POE Advisory Group Details

6/9/2022 Jurisdiction K Part A POE Advisory Group Meeting Minutes

Meeting Minutes

Meeting Time: 10:30 a.m. to 12:30 p.m. ET

Member Attendees: Susan Albaitis, Raeann Couture, Blanca Goico (guest), Chelsie Higgins, Maureen McCarthy, Mary Ann Miccichi, Larisa Orlando, Yvonne Ramjeet, Anna Santoro and Amanda Selman

National Government Services Associates: Laura Brown, Mike Davis, Alicia Forbes, Andrea Freibauer, Jeanine Gombos, Allison Hamilton, Christine Janiszcak, Christine Klimek, Linda Mayer, Julia Meehan, Jean Roberts, Susan Stafford, Michelle Vannater-Johnson, Christine Warshel and Kathy Windler

Agenda

  1. Welcome, Agenda, Attendance and Minutes from Previous Meeting
  2. Departmental/Operational Updates
  3. Education
  4. Review of Educational Topics/Material
  5. Open Forum

I. Welcome, Agenda, Attendance and Minutes from Previous Meeting

Christine Janiszcak, POE Consultant, NGS

Christine apologized for arriving late and indicated she had difficulty getting into the webinar. She welcomed everyone, reviewed the agenda and explained that the meeting material remains available on the link she provided until a week before the next meeting. She asked those who are present but who did not register for the meeting to email their attendance to her at Christine.Janiszcak@anthem.com. Christine reminded everyone she sends an email when we post the meeting minutes to our website, which is by the 30th business day after the meeting date. She asked members to review the minutes then and email her any changes or questions.

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II. Departmental/Operational Topics and Updates

Christine Janiszcak, POE Consultant, NGS

Christine introduced the following NGS staff who provided updates:

Christine Klimek, Manager, A&R

Christine provided the following information for members to share with their finance staff:

PS&R and MCReF

Providers must maintain CMS IDM accounts to access the PS&R and MCReF systems.

There are two announcements related to these systems:

Multi-Factor Authentication

Effective 6/3/2022, MFA is not optional for logging into IDM accounts. If users have not set up an authentication source, the default is the email on file. Once you sign into the IDM system, you can add IVR and Text Message (SMS) as MFA devices using these steps:

  • Click the My Profile button.
  • Click the Manage MFA and Recovery Devices button.
  • Use the Add another device menu to select the Interactive Voice Response option or Text Message (SMS). You can add only one device at a time. The device configuration window appears.

  • Follow the online instructions.

Users experiencing problems with their MFA after 6/3/2022 must contact the EUS Support desk:

Annual Security Official Certification

Roles not recertified by 7/15/2022 will be revoked. If the user still needs the corresponding access after that, they will need to re-request the access and have the corresponding Security Official approve it. This is an on-going responsibility for Security Officials, who need to review and certify the individuals who have been delegated access to their organizations at least once a year. This feature of EIDM was paused during the IDM transition and has now resumed. EIDM transitioned to IDM in January 2021. For guidance in annual certifications, Security Officials can click the Help link in the IDM system to access the Annual Role Certification Quick Reference Guide.

Mailing Address for Cost Reports

We encourage our providers to use MCReF to submit their cost reports. If you are unable to and need to mail it, the mailing addresses have changed. We are no longer receiving mail in the South Portland office location. The new mailing addresses are:

Street Address (FedEx/Courier)
National Government Services, Inc.
Attn: Cost Reporting Unit
6345 Castleway Court
Indianapolis, IN 46250

USPS Mailing Address
National Government Services, Inc.
Attn: Cost Reporting Unit
P.O. Box 7040
Indianapolis, IN 46207-7040

For questions regarding your cost report filing, contact JK_Cost_Report_Filing@anthem.com.

A&R Inquiries in NGSConnex

The new NGSConnex portal went live on 2/28/2022. A&R continues to use it for correspondence. At this time, we have only about 65% of our A&R Inquiry users migrated. If an account is not migrated, we are unable to send correspondence to the user via NGSConnex. We sent several email notifications to users who are not yet migrated. We have a dedicated shared email mailbox for inquiries related to using A&R Inquiries in NGSConnex: ARConnex@Anthem.com. Please use this to update your NGSConnex contacts, such as when you have staff turnover.

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Laura Brown, POE Consultant, Comprehensive Error Rate Testing

Laura reviewed the “Comprehensive Error Rate Testing (CERT) Updates” handout and provided the following information:

  • On slide 2, we provide a chart with the final internal unofficial error rates as of 5/13/2022 for the November 2022 reporting period, which includes claims received from 7/1/2020 to 6/30/2021. Please do not share this data outside of this meeting. The CMS goal MACs must meet for this reporting period is 6.16%.
  • On slide 3, we indicate the number of claims in each error category using the November 2022 data reports. So far, 20% of claims reviewed by CERT were in error. Top errors include insufficient documentation (20 claims missing orders and 12 claims with inadequate physician’s certification/recertification), incorrect coding (87 claims with incorrectly coded discharge status codes) and services not medically necessary (51 claims for inpatient admissions and 34 claims with documentation that does not support medical necessity).
  • On slide 4, we provide CERT resources. The link at the top directs you to the CERT C3HUB website where you can find general information about the CERT program, sample letters, lists of documents and documentation submission methods for replying to request letters. Using the website paths on this slide, you can view general information about CERT, CERT Alert articles and CERT Task Force material about preventing CERT errors as well as some available tools. We ask you to continue to review all of the CERT material on our website and send us any suggestions or comments to improve our CERT page.
  • On slide 5, we provide the CERT contractor’s new address, as they have moved, so you can mail medical records to their new address.

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Allison Hamilton, RN, Clinical Review Nurse Senior and JK Medical Review Case Manager, Clinical Operations

Allison reviewed the handout “Medical Review and Case Management Updates”. During this review, she discussed TPE notification letters and ADRs. She provided a link to our TPE manual. Allison reviewed tips to prevent avoidable denials. She provided a point of contact, the ADR response timeline and the discussed the importance of double checking submissions. She encouraged providers to take advantage of the TPE post-probe education sessions we offer. Allison provided various resources and contacts providers can use for finding information and reaching NGS.

Michelle Vannatter-Johnson, BSN, RN, Clinical Review Nurse, Prior Authorization

Michelle reviewed “The Exemption Process” handout and provided the following information:

  • On slide 1, we provide a list of the seven services subject to the PA outpatient department process: blepharoplasty, botulinum toxin injections, panniculectomy, rhinoplasty, vein ablation, cervical fusion with discectomy and implantation of spinal neurostimulators.
  • On slide 2, we advise we have 17 JK exempt providers since November 2021.
  • On slide 3, we provide the 2022 timeline for exempt providers.
  • On slide 4, we provide a list of keys to success for the PA process.
  • On slide 5, we provide information on how to qualify for the 2023 exemption cycle.
  • On slide 6, we provide information about an upcoming PA process webinar on 6/22/2022.

Michelle explained providers can find information on the PA Exemption Process and timeline, on our website under > Resources > Medicare Compliance > Prior Authorization > Exemption Process.

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Susan Stafford, POE Consultant, PE/Revalidation

Susan reviewed the handout “Provider Enrollment Updates”, a separate handout on “Provider Enrollment Systems” and provided the following information:

  • Provider Enrollment has a high frequency of development on submitted applications.
  • Medicare requires any organization/individual that has direct/indirect ownership of, a partnership interest in, and/or managing control of the provider/supplier must be identified with the percentage of ownership, when applicable.
  • An organizational diagram chart is required to help understand relationships.
  • Authorized officials must be an owner, partner, Director/officer. Delegated Officials must have a relationship of what I just mentioned or just be a W-2 managing employee. All NPI type II enrollments must have one managing control individual too.
  • New enrollments or changes of ownership for a certified provider will need the attestation for transferring or establishment of an enrollment and, when applicable, capitalization and sales agreement.
  • When establishing, changing or revalidating, provide a copy of a voided check or bank confirmation letter to verify the legal business name for the entity’s enrollment.
  • An application fee is required for initial enrollment, revalidation or additions to a new practice location for certified providers.
  • When applicable, all newly added Authorized/Delegated Officials and/or just a signature for the application with a date and other required documents certifies the submitted application.
  • The application has a section where you can identify licenses/certifications. It is a best practice to add a copy of the document for verification.
  • On our website under Education > Help and FAQs, we placed answers to FAQs our PCC receives to assist in reducing development on applications.
  • We added more articles on our website under Enrollment > Determent/Pay Application Fee to assist with application questions and in understanding the application fee. A Decision Tree Tool is located on our website under Resources > Tools & Calculators to help you determine if you need to pay the fee or not.
  • A listserv posted requirement of submitting the revalidation application by the due date is all that CMS requires to prevent deactivation or a payment hold. Do not worry if the application is not processed; just make sure to have it in-house.
  • In May of 2022, during our Spring Virtual Conference, we provided presentations on Provider Enrollment 101 and Maintaining Your Provider Files. In these webinars, we provided general assistance with the basic understanding of CMS’ provider enrollment (including where and when updates are needed for the enrollment).

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Alicia Forbes, Provider Experience Consultant, Provider Experience Team

Alicia reviewed the Provider Experience handout and the following information:

  • On slide 1 regarding NGSConnex, it is been three months since we transitioned to the new portal and it is going well. We were able to migrate more than 80,000 users to the new portal and we saw approximately three million portal transactions in the first four weeks. We continue to see increased provider adoption and use of the new portal and receive positive feedback regarding the ease of use.
  • On slide 2, we share some feedback with you. We received positive feedback from our users over the last three months and some constructive feedback as well. We wanted to thank our POE Advisory Group, as you have been instrumental in our success. As a reminder, if you have feedback or ideas for items you would like to see added, please complete the survey on our site when prompted or you can use the Feedback button.
  • On slide 3, we share changes we have made since we last met. Prior to the portal cutover on 2/28/2022, we had some financials functionality available that was not part of the initial transition to the new portal. Over the last few months, we have been updating NGSConnex to add that functionality back.
    • Part A, FQHC and HHH providers have the following available:
      • View Outstanding Overpayments and associated demand letters>
      • Submitting Credit Balance Reports
      • View Checks and the associated Remittance under Financials>
    • Part B providers have the following available:
      • View Outstanding Overpayments and associated demand letters
      • View Checks and the associated Remittance
      • View Financial Claim Number (FCN) Details and Beneficiary Details

Alicia asked the members to watch our listserv messages as we continue to add new and exciting functionality to the NGSConnex portal.

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III. Education

Christine Janiszcak, J6 POE Consultant

Christine advised the attendees of the following information:

JK Part A POE AG:

Educational Events:

  • We offer a variety of educational sessions. Please review the event listing on the agenda and our Events calendar. The events include our ACT on 6/22/2022, our Home Health and Hospice MAC collaborative in person event from 9/13/2022-9/15/2022; in person) and webinars on provider enrollment, preventive services, MSP, appeals, prior authorization, CMS’ Quarterly Release and many other topics.
  • Please promote these events and our self-service tools within your organizations.
  • CMS is holding a National Provider Enrollment Conference (8/16/2022-8/17/2022) at the Boston Convention and Exhibition Center. Take advantage of this opportunity to meet with the CMS and MAC PE experts.
  • Our 2022 Spring Virtual Conference (5/11/2022-5/12/2022) was successful with great feedback from our providers. We will be planning our Fall Virtual Conference shortly.

2022 Education topics (webinars, articles, job aids, etc.):

  • POE AG members previously submitted topics (see list below). We addressed the outpatient repetitive service billing suggestion with a handout Jean Roberts, POE Consultant, developed which she will review shortly. Once we collect all feedback and make any necessary changes, Jean will post the handout as a job aid on our website. We also included the topic of billing for a noncovered procedure during an inpatient hospital stay in our Spring Virtual Conference during an inpatient acute care hospital billing session. Our SNF educators are currently working with providers from the SNF community to gather their questions on COVID-19 billing and the remaining suggestions are pending.
  • Topic suggestions:
    • Completing a HINN 12
    • Clinical Trial billing for MAO plan enrollees (when claims sent to FFS Medicare)
    • SNF and COVID-19 billing
    • Outpatient repetitive service billing
    • Billing for a noncovered procedure during an inpatient hospital stay
  • Please send all education suggestions to Michael.D.Davis@anthem.com or Christine.Janiszcak@anthem.com at any time.
  • Please share the CMS and NGS resources provided in the agenda with your organizations.

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IV. Review of Educational Topics/Materials

Christine Janiszcak, Jean Roberts and Andrea Freibauer, Consultants, POE

Christine reviewed the website article “Prepare and Submit an MSP Conditional Claim” handout since we will conduct a Conditional Billing Webinar on 7/6/2022. She received no comments.

Jean reviewed the draft Repetitive Services job aid (handout). She received a question asking if she could include other services that are not repetitive and explain how providers should bill for those services. Jean explained that the job aid has some information about recurring services but the focus of the job aid is repetitive services. Jean received no additional comments.

Andrea reviewed the draft PowerPoint on the SNF ABN (handout). She received a few comments:

  • Can the slide on page 87 include instructions on how to deliver notices of noncoverage when we are contacting a representative by mail?
  • Can the slide on page 95 mention an option three regarding the SNF ABN and explain when we need to use that option?
  • This looks great, we mainly have to send these by mail, we aren't able to provide these directly to beneficiaries themselves so that direction would be helpful as well as what providers should do with option 3, I see option 1 and 2 but no reference to 3.

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V. Open Forum

Christine Janiszcak, JK POE Consultant, NGS and all

Christine asked for questions and received none. She thanked everyone for presenting and participating.

Meeting adjourned

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