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Last Modified: 7/1/2017 Location: FL, USVI Business: Part A


Florida and U.S. Virgin Islands Part A Provider Outreach and Education Advisory Group (POE AG)

Tuesday, March 7, 2017

2:00-3:30 pm

External participants
Christine Davenport, Brooks Rehab
Felice Landry, Reingruber & Company
Heather Meloy, Therapy Management Corporation
Robert Sikorski, Davita
Internal participants
Christine Cubillan , Sr. Provider Relations Representative (PRR), Data Analysis and Compliance (DAC)
Charles Johnson, PRR, Provider Outreach and Education (POE)
Kimberly Karnes, Manager, POE
Shari Bailey, Manager, DAC
Robert Lewis, PRR, POE
Cara Page, PRR, DAC
Mary Pita Carrazana, PRR, DAC
Robert Stroud, Learning Solutions Center
Stephanie Scott, PRR, POE
Terri Stanton, Sr. PRR, POE
Ursula Weaver, PRR, POE
Leslie Brinson, Provider Customer Service (PCC)
Mark Willett, Sr. Manager, Medicare Websites and Provider Self-service Technologies


1. Welcome and introductions
2. Review of minutes/action items from prior meeting
3. First Coast self-service technologies
4. First Coast 2017 educational strategy update
Medical documentation
Provider enrollment
Medicare Speaks
Project to measure effectiveness of comparative billing reports (CBRs)
5. Education Action Team (EAT) update
6. 2016 Medicare Administrative Contractor (MAC) Satisfaction Indicator (MSI) survey action plan
7. Collaboration with Medicare contractors
8. Upcoming events
Events calendar
9. Open discussion and announcements
Social Security Number Removal Initiative (SSNRI)
Medicare Outpatient Observation Notice (MOON)
10. Verify all action items and process out
a. Next webcast meeting scheduled for July 18, 2017

Welcome and introductions

Kim Karnes welcomed everyone to the meeting. All participants and staff present within the room and on the teleconference introduced themselves. Kim reviewed the agenda.

Review of minutes/action items from November 8, 2016, meeting

There were no action items from the previous meeting. She demonstrated the pathway to find minutes from previous POE AG meetings on First Coast's provider website.

First Coast self-service technologies

Mark Willett reported since the last November 2016 meeting that the remittance advice has been implemented on SPOT. Last week Part A providers requested 274 remit advices. Since implementation in November 2016, the total number of remits requested for both A/B providers was more than 18,000. Mark also encouraged users of First Coast’s provider website to complete the ForeSee survey. Our goal is to collect at least 300 surveys by April 6, 2017. Feedback from the survey helps ensure that the website meets the needs of the provider community. We carefully analyze customer feedback to implement enhancements to the provider site and improve provider satisfaction. Mark also announced the early stage of development of an enterprise-hosted version of Enterprise Identity Management (EIDM). The target date is before December 1, 2017. The move away from the current CMS-hosted solution will allow us to provide more specific user-friendly messaging and functionality as it pertains to registration and authentication.

First Coast 2017 educational strategy update

Kim introduced the topic and provided the overview of First Coast's educational strategy and project teams.
Medical documentation
Terri Stanton provided an update for the Medical Documentation project team.
Physical therapy services have been added back in to our strategy this year, specifically focusing on procedure code 97110 for therapeutic exercise. This is one of the two highest billed codes nationally as well as in our jurisdiction. Physical therapists in private practice are also on the Office of Inspector General (OIG) work plan for 2017. On March 22, 2017, we’ll deliver the “Ask-the-contractor webcast for physical therapy services (Part B)” where we’ll focus on CERT related errors and the medical policy requirements to reduce or eliminate those errors.
As a carry-over from last year, the clinical laboratory specialty specific to drug assays and substance abuse screening will be monitored. We’ll continue to market our webcast recording from last year and possibly hold another webcast later on this year. The drug screening is also on the OIG work plan this year.
A new topic to our strategy this year based on CERT errors and local data is chiropractic services. CMT or chiropractic manipulative treatments are on the OIG work plan this year and are also the subject of the Supplemental Medical Review Contractor (SMRC) post-payment reviews. At this time, we’re going to update the web-based training we have on First Coast University with examples of current CERT errors and promote the WBT and other related educational materials pertaining to CMT through our eNews.
For our ambulance services specialty, another carry-over from last year, we facilitated a face-to-face presentation earlier in the year to the Florida Ambulance Association. Our plan is to have this material converted into a webcast and schedule it for later this year. Members that attended the association presentation requested this presentation in other parts of the state. By doing a widespread webcast, we can reach all members of the association across our jurisdiction. Ambulance services are also on the OIG work plan for 2017.
For psychiatric/psychotherapy services, another carry-over from last year, a webcast was held in January 2017 and the recording is available through Jan. 2018. For now, we plan to market the recording and send focused education letters to newly identified providers in our data analysis that may need additional education.
Finally, cardiology is another specialty that we’ve adopted this year on our project team due to errors that reflect medical policy education is needed, specifically for myocardial perfusion imaging procedures. POE facilitated a webcast last month on this topic and we will conduct a Spanish webcast in June 2017.
Up to this point most of our focus is pertaining to Part B; however. we will also continue this year with our outpatient hospital services billed on type of bill 13X, concentrating on the specific types of insufficient documentation errors we are seeing for those services in our CERT feedback files.
Provider enrollment
Stephanie provided an update on the provider enrollment project team. The POE-AG members were reminded that anyone interested in joining may notify Stephanie via email at
The project team will continue to focus on education regarding Internet-based PECOS. The option for requesting appointments is still available on our events calendar. So far this year, we received about 5 or 6 inquiries about scheduling a one-on-one session. Also, our provider enrollment POE AG subcommittee suggested a webcast on registering for the system, which is done via PECOS I&A, so we are looking at doing a webcast on this system and process this year.
We’ll continue to educate on revalidation, as necessary, and will communicate with the provider community on any issues trending with those applications.
Finally, we have the provider enrollment section on the First Coast provider website. We’ll continue to review and make enhancements as we receive feedback. Changes and enhancements have been made to the revalidation FAQs based on feedback received from the POE AG subcommittee.
Medicare Speaks 2016
Ursula Weaver provided a year in review of our signature face-to-face event Medicare Speaks. This year we are planning three locations to attend the face-to-face events. We will be in Miami May 17-18, Tampa July 26-27, and Jacksonville September 13-15. We are excited to collaborate again with SafeGuard Services for fraud and abuse, Quality Improvement Organization on Quality Payment Program, and Cigna Government Services (CGS) Administrators on DME documentation. We will also continue the Part A and Part B forums this year in Tampa only. We will have advertising for these events out of the website and coming to you via email and eNews within the next couple of weeks. Ursula will be reaching out to the members to distribute the information to colleagues, providers, and staff.

EAT update

Christine Cubillan provided the Education Action Team (EAT) update, advising that the EAT is only one component of First Coast's data driven educational strategy. The EAT will continue to deliver focused education to providers with a significant non-MR claim error rate, by mail and making phone calls. Our education will focus on promoting our self-service tools on the provider website (such as our FAQ’s), as well as what’s available on SPOT.
In addition, the EAT will also continue to monitor the EAT data for the top non-MR claim errors to determine if any new FAQs or educational articles should be posted to the provider website.
During our data review for January 2017, a new RTP reason code appeared and was also the top RTP claim error. The reason code is 31164, which indicates an invalid line item modifier was submitted. We checked with the PCC for both Florida and PR, and found that numerous providers were still submitting the “L1” modifier for unrelated lab test on hospital outpatient claims (TOB 13X). The modifier “L1” was expired for those claims with dates of service on/after January 1, 2017. This change occurred with the January release for the hospital outpatient prospective payment system (OPPS), and is tied to change request 9930 (MM9930).
The PCC has not been receiving many calls regarding this reason code, and determined that no additional education is needed at this time. Christine asked members to review them and provide feedback. She is open to any suggestion POE AG members may have on how we can make improvements. No feedback given.

MSI survey

Kim shared that First Coast’s leadership implemented a company-wide action plan in January 2017 to address findings and survey comments. Some of the action plans included improving the accuracy and clarity of redetermination decisions and enhancing the performance of First Coast’s provider website.

Collaboration with Medicare contractors

Kim reviewed First Coast's collaboration with internal and external partners at Medicare Speaks this year, as well as collaborations with the Recovery Auditor Cotiviti.

Upcoming events

Ursula announced the upcoming events while displaying our event calendar on the Medicare provider website. She highlighted the Medicare changes and regulations (A & B) webcast, June 13 and 14.

Open discussion

The following topics were discussed:
Social Security Number Removal Initiative (SSNRI)
As mandated by the MACRA (Medicare Access & Children’s Health Insurance Program Reauthorization Act of 2015), SSNs will be removed from all Medicare cards by April 2019. Under the new system, a randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based HICN on the Medicare cards for Medicare transactions.
Currently, CMS uses a Social Security number (SSN)-based Health Insurance Claim Number (HICN) to identify people with Medicare and administer the program. CMS also uses the HICN with the following business partners:
The Social Security Administration
The United States Railroad Retirement Board
State Medicaid Agencies
Health care providers
Health plans 
The MBI will be clearly different than a beneficiary’s current number. It will be 11 characters in length, and consist of numbers and uppercase letters, and it will not contain any embedded intelligence or special characters.
Each person enrolled in Medicare will receive a new MBI Medicare card to replace their current Medicare card. CMS will start mailing the new MBI Medicare cards to beneficiaries in April 2018 with all new MBIs issued by April 2019. Beneficiaries may start using their new MBI Medicare cards as soon as they receive them.
During the transition period of April 1, 2018 through Dec. 31, 2019, providers and beneficiaries can use either the current Medicare card or the new MBI Medicare card for Medicare transactions. Also during the transition period, when providers submit a claim using the patient’s HICN, Medicare will return both the HICN and the MBI on the remittance advice. CMS will tell you in the message field on the eligibility transaction responses when they’ve mailed a new Medicare card to each person with Medicare. Your eligibility service provider can give you this information.
Medicare Outpatient Observation Notice (MOON) Instructions
The new Medicare outpatient observation notice or MOON, which is a form and written notification used to inform beneficiaries when they are an outpatient receiving observation services, and not in an inpatient status at a hospital or a critical access hospital (CAH). The MOON is effective 02.21. The MOON is mandated by the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), a law passed on August 6, 2015. This law amended the Social Security Act to require hospitals and CAHs to provide written notification and an oral explanation of such notification to beneficiaries in original Medicare who receive observation services for more than 24 hours. Beneficiaries must receive a MOON no later than 36 hours after observation services as an outpatient began. MM article 9935 external pdf file, which will be reviewed during our Medicare Changes and Regulations (A/B) webcasts next week, provides detailed instructions regarding the scope of, completion of, and delivery of the MOON, as well as ensuring patient comprehension and specifics on retention of this notice. The notice and accompanying instructions may be found online at a web link included in the article. Please ensure your facility staff members are aware of this important notification.

Verify all action items and process out

There were no action items. Kim identified that the next Part A POE AG meeting is scheduled for July 18, 2017. The meeting was concluded at 3:05 pm.
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