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Florida and U.S. Virgin Islands Part B POE-AG minutes -- July 13, 2023
Last Modified: 3/22/2024
Location: FL, USVI
Business: Part B
External participants
Anna Valdes, Neurosurgery & ASC
Antoinette Puricelli, USF Health
Becky Ferrando Walker, Edward S Walker MD PA
Brenda Tuohey, Health First
Bryce Hollinger, Cora Health Services
Cathy Picillo, Raul Rodriguez, MD PA
Cary Boles, Chapters Healthcare
Christina Negron, Radiology Associates of venice and Englewood
Davia Bailey, CMS
Debbi Hogg, Healthcare Mgmt. Consulting
Donna Smith, Lorraine Molinari & Associates, Inc.
Eric Riker, Gulf Coast Cardiothoracic Surgeons
Gianni Gonzalez, HealthCare Management Solutions
Jill Paiva, Medicomp, Inc.
Karen Perry, Compulink Healthcare Solutions Vision Health Institute
Kerry Treshock, Future Healthcare
Kimberly Gregory, Millennium Physician Group
Michelle Jennings, Medical Insurance Services and Consultants, Inc.
Pamela Butler, Sarasota Memorial Healthcare System
Rachel Spade, Henry Schein Medical Systems Inc. MicroMD
Sandy Bertrand, PhyBill
Shelli Johnson, FLASCO
Sheryl Tunstall, Moffitt Cancer Center
Shirley Knoll, TLC Rehab and ProRehab
Susan H Fulton, CPC, CPB, Fulton Medical Billing LLC
Tara Montgomery, Ascension Sacred Heart Hospital
Tera Jennings, Norman H. Anderson MD PA
Wilma N Torres, Coleman Consulting Group, Inc.
Internal participants
Brad Bohner, Provider Education Specialist PES, POE
Charles Johnson, PES, POE
Gloria Franceschini, PES, POE
Kimberly Karnes, MAC JN Project Manager, POE
Robert Lewis, PES, POE
Cesar Hernandez, Sr. PES, POE
• Welcome and introductions
• Review and approve minutes from prior meeting
• Welcome our newest POE team member Bradley Bohner
• JW and JZ modifiers
• Evaluation and management (E/M) update
• Secure Provider Online Tool (SPOT) update
• Review of Customer Service escalation process
• What’s new with the Prior Authorization Program?
• Appeals education campaign
• LCD process campaign
• Upcoming events
• Open discussion
• Verify all action items and process out
Kim Karnes welcomed everyone to the meeting and First Coast staff introduced themselves. Kim also introduced Bradley Bohner as new team member
Kim verified there were no action items from the previous meeting.
For E/M, a lot of updates were made in 2023. There have been provider questions about “other E/M” services outside of office visits (hospital, observation, nursing facility, home, and emergency department services, along with cognitive impairment assessment) and the clarity of the updated split or shared guidelines. CMS updated the CMS Internet-Only Manuals or IOMs in May 2023 and prior to this, direction was provided in CMS change requests and CPT manual specifics. These resources have helped guide our education this year during which we offered multiple E/M webinars and a virtual E/M Conference that addressed the 2023 changes and impacts on separate types of E/M services.
In the upcoming weeks we have additional E/M webinars scheduled such as Critical Care on July 26 and a cognitive assessment webinar in August. Our E/M interactive worksheet has been updated with the 2023 changes and is ready and able to assist with proper code selection and verification. Most of the E/M webinars offered over the past eight months have been recorded, so our On-Demand Learning page is a great resource for you and your co-workers to find the presentations and learn more about the 2023 updates.
We’re now getting ready to learn about E/M proposals for 2024. We will adjust and develop future E/M education as we identify what will impact you and do our best to clarify and provide answers.
The CMS identify management system or IDM, change passwords rules effective last June 27. How is this impacting you? Well, the IDM manages your SPOT ID and password, and with this change you will no longer be required to change your password. The password will no longer expired if you keep your account active. Accounts in an inactive status for 60 days will have their password expired.
Remember to log into SPOT at least once a month to avoid having your account inactivated for lack of use.
Kim reminded our providers that we have an escalation process in the Customer Service department. Anytime you call our general inquiries line and if for some reason you are not satisfied with that level of service that you received or the issue is not resolved, you can ask to speak with a supervisor and that supervisor will return your call. You should be given a reference number for the call in case you need to call back. Please pass this information to any of your peers and colleagues that may need to escalate their issue.
Robert provided an update for the prior authorization program. Effective July 1, a new service category, facet joint interventions, was added to the list of services provided in the hospital outpatient department that require prior authorization before those services are provided. A prior authorization request or PAR form is available via our website, along with instructions on how to complete it, which should be submitted to receive affirmation of coverage. This request (along with supporting documentation) can be submitted in different ways, with the best option being the SPOT since photos don’t come through clearly via fax.
We have a prior authorization webpage devoted to guidelines and resources, and this now includes resources relating to facet joint interventions. We’ve offered separate webinars to introduce this new service. In fact, a webinar was offered just yesterday, and included detailed review of the LCD and local coverage article relating to these services (L33930). That recording is now available on our On-Demand Learning webpage.
The other services that require prior authorization are listed on our prior auth webpage also, with links to corresponding articles, LCDs and other resources addressing each separate category of service.
The repetitive scheduled non-emergent ambulance transport (RSNAT) prior authorization program is also in effect and a RSNAT webinar is scheduled for July 25. We have a RSNAT webpage with links and resources to assist such as a comprehensive FAQ list that is quite helpful, and links to a prior auth coversheet and instructions on its completion.
We will provide more focused education for appeals and the appeals process.
We will provide more focused education on the LCD process and how providers can participate in the decision-making process. This is a good opportunity to reinforce changes made to the LCD process with the intent to make it more transparent. We’ll be providing more education over the next year, partnered with our Medical Affairs department, with a team approach.
Bradley highlighted several webinars from the events calendar. We are constantly adding new webinars to the calendar so be sure to bookmark this page and sign up for eNews which highlights our events as we post them.
The open discussion is captured in the action items below.
Bradley took notes of action items as follows.
Action Items:
• Is JW modifier allowed for HCPCS A9585 – Note, we referred to our Customer Service team for handling
• Provider suggestions for LCD campaign:
• Remind providers in our education what to look for if the HCPCS codes are denying for incorrect diagnosis, but there is no LCD listed with codes (in this case, it was likely an NCD causing it)
• Can retired LCDs list active NCDs in policy as a point of reference?
• First Coast will monitor if appropriate use criteria matter is addressed in the 2024 proposed rule
• Next meeting will be November 2, 2023.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.