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Florida and U.S. Virgin Islands Part B POE-AG minutes -- November 2, 2023
Last Modified: 2/10/2024
Location: FL, USVI
Business: Part B
External participants
Allison Wakeland, Small surgery practice and ASC
Angela Amey, Trident USA
Anna Valdes, Dermatology Medical Partners
Antoinette Puricelli, USF Health
Becky Ferrando Walker, Edward S Walker MD PA
Brenda Tuohey, Health First
Brian Brijbag, Corin USA
Cathy Picillo, Raul Rodriguez, MD PA
Christina Negron, Radiology Associates of Venice and Englewood
Colleen Schaeffer, BayCare Health Systems
Donna Smith, Lorraine Molinari & Associates, Inc.
Eric Riker, Gulf Coast Cardiothoracic Surgeons
Gianni Gonzalez, HealthCare Management Solutions
Jennifer Childress, University of South Florida
Jennifer Collazo, Baptist Health South Florida
Kim Corkins, Watson Clinic, LLP
Kimberly Gregory, Millennium Physician Group
Lisa Ball, Harmony Cares
Michelle Jennings, Medical Insurance Services and Consultants, Inc.
Nancy Hall, Streamline Health
Patty Evans, Volusia County
Peggy Palmer, Frantz Eye Care
Philip Choung, Carpe Diem Consulting
Rachel Lewis, Henry Schein Medical Systems Inc. MicroMD
Sandy Bertrand, PhyBill
Sheryl Tunstall, Moffitt Cancer Center
Shirley Knoll, TLC Rehab and ProRehab
Stacey Singer, Cleveland Clinic
Susan H Fulton, CPC, CPB, Fulton Medical Billing LLC
Tara Montgomery, Ascension Sacred Heart Hospital
Tera Jennings, Norman H. Anderson MD PA
Teresa Beard, Mayo Clinic Florida
Internal participants
Bradley Bohner, Provider Education Specialist PES, POE
Charles Johnson, PES, POE
Cesar Hernandez, Sr. PES, POE
Kimberly Karnes, MAC JN Project Manager, POE
Janice Mumma, Supervisor, POE
Brad Plevyak, Manager, Provider Websites
Stephanie Portzline, Manager, Provider Engagement
Ursula Weaver, PES, POE
1. Welcome and introductions
• Review of minutes and action items from prior meeting
• Special announcement
• Request for feedback: Enhancements to eNews
1. First Coast educational strategy
2. Provider enrollment news
3. Appeals education campaign
4. Medicare Spotlight: Behavioral health services
5. Evaluation and management (E/M) update
6. Prior authorization program updates
7. Coming soon! – Secure Provider Online Tool (SPOT) enhancements
8. CMS.gov website enhancements
9. Upcoming events
10. Open forum
11. Verify all action items and process out
Kim reviewed the action items from last meeting. Regarding appropriate use criteria (AUC), CMS has decided to indefinitely pause the implementation of this program.
Kim advised the POE team will begin reporting to Stephanie Portzline and Janice Mumma, the manager and supervisor from the Novitas POE team. Stephanie and Janice introduced themselves.
Brad Plevyak explained a new process and format with eNews will be implemented soon, with a change to the layout of eNews. Updates will be made to avoid multiple and repeated emails being sent. He displayed the new layout and requested feedback.
Kim reviewed the 2023 POE provider satisfaction survey results and explained this feedback has been reviewed for future education topic suggestions. These five topics were identified:
§ Provider enrollment
§ Physical therapy
§ Radiology
§ Medical policy
§ Part B Medicare 101
Brad Bohner reviewed separate updates relating to provider enrollment:
• Regarding the 855I application, there is a new
Physicians and non-physician practitioners (including clinical psychologists) CMS-855I paper application. The revised form was effective September 1, 2023, and expires May 2026. The new form combines the old CMS-855I and 855R paper applications. CMS is expiring the 855R paper application effective November 1, 2023. First Coast will not accept any 855R forms received after this date. CMS added section 4F to the new CMS-855I application to replace the 855R form. Other items and sections were added to the 855I form including two new specialties and acupuncture questions.
• Brad showed how to access the new "simple guide" tutorials for completing the most common CMS forms on the First Coast website, via the 'Tips & Tutorials' section of the Provider Enrollment page.
• Brad notified attendees of upcoming enhancements to the Provider Enrollment home page, including new areas and widget boxes on the landing page as well as updated content to improve users' experience.
Brad explained in September, an Appeals educational campaign for Medicare Parts A and B was initiated. This included new
redetermination request forms,
tutorials, and a
tip sheet on medical documentation submission. He demonstrated links to the documents on the Appeals page of the First Coast website.
A webinar was held on October 16, 2023, for Part B providers titled "Eliminate Duplicate Denials by Billing with the Proper Modifiers" as part of this campaign. The recording of the event is available on our Learning on Demand page.
Charles Johnson shared that Medicare covers behavioral, mental, and psychiatric health services which may improve outcomes for Medicare patients and provided an overview.
Overview of Behavioral Health Integration (BHI) Services, Psychotherapy for Crisis, and Opioid Use Disorder (OUD) Screening & Treatment
• BHI is a model of care incorporating behavioral health care into other care, like primary care, to improve mental, behavioral, or psychiatric health for many patients. These BHI services may be particularly helpful for patients who aren't improving under other models of care.
• BHI includes Psychiatric Collaborative Care Model (CoCM) and general BHI services.
• These services are appropriate for patients in high distress with life-threatening, complex problems requiring immediate attention. These services can help reduce a patient's mental health crisis (including substance use disorder [SUD])
New education campaign
Letters were recently mailed to all active physicians and non-physician practitioners to help promote these covered services and provide details and resources available to assist with more information. The letter details were included in
change request (CR) 13389 .
First Coast will include information on these services in upcoming education throughout 2024.
Charles shared information on First Coast's outreach and education efforts on E/M coding and documentation during 2023, which addressed the most significant changes to Medicare E/M coding since the revision of the office and outpatient services in 2021. CMS aligned all 'other' E/M services with the AMA's CPT guidelines, creating major revisions for hospital inpatient, outpatient and observation services, home and residence services, nursing facility care and prolonged services.
First Coast provided extensive outreach and education on these guideline revisions during 2023, conducting 19 separate E/M events, producing 12 recordings, and an E/M-specific virtual conference in June with 10 classes. More events are planned before the end of the year. First Coast enhanced our E/M center to include information on the revised guidelines, reorganized the landing page and included care management services as a new breakout topic.
First Coast will be conducting more education on E/M services into 2024 and beyond.
Kim addressed a question regarding mid-level providers (APRN and PA) providing new patient visits, with providers receiving denials for more than one visit per day. As the providers are the same specialty, Medicare systems identify these as the same provider. Kim responded that CMS is currently looking at ways to address this.
Cesar Hernandez provided an update on the outpatient department (OPD) prior authorization (PA) program, reviewing a new category of services included in the PA process starting in July: facet joint interventions. Multiple webinars have been provided to cover this recently added service, including review of the LCD guidelines relating to facet joint interventions.
Based on recent data, attention has been given to assisting providers make sure their submissions for prior authorization are affirmed. The PA process is specific regarding submission of coversheets and related documentation, and identification of the point of contact if a response is needed. A helpful article is available on the Prior Auth webpage. Cesar demonstrated the pathway to the article and additional resources on the First Coast Prior Authorization page for OPD services.
Additional webinars are planned with the next OPD webinar scheduled for December 7.
Cesar Hernandez announced the new redesigned SPOT will be implemented December 4. A new claim submission feature is also coming soon, providing the ability to submit electronic claim files through SPOT. To prepare for this feature, existing users should complete the
SPOT claim submission agreement today if you have not done so already. For anyone not yet enrolled, you can access the
SPOT webpage to learn more.
Ursula advised CMS is committed to easing providers' burdens and heard requests to make the website more user friendly. CMS enhanced the search feature on the website and the redesign is more appealing. Ursula demonstrated the CMS website enhancements.
Ursula 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.
Kim addressed a question asked if there is a standard appeal form for provider enrollment? Kim advised there isn't a form, but the letter from provider enrollment will provide instructions about necessary documentation needed to complete the application.
The open discussion is captured in the action items below.
Action items:
• Education suggested for future sessions on laboratory reimbursement, chiropractic coverage and documentation, billing errors for modifiers 59 and 51, NCDs and LCDs, care management services and documentation (CCM, TCM, AWV), multiple procedures, infusion billing, screening services coverage and limitations, behavioral health assessments, advance hospital care at home.
The next meeting is March 21, 2024.
Kim concluded the meeting at 3:30 p.m.
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.