessity.
    • For tips:
      • Read your non-affirm decision letter received carefully.
      • Include all documentation required to support medical necessity of the service being requested including the documentation previously submitted as well as medical records that include the missing information.
      • Submit the coversheet with all required elements (including any missing or corrected data provided previously). Edit the date of service field if the proposed date has changed.
      • Documentation requirements for each service requested is on our Prior Authorization for OPD services web page under Documentation Information.

Michelle asked if anyone had any questions and she received none.

Medical Review and Case Management Team Updates

Alison Hamilton, Clinical Review Nurse Senior, JK Medical Review Case Manager, NGS

Alison reviewed Handout 3 “Medical Review & Case Management Team Update” and provided the following information:

Alison asked if anyone had any questions and she received none.

Part A Comprehensive Error Rate Updates

Laura Brown, POE Consultant, NGS

Laura reviewed Handout 5 “Comprehensive Error Rate Testing (CERT) Update“, reminded everyone that the data in this handout is confidential and not to be shared outside of this meeting, and provided the following information:

  • On slide 2 (J6 CERT Error Rate), we provide the J6 CERT data for the November 2024 reporting period, which is for claims received 7/1/2022 to 6/30/2023.
  • On slide 3 (J6 Part A CERT Errors), we provide a chart with the error codes, the code definitions and the number of claims for each error.
  • On slide 4 (JK CERT Error Rate), we provide the JK CERT data for the November 2024 reporting period, which is for claims received 7/1/2022 to 6/30/2023.
  • On slide 5 (JK Part A CERT Errors), we provide a chart with the error codes, the code definitions and the number of claims for each error.
  • On slide 6 (CERT Resources), we provide the following CERT resources:
    • CERT Provider Website – C3HUB
    • National Government Services Website
    • www.NGSMedicare.com - CERT Program Information: Resources > Medicare Compliance > Comprehensive Error Rate Testing
      • CERT Alerts
      • CERT Tools
      • Documentation Submission Responsibilities
      • CERT Task Force (Under Related Links: CMS View all Fast Facts)
      • CERT Denial Finder
  • On slide 7 (November 2023 Report Period Error Rate), we provide the CERT data for the November 2023 reporting period, which is for claims received 7/1/2021 to 6/30/2022.
  • On slide 8 (November 2023 Report Period Reports), we provide the following links:
    • CERT Reports | CMS
      • 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (when published)
    • HHS Agency Financial Reports (AFR) | HHS.gov
      • The Medicare FFS information can be found in the “Other Information” portion of the AFR under the Payment Integrity Report section. (page 223)
      • The 2023 national Medicare FFS improper payment rate is 7.38% or $31.23 billion in improper payments.

Laura asked the members to continue to review the material on our website and forward any suggestions and/or comments to Christine and Jean to improve our CERT page. She asked if anyone had any questions and she received none.

Part A Provider Enrollment Updates

Susan Stafford, POE Consultant, NGS

Susan reviewed Handout 6 “Provider Enrollment Updates” and provided the following information:

Susan asked if anyone had any questions and she received none.

NGSConnex Updates and Reminders

Charity Bright, Agile Product Owner NGSConnex, NGS

Charity reviewed Handout 4 “POE AG Meeting NGSConnex Reminders” and provided the following information on NGSConnex:

  • On slide 3 (Eligibility Look Up), we show you can check a beneficiary’s Medicare eligibility, once you are logged in, under Eligibility Look Up.
  • On slide 4 (Medicare Advantage), we show you can check a beneficiary’s enrollment in Medicare Advantage coverage. Beneficiaries could have changed coverage so you should always check this coverage as it is an alternative to traditional Medicare.
  • On slide 5 (2024 Deductible Information), we show you can check Medicare deductible information and explain the annual deductible for Medicare Part B beneficiaries will be $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023. The Medicare Part A inpatient hospital deductible beneficiaries pay if admitted to the hospital will be $1,632 in 2024, an increase of $32 from $1,600 in 2023.
  • On slide 6 (Qualified Medicare Beneficiary [QMB]), we show you can check for QMB enrollment.
  • On slide 7 (Quarterly Credit Balance Reports), we explain you can use NGSConnex starting 1/1/2024 to submit your quarterly credit balance reports. This option is under the Financials tab.
  • On slide 8 (Resources), we provide resources of a YouTube video Navigating the New NGSConnex and the NGSConnex User Guide.
  • We are adding ability for providers to view your TPE decision letters in NGSConnex as of 12/8/2023. This option will be under ADR.
  • We are wrapping up the development and testing of viewing entire ADR letters.

Charity asked if anyone had any questions or comments.

Comment: Larissa commented on the ADRs in NGSConnex and stated that when their facility goes in and we pick our facility by NPI (we have different NPIs), they are not sorting by NPI, they are sorting by PTAN. Charity said when you go into the NGSConnex portal to view ADR letters, you need to select the applicable NPI and PTAN where that request was sent so if you have multiples, you have to choose that selection. Larissa said when she selects with their PTAN, the system selects all of the NPIs. Charity asked Larissa to enter her contact information into the question box and Charity would contact her directly.

POE Jurisdiction Affairs Update

Michael Dorris, Jurisdiction Affairs Lead, NGS

Michael reviewed Handout 7 “CMS & Key Initiatives Resource Websites” which provided various helpful links under the categories of Medicare Patients & Caregivers and Medicare providers. He explained the reasons he provided the resources. He asked members to, when possible, advise beneficiaries to ensure their information is correct with Social Security. He also advised the members CMS updated their website this year so if they are having trouble finding information that was on the website but is no longer there, to let Jean or Christine know as they may be able to inform CMS.

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NGSMedicare.com – New Table of Contents Feature

Emily Fox-Squairs, Manager, POE and PEX Team

On behalf of the PEX team, Emily advised the members we added a “Table of Content” feature to various articles and instructions on our website that contain a lot of content. We did this to make it easier for you, when there is a wall of text, to find the information you are looking for and to share the direct URL with someone else who may be looking just for a portion of the article or instruction. Emily demonstrated, on our website, the table of contents feature and the links listed under each article/instruction that will bring the reader directly to that information.

Comment: Lucy commented she loves this feature. Emily replied she would share this feedback with Alicia who developed the feature.

III. Review of Educational Materials

Christine Janiszcak, POE Consultant, NGS and Jean Roberts, POE Consultant, NGS

Christine reviewed the following MSP information:

  • During our 2023 MSP webinar series, we heard from providers that the BCRC was not accepting provider calls even when such calls were permitted per CMS’ article SE1416. The callers were asking the BCRC to set up MSP records for liability cases so the records would be in the CWF when they submitted claims. We recently learned CMS does not want providers to contact the BCRC. Providers can submit MSP or conditional liability claims, and the MAC can send the BCRC requests to set up MSP records. Refer to “Conditional Payment Claims: Continue to Submit to Your Medicare Administrative Contractor” in CMS eNews on 10/26/2023.

Jean reviewed the following REH information:

  • Jean explained that in January of 2024 (tentative), she will be conducting a webinar on REHs. She asked if there were any comments on Handout 8 “: DRAFT NGS REH New Prov eff 1 2023” which she updated to include updates expected for 2024. In 2023, REHs became a new provider type. When she received no feedback, she asked members to email her if they want to provide feedback.

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IV. POE AG Members Suggestions for Education and Open Forum

Jean Roberts, POE Consultant, NGS

Jean reviewed Handout 9 “J6 & JK Part A POE AG Ed Tracker~12 7 2023” and provided the following information:

  • The topics members suggest for education are placed in our tracker.
  • We had a suggestion for billing outpatient behavioral health claims including the new IOP and the PHP. We presented a session on PHP Basics on 11/1/2023 in the 2023 Fall VC.  IOP becomes effective 1/1/2024 so we are planning to conduct a webinar on it but have not determined a date yet.

Jean asked for comments on the tracker. When she received none, she asked members to email us with any comments.

Jean advised everyone the Fall VC was very successful with over 800 attendees.  She asked for any comments on the VC as well as for topic suggestions for the Spring VC. When she received none, she asked members to email us with any suggestions.

Jean reviewed the digital solutions we use for education including YouTube, Medicare Mobile, LinkedIn, Podcasts (Listen at Spotify or Apple Podcasts) and Medicare University. She asked for topic suggestions for these methods. When she received none, she asked members to email us with any suggestions.

Jean then received the following questions and comments:

  • Suggestion: Lucy suggested education on code C729I, OP to OP overlap denial code. Jean advised we can add this to the tracker and if we need more information, we will contact her.
  • Question: Louise asked if the links in the agenda are hotlinks and said they do not work.
  • Comment (on above): Kay commented the links are not working for her either. Jean said this could be because the agenda is a PDF. She said she will email the agenda as a word document.

Jean asked for topic suggestions for any type of education for 2024.

  • Question: Kay asked if she could listen to the PHP education provided at the 2023 Fall VC.  Jean advised her she can review the presentation under our Past Events tab on our website using the date of 11/1/2023.
  • Question: Kafi said she has questions on established patient vs. new patient billing indicating there has been guidance from NGS but they are still confused. Jean asked Kafi to email us (no PHI) so we can better understand the question and any confusion.
  • Question: Kafi asked if there have been changes to the FISS DDE DRG option 12 which seems to work differently. Jean and Christine advised we are not aware of any changes, but we can check. Jean also commented that the way providers view information in FISS DDE has changed, it is condensed now, but we posted articles about this on our website.
  • Question/Suggestion: Jacqueline asked for clarification using SNF E/M codes on CAH SB claims. She also asked for clarification on the new rules for observation E/M codes. She indicated CAH method 2 billing for Part B is a struggle. Jean asked her to email us (no PHI) to explain the issues.
  • Question/Suggestion: Jacqueline asked about CERT recoupment of CAH IP E/M codes being recouped from SB claims. Jean indicated that if coding is incorrect and if you don’t submit documentation or if what you submit doesn’t match what you billed, then CERT will recoup. Jean then added that the E/M coding for IP SB claims would be under Part B. Jacqueline advised that they need training on this. Jean asked her to email us with an example (no PHI) and we will see if this is Part A or B. If Part B, we will see what they can do.  

Jean asked the members if there are topics they feel would be good for podcasts, what they think about podcasts, whether or not their staff is allowed to listen to them and, if so, do they find them beneficial?

  • Comment: Kay commented she likes text messages but also likes podcasts if they can get the information providers need out there. She said visual aids are helpful though so if a podcast can reiterate training NGS is already doing and refer the listener to that training, that may be helpful. She added that it is sometimes hard to join our scheduled training so if providers can just go watch a YouTube or listen to a podcast, that would be beneficial.

Jean asked if our training times we offer would be better if offered at different times. 

  • Comment: Kay indicated the timing is variable, but she can ask her billing staff.
  • Comment: Kafi commented a podcast would be good on topics that don’t require visuals.  

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V. Upcoming Events and Additional Information

Jean Roberts, POE Consultant, NGS

Jean reviewed the resources listed in the meeting agenda. She also reviewed the below events and asked members to visit our website’s Events tab for the most current events.

  • 12/12/2023; 12/29/2023 Counseling to Prevent Tobacco Use
  • 12/12/2023 Completing the CMS-855I Paper Application
  • 12/14/2023 Let’s Chat About MSP for Part A Providers
  • 12/14/2023 Submitting Revalidation via CMS-855A Paper Application for Part A Providers
  • 12/18/2023 PECOS: Manage Signatures and Additional Information Requests
  • 12/19/2023 Submitting Revalidation via PECOS
  • 12/19/2023 Let’s Chat About Provider Enrollment Revalidation

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VI. 2024 POE AG Meeting Schedule

Jean Roberts, POE Consultant, NGS

The 2024 meeting schedule is:

  • 4/4/2024 9:30 a.m. to 11:30 a.m. CT/10:30 a.m. to 12:30 p.m. ET
  • 8/1/2024 9:30 a.m. to 11:30 a.m. CT/10:30 a.m. to 12:30 p.m. ET
  • 12/5/2024 9:30 a.m. to 11:30 a.m. CT/10:30 a.m. to 12:30 p.m. ET

Meeting Adjourned

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Posted 1/12/2024