9/8/2022 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, Mary Altieri, Benjamin Cangiano, Christina Collins, Mathew Felton, Luci Hendrickson, Chelsie Higgins, Christine Leibold, Maureen McCarthy, Mag Morelli, Larisa Orlando, Joseph Rega, Anna Santoro, Liz Saulnier and Amanda Selman

National Government Services Associates: Charity Bright, Laura Brown, Cathy Delli Carpini, Mike Davis, Andrea Freibauer, Kathy Gates, Christine Janiszcak, Auburn Puckett, Jean Roberts, Susan Stafford, Michelle Vannater-Johnson, Christine Warshel and Kathy Windler

I. Welcome, Agenda, Attendance and Minutes

Christine Janiszcak, POE Consultant, NGS

Christine welcomed everyone, reviewed the agenda and advised the meeting material will remain on the link she provided until about a week before the next meeting. She asked those who are at the meeting but who did not register for it to email their attendance to her at Christine.Janiszcak@elevancehealth.com. Christine indicated she sends an email to members when we post the minutes to our website, which is by the 30th business day after the meeting. She asked members to review the minutes then and to 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:

Laura Brown, POE Consultant, Comprehensive Error Rate Testing

Laura reviewed the “CERT Updates” handout and provided the following information:

On slide two is a chart with the final internal unofficial error rates as of 8/11/2022 for the November 2022 reporting period. It includes claims we received from 7/1/2020 to 6/30/2021. Please do not share this data outside of this meeting. The CMS’ goal MAC's must meet for this reporting period is 6.16%.
On slide three is the number of claims in each error category from the November 2022 data reports. So far, 21% of claims CERT reviewed were in error. Per the CERT team, please ensure providers sign all orders. Verify signatures/dates are on the documents. If you pull electronic records, verify signatures are on the documents before sending them to CERT.
On slide four are CERT resources. The top of the slide has the CERT Contractor’s new address for submitting documentation. We have been receiving questions about which documents you should submit to CERT so we provided some resources for this information. The primary place to look is in the CERT ADR, which lists the documents CERT needs for the review (contact the CERT Contractor with any questions). Second, on the CERT website, you can view the documentation listing which informs you of the documents you need to submit by specialty type or service. Third, some services may have a LCD or NCD. If you look up the service and find a LCD or NCD, it should list the required documents for that service. Fourth, you may also review the articles NGS CERT Alerts or CERT A/B MAC Outreach & Education Task Force Educational Resources. If several providers receive the same error for the same service, we may create an article and post it to our website under CERT Alerts or the CERT task force may create an article for all MACS to use for education, which they post on the CMS’ website. If a provider is unsure which documents to send or wants to verify it is sending the required documents, direct them to these resources.
On slide five is the link to the CERT C3HUB website where you can find general information about the CERT program, sample letters, lists of needed documents and documentation submission methods for replying to request letters. On our website, under CERT Alerts, we have two articles we recently posted to inform providers of deadlines for the November 2022 reporting period. The article has a past due date but it informed you that the CERT Contractor accepts documentation from providers until 8/22/2022. The second article informs you that you should appeal all claims with CERT errors by 9/27/2022 although we recommend you appeal earlier. In addition, we sent a listserv to promote the CERT Alert article Amending Medical Records. Also, because of an increase in signature errors, please promote the CERT Alert article Signature Requirements.
On slide six is the link to the CERT Alert article Comprehensive Error Rate Testing Documentation Deadline 8/22/2022.
On slide seven is the link to the CERT Alert article Comprehensive Error Rate Testing Redetermination Deadline 9/27/2022.
On slide eight, we remind you to continue to review material on our website and forward any suggestions and/or comments to us for improving our CERT web page.

Laura asked if anyone had questions but received none. She provided the CERT team’s email, CERTInquiry@elevancehealth.com.

Kathleen Gates, RN, BSN, Clinical Review Nurse Senior, Clinical Operations

Kathy reviewed the handout “Medical Review and Case Management Updates” for September 2022 and she provided the following highlights:

The CMT created and posted a new article “Targeted Probe and Educate Letters – An Informational Overview” to our website to provide more detailed information about the TPE notification and results letters.
We encourage providers to take a multi-department approach in responding to ADRs and ensure they include, in the TPE letter response, a clinical person familiar with CMS documentation requirements.
We encourage your feedback when you complete the survey you receive following your TPE educational session. After an educational meeting with a CMT member, we will send a survey to your primary point of contact. The purpose of the survey is to ask you to provide constructive feedback on the educational portion of the TPE process. Please base your responses on your interactions with the CMT member during the educational call.
New topic areas for TPE include the KX modifier for therapy services as well as SNF services, which we will initiate in the coming months.
The CMT developed articles available on our website on Psychiatric and Psychology Services with treatment plan requirements and on Medicare Part B Breast Ultrasounds.
Please continue to use the JKCaseManagement@elevancehealth.com mailbox for questions related to TPE, specific claims, or coverage scenarios.

Susan Stafford, POE Consultant, PE/Revalidation

Susan reviewed the handout “Provider Enrollment” and provided the following information:

Provider Enrollment Activities and Information:

We ran a Medicare Blast to help providers understand PE -related terms.
We added website articles with resources under our website Enrollment tab and promoted the Provider Enrollment Application Fee Decision Tree in our Monday Provider Self-Service Tool Pulse Newsletter.
We run a list serve article once a month to reduce development on submitted enrollment applications. The provider application processing area has been experiencing a high frequency of development on submitted applications.
An application fee is required for initial applications, revalidations or when adding a new practice location for a certified provider.
The application has a section where you can identify license/certifications and it is a best practice to add supporting documentation for verification purposes. Supporting documents depend on the situation. For example, new enrollments or changes of ownership for certified providers need the attestation for transferring or establishment of an enrollment and capitalization and sales agreement, voided check/bank letter.
When applicable, submit all newly added authorized/delegated officials and/or just a signature for the application with a date and other required signature certifications.
An Authorized official must be an owner, partner, director or officer. A Delegated official may have an aforementioned role or be a W-2 managing employee. All NPI Type II enrollments must have one managing control individual.
An organizational diagram chart is required to assist us in understanding relationships.

Revalidation Activities and Information:

CMS started requiring enrollments effective 1/31/2022 to revalidate. We encourage you to check the Medicare Revalidation List Tool to verify if a due date has been determined for your facility. We send listserv articles early in the month and mid-month until the end of the year and information to reduce development upon your submission of a revalidation application. We mail reminders to non-responders where the due date is the end of the month if we have an email on file with the enrollment due for revalidation.

Charity Bright, Program Operations/Provider Experience Team

Charity reviewed recent updates to the NGSConnex portal.

We updated the portal to allow Part A providers to initiate A&R documentation submissions. When logged in, select the ‘Inquiries’ tab from the home page, select ‘A&R Inquiries’ and then select ‘A&R Documentation’. For instructions, review our NGSConnex User Guide section “Initiate Audit and Reimbursement Document Submissions”.
We updated functionality within the MR ADR section to show which requests are awaiting documentation. For information, review the ADR section of our NGSConnex User Guide.
We increased time out minutes to log you out automatically after 30-minutes of inactivity. This is a CMS security requirement to protect provider and beneficiary information.
Several updates will be coming soon. We will add new functionality to allow providers to respond to claims ADRs, the ability to view/print duplicate 1099 forms and Medical Review Two-Way Communication.

One provider commented that these seem like great new features.

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III. Education

Christine Janiszcak, J6 POE Consultant

Christine advised the attendees of the following information:

JK Part A POE AG:

The 2022 remaining meeting will be held on 12/8.
Please continue to share the POE AG’s Mission and Charter with anyone interested in joining the POE AG and advise them to contact Michael.D.Davis@anthem.com.

Educational Events:

We offer a variety of educational sessions. Please review the event listing provided as a handout. The handout includes all events posted to our Events calendar as of two weeks ago as well as some provider self-service tool reminders and links for you to promote and share within your facilities and organizations. Christine reviewed event details as well.
- One member asked if we record and post the webinars so providers can listen to the information after we conclude the event. Jean Roberts advised the member that the presentation slides are available after each event under our Past Events tab on our website but we do not record the webinars for our website. She added that we also have roster bill information in the FISS DDE manual on our website.
- One member asked about a webinar we previously conducted on the SNF ABN and questioned if providers should be using the 2018 SNF ABN version. Jean Roberts advised the member to use the 9/2020 SNF ABN version CMS has available.
We will conduct our Fall Virtual Conference on October 18th and 19th. The theme is Medicare Essentials and it will include eight sessions; four each day. The sessions provide a great foundation for further advanced education. Please check our Events page and let your staff members know about it (new staff as well as any who may need a refresher).
We are seeking input from our members on if they/their staff would use podcasts for education. Podcasts are audio programs you can listen to at your leisure similar to YouTube videos but without the video. The podcast would run from 10 to 20 minutes.
We are considering using QR codes for you to respond to our surveys and are seeking input on this from members. A QR code is a machine-readable optical label consisting of an array of black and white squares. The code stores URLs or other information for the ease of reading by using your camera on your smartphone.
We are seeking feedback on our latest news option, Medicare Mobile. Medicare News has expanded and anyone interested in NGS and Medicare News can stay up-to-date on the latest information by texting NEWS to 37702 to get exclusive notifications via your mobile phone. The texts you receive allow you to be the first to hear about breaking news, important updates, educational events and more.
Note: Christine received no feedback on podcasts, QR codes for surveys or Medicare Mobile so she asked the members to consider all of this information and to email her if they have any comments or questions.

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

Christine provided an update on educational topics members previously suggested:

Completing a HINN 12 – Christine asked whoever suggested this topic to email her and let her know if there is a reason for suggesting education on just the HINN 12. She also referred the members to CMS’ web page on HINNs.
Clinical trial billing for MAO plan enrollees when providers submit claims to FFS Medicare – Christine asked whoever suggested this topic to email her and let her know what the specific concerns are that the provider would want to include in the education requested.
SNF and COVID-19 billing – Christine explained our POE staff worked with the provider requesting this topic so we are not currently planning education on this topic.
Outpatient repetitive service billing – Christine explained that we provided this information in an article posted to our website on 6/21/2022 Repetitive Outpatient Services for Providers Submitting Institutional Outpatient Claims.
Billing for a noncovered procedure during an inpatient hospital stay – Christine explained we covered this in our May 2022 Virtual Conference. See May VC slide 18

Christine asked for suggestions for education and when she received none, she asked members to send such suggestions at any time to her or to Michael.D.Davis@elevancehealth.com.

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IV. Review of Educational Topics/Materials

Christine Janiszcak, Kathy Windler and Jean Roberts, Consultants, POE

Christine reviewed the website articles listed below and asked for any feedback since she is going to be working on updating all the MSP-related articles on our website as needed. Christine received no comments or questions but asked the members to email her if they do.

Determine if Medicare will Make an MSP Payment (Handout)
Determine Beneficiary Responsibility on an MSP Claim (Handout)

Jean reviewed the draft PPT “Inpatient Rehabilitation Facility (IRF): Benefit, Coverage and Documentation” and asked for any feedback. She explained we prepared the PPT for a webinar we are conducting on 9/14/2022 because our Medical Review staff found many issues with IRF services and documentation. Jean received no comments or questions but asked the members to email any to Christine.Janiszcak@elevancehealth.com by 9/9/2022.

Kathy reviewed the website article “Use Our Provider Self-Service Tools and Spend Less Time on the Phone”. She explained our PCC experiences high call volumes at the beginning and ending of each month and we used this article to remind providers of the self-service tools available that allow providers to avoid experiencing prolonged hold times. She explained the CMS does not permit our PCC representatives to answer certain questions via phone when providers can obtain those answers through self-service tools. Kathy highlighted the self-service options: NGSConnex, IVR, Production Alerts, FISS DDE, Medicare Mobile News, email updates and Twitter.

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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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