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Florida and U.S. Virgin Islands Part A POE-AG minutes -- October 31, 2023
Last Modified: 2/12/2024
Location: FL, USVI
Business: Part A
External participants
Davia Bailey, Centers for Medicare & Medicaid Services (CMS)
Margaret Gil, Baptist Health South Florida
Donna Hamilton, Goldstein Management
Luci Hendrickson, Davita
Shirley Knoll, TLC Rehab
Ana Navarrete, Baptist Health South Florida
Brenda Touhey, Health First
Internal participants
Bradley Bohner, Provider Education Specialist (PES), POE
Charles Johnson, PES, POE
Kimberly Karnes, MAC JN Project Manager
Robert Lewis, PES, 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. Prior authorization program updates
5. Coming soon! – Secure Provider Online Tool (SPOT) enhancements
6. Medicare Spotlight: Behavioral health services
7. Activation of systematic validation edits for Outpatient Prospective Payment System (OPPS) providers with multiple service locations
8. CMS.gov website enhancements
9. Upcoming events
10. Open forum
11. Verify all action items and process out
Kim Karnes welcomed everyone to the meeting, and First Coast staff and POE AG team members introduced themselves.
Ursula Weaver addressed a previous inquiry regarding
return to provider (RTP) reason code 34963, which indicates the attending physician on the claim is invalid or not present in the Provider Enrollment, Chain, and Ownership System (PECOS). Based on the inquiry regarding whether a middle initial is required with enrollment, she explained if not required, it's best not to use the middle initial with enrollment.
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 A 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 form via the First Coast website.
• While on the First Coast website, Brad showed access to the new "simple guide" tutorials for completing the most common CMS forms, 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.
Robert Lewis 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 to 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. Robert 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.
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.
Ursula reminded providers it is imperative they keep their enrollment records up to date to prevent claim rejections. Be sure ownership information is consistent across all enrollment records under one tax identification number (TIN). If an individual or organization has 5% or more partnership or indirect or direct ownership in your organization, they must be listed on all enrollment records under your TIN. If you need to perform a change of information to update your ownership information, you can update it online through PECOS or download a paper-based application.
Verify your practice addresses in PECOS. If any locations are not in PECOS, submit the CMS-855A enrollment form to add locations. Ensure your enrollment information is up to date and claim submissions reflect practice locations exactly as they appear from the practice location address screen received from PECOS and viewed in the Fiscal Intermediary Standard System (FISS) under 'Short Cut 1D Provider Practice Address'. Ensure claims are submitted with the practice location listed in direct data entry (DDE) and PECOS (e.g., Road vs. Rd, Suite vs. Ste. etc.). Include special characters if listed in the address.
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 upcoming 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.
No additional discussion.
Follow up to inquiry regarding ESRD compounded drugs: do they fall into a functional category and composite rate (i.e., are related claims separately payable or are they included in a bundled rate?)
The next meeting is March 19, 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.