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Last Modified: 8/14/2017 Location: FL, USVI Business: Part B


Florida and U.S. Virgin Islands Part B Provider Outreach and Education Advisory Group

Thursday, July 20, 2017

2:00-3:30 p.m.

External participants
Jean Acevedo, Acevedo Consulting Incorporated
Shelly Asbury, Advize Health
Amanda Attaway, Mayo Clinic
Joan Beauchamp, Coastal Administrative Services, LLC
Lisa Burdue, Internal Medicine Specialists, Inc
Pamela Butler, SMH Physician Services, Inc
Alan Duretz, Phybill, Inc
Jennifer Erskin, Florida Medical Reimbursement Services
Nancy Farrington, Foundational Health Center
Michelle Flowers, Oncology Managers of Florida
Lisa Hanley, Plessen Healthcare
April Hicks, Baptist Primary Care
Deborah Hogg, Navigant
Michelle Jennings, Medical Insurance Services Consultants, Inc
Jim Lennie, Raina Imagining, Inc
Rachel Lewis, Henry Schein MicroMD
Najwa Liscombe, University of Florida Physicians
Susan Lukens, UF Shands
Holly Martin, Nature Coast EMS
Barbara McIntyre, High Springs Medical Center
Celia Myres, Excel Hospitalist Partners
Donna Osso, Alliqua BioMedical
Jill Paiva, Medicomp Inc
Valarie Prusia, Prusia Medical Practice Consulting
Jeannie Randhan, CPC, Orlando Health Physician Partners
Anna Schneider, Melbourne Internal Medicine Associates
Sarah Scott, CPC, St. Vincent's HealthCare
Samir Shah, Accumax Systems, Inc
Donna Smith, Lorraine Molinari & Associates
Wilma Torres, Coleman Consulting Group, Inc
Rona Traub, Florida Department of Health
Brenda Tuohey, Health First
Linda Zane, Physical Therapy Institute
Michael Zelin, Torne Rehabilitation Services LLC
Internal participants
Charles Johnson, Provider Relations Representative (PRR), Provider Outreach and Education (POE)
Clauda Laster, Sr. Manager, Health Data Analysis
Heather Blasini, Web Analyst, Medicare Website
Kimberly Karnes, Manager, POE
Mary Pita Carrazana, PRR, Data Analysis and Compliance (DAC)
Stephanie Scott, PRR, POE
Terri Stanton, Sr. PRR, POE
Ursula Weaver, PRR, POE


1. Welcome and introductions
2. Review of minutes and action items from prior meeting
3. Discussion of member suggestions for reducing providers’ administrative burdens
4. First Coast’s self-service technologies
5. First Coast 2017 educational strategy update
Project teams focused on improper payments, inquiries
Provider enrollment project
Medical documentation project
Evaluation & management (E/M) subgroup
6. Project to measure effectiveness of comparative billing reports
7. Education Action Team (EAT)
8. Upcoming educational events
Medicare Speaks
Events calendar
9. Collaboration with Medicare contractors
10. Open discussion and announcements
New Medicare card project
Educational videos
11. Verify all action items and process out
Next meeting November 9

Welcome and introductions

Kim Karnes welcomed everyone to the meeting and completed the review of the agenda. Due to having a full agenda, introductions were circumvented for this meeting.

Review of minutes and action items from March 10 meeting

Kim reviewed the location of meeting minutes from prior meetings on the First Coast website and reported two action items from the last meeting:
Follow up with a POE AG member to address prior inquiry submitted to Mark Willett regarding the possibility of submitting documents via Secure Provider Online Tool (SPOT) in response to probe audits.
POE representatives to verify directives among other Medicare Administrative Contractors (MACs) regarding additional documentation request (ADR) address to be used wen responding to ADR letters.
For the first action item, Kim went over the different types of reviews and advised that the SPOT submission of documentation for probe audits is not allowed yet but may be considered in the future.
For the second action item, Kim advised that we added an article to the website regarding ADRs and updating the address they are sent to if desired.

Discussion of member suggestions for reducing providers’ administrative burdens

Kim spoke about a conference she attended with others MAC representatives that was hosted by the Centers for Medicare & Medicaid Services (CMS). The discussions during the conference included ways to reduce provider burdens. Kim requested feedback prior to this meeting from our POE AG members for questions on this topic and reviewed some of the responses during the call.
One POE AG member requested SPOT provide eligibility for older dates. While this cannot be done at this time, we do have a frequently asked question (FAQ) on the First Coast website that does not address the timeframe for accessing eligibility on SPOT or with the interactive voice response (IVR) system. This FAQ will be updated to address timeframes.
Another POE AG member requested patient supplemental insurance inclusion in SPOT eligibility lookup. Supplemental insurance is not available at this time but SPOT does provide Medicare secondary payer (MSP) information.
Several POE AG members provided feedback and requests regarding the sign-on process for SPOT. Kim discussed the current registration process with Enterprise Identity Management (EIDM) and that First Coast will be moving to our own registration platform. The process will look the same but it gives First Coast more communication abilities.
Other requests included additional reopening types on SPOT, denial details for pre-pay reviews, sending documentation through fax or electronically, and simplifying the debt recovery process on the remittance advices. The suggestions for additional reopening types and pre-pay denial details are being looked into. Kim advised that First Coast does allow documentation to be faxed and can also be sent through SPOT for ADRs. For the debt recovery process, Kim provided resources we have to assist with the process and asked a POE AG member to share their system for handling the requests with the rest of the POE AG.
A POE AG member asked a question regarding the situation when a primary insurance has paid on a claim and Medicare is secondary, however, the primary payer requests a refund two to three years later. Is there a way to submit the information with the claim to prevent submission of an appeal? We will look into this situation to see if other options are available.
Another POE AG member suggested a bulk submission method for pre-pay reviews/ADRs when responding via SPOT. Currently, providers must upload documentation separately for each individual internal control number (ICN). Kim will provide this as a suggestion for reducing provider burden.
Kim facilitated a poll regarding features that First Coast is looking to add to SPOT. Kim will provide responses to Mark Willett for consideration.
Kim then introduced Clauda Laster, the Sr. Manager for the First Coast’s Health Data Analysis team. They requested feedback from the POE AG members regarding the user friendliness of the comparative billing report (CBR) and how it can be improved. Suggestions received to post state and national data on the First Coast website for providers to use for comparisons and to improve description of CBR fields using plain language.

First Coast’s self-service technologies

Heather Blasini provided the report for self-service technologies. She reminded members that the local coverage determination (LCD) lookup was removed from the First Coast website but advised that the LCDs will be loaded to the First Coast website as PDFs and will allow providers to search again.

First Coast 2017 educational strategy update

Kim introduced this topic and additional POE team members gave updates to multiple strategies.
Provider enrollment
Stephanie Scott 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 internal project team continues to focus on education regarding internet-based Provider Enrollment, Chain, and Ownership System (PECOS). The option for requesting appointments is still available on our events calendar and Stephanie works with those providers individually. Also, our provider enrollment POE AG subcommittee suggested a webcast on registering for the system, which is done via PECOS Identity & Access (I&A), and this has been added to POE’s internal events calendar for October 25, 2017.
We’ll continue to educate on revalidation, as necessary, and communicate with the provider community on any issues trending with those applications. Also, the provider enrollment section on First Coast provider website will continue to be reviewed and enhanced based on feedback, suggestions, and CMS changes.
Stephanie advised she may do a webcast for Part D prescribers due to their enrollment requirements. This is still tentative but she is looking at September to perform this education. The education may be targeted and invitation only, contacting specific providers for attendance. If it is posted to the First Coast website, Stephanie will notify members.
The last topic Stephanie shared was regarding the modernized National Plan and Provider Enumeration System (NPPES). She explained some of the updates CMS has made for NPPES, including surrogacy, single account for multiple individuals or organizations, submission of multiple applications at the same time, and the ability to add more than one practice location. The resources available for the modernized NPPES implementation were also shared.
Medical documentation
Terri Stanton provided an update for the medical documentation project team.
Terri advised since the March POE AG meetings, as well as throughout the remainder of the year, the medical documentation project has focused on several specialties with a high error rate nationally, as well as within our jurisdiction, mostly due to insufficient documentation errors.
On March 22, 2017, we held the ‘Ask-the-contractor’ teleconference (ACT) webcast for Physical Therapy Services (B), where we focused on Comprehensive Error Rate Testing (CERT) program related errors and the medical policy requirements to reduce or eliminate those errors.
Terri also said we are continuing with a focus from last year for the specialty clinical laboratory, in particular for drug assays and substance abuse screening. We have a webcast scheduled for September 6, 2017, that will focus on the CERT errors and the LCD for controlled substance monitoring and drugs of abuse testing.
As reported in March, we added a new topic to the strategy this year for chiropractic services based on CERT errors and local data. At this time we’re in the process of updating the web-based training (WBT) on First Coast University with examples of current CERT errors and how to avoid those errors based on documentation requirements. Once the update is completed, the WBT will be marketed to the Chiropractic Association as well as through eNews.
For ambulance services specialty, a face-to-face presentation was facilitated earlier in the year to a small group of association members and a webcast was held on July 11, 2017. As a result of probe reviews on ambulance services and CERT errors, a pre-payment edit will be put in place in August 2017, on certain ambulance services. The purpose of the webcast was to continue to provide education to our ambulance providers on common errors found through the probe reviews and CERT errors and how to be proactive with their documentation requirements for the upcoming prepayment reviews.
Terri spoke about psychiatric/psychotherapy services and the webcast held in January. The recording is available on the First Coast website. The POE team for Puerto Rico also held a Spanish webcast on Psychotherapy Services (B) on May 11, 2017, discussing results of probe reviews and the LCD for the psychiatric diagnostic evaluation and psychotherapy services coverage and documentation requirements. We are currently monitoring the billing patterns and plan to send focused education letters to newly identified providers in our data analysis that may need additional education in addition to promoting the webcast recordings.
Terri continued with the specialty of cardiology, explaining that we’re renewing the focus on this due to errors that reflect medical policy education is needed, specifically for myocardial perfusion imaging procedures. POE facilitated a webcast in February 2017, on this topic and Puerto Rico POE conducted a Spanish webcast in June 2017. In addition, major enhancements have been made to the specialty page on our English and Spanish provider website.
Even though much of the project team’s focus is Part B, we also continue to monitor the 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. Examples of these CERT errors have been included in our Medicare Speaks Part A Tackling the Complexities of Institutional Medical Documentation class.
POE collaborated with POE AG on enhancements to the resources section of the oncology specialty webpage, standardizing information to include and adding several links to useful First Coast and CMS resources, as well as specialty associations and societies. Additionally, links were added directly to the PWK process article, as this is essential to that specialty. The POE AG member provided the following comments: "This resource list is extremely comprehensive…the most comprehensive list for anything oncology-related."
Our ADR campaign continues this year with education on ways for providers to respond to an ADR effectively, efficiently, and timely. For upcoming events, we have our classes at Medicare Speaks Tampa and the clinical lab ACT coming up September 6, 2017, that will cover the controlled substance monitoring and drugs of abuse testing.
Terri reported with all the efforts that go in to what the project team members do, five of the seven specialties we focused on have had an error rate reduction, with some being substantial, since the 2016 final report.
Evaluation and Management (E/M) subgroup
Charles Johnson provided the updated for this topic. He reminded the group that at the last meeting Kim announced the formation of a new POE AG E/M subgroup as part of the First Coast E/M education strategy. Charles provided a listing of the POE AG members who have volunteered for this group and welcomed other members to join. The purpose of this group will be to improve the education provided for E/M services. Current education includes a webcast held in April that addressed nursing facility E/M services and webcasts have been scheduled for August 9, 2017, that will focus on office visits and documentation and September 5, 2017, which will review emergency room (ER) services and documentation. In addition to webcasts, tip sheets and animations have been created for education in conjunction with our current E/M interactive worksheet. The POE team is looking for ways to move education on E/M in a different direction and this group will review and develop ideas. The first meeting will be scheduled for August 2017.

Project to measure effectiveness of comparative billing reports

Kim provided an overview of this project and advised it was completed in June 2017. A post analysis will be completed in four and six months.

Education Action Team (EAT)

Mary Pita Carrazana reported for EAT. She provided the background of the EAT. She asked for feedback regarding a specific return unprocessable claim (RUC) message for which they have seen an increase. She provided the codes and descriptions as well as the top procedure codes receiving this RUC message.
Claim adjustment reason code (CARC) CO-16: Claim/service lacks information or has submission/billing error(s) which is/are needed for adjudication.
Remittance advice remark code (RARC) M51: Missing/incomplete/invalid procedure code(s).
POE AG members responded that they believe these codes are for required Medicare Advantage plans reporting purposes.

Upcoming educational events

Ursula briefly reported on upcoming education. She advised that Medicare Speaks Tampa was the following week on July 26 and 27, 2017. She then stated that if providers could not make it to Tampa, we would be in Jacksonville in September.

Collaboration with Medicare contractors

Kim summarized First Coast’s recent and upcoming outreach partnerships with multiple external contractors, including the durable medical equipment (DME) MAC, CGS, and the home health and hospice (HHH) MAC, NGS.

Open discussion and announcements

Terri provided a report out for the Social Security Number Removal Initiative (SSNRI), which is now being referred to as the new Medicare card project. She recommended that everyone ensure they received CMS and First Coast list serve messages to obtain the latest information about this project as it is released. First Coast has added resource links to the First Coast provider website.

Educational videos

Kim will send a list of questions regarding this topic to the POE AG members for feedback.

Action items

The following action items were captured during the meeting:
Update FAQ that provides resources for obtaining eligibility to include the timeframes for SPOT and IVR.
In situations where a primary payer requests a refund on a paid claim two to three years later, the provider must submit to Medicare as primary and received timely filing denial that they then appeal. To prevent timely filing denials and then appeals, can the information be submitted with the claim? Is the Part A option for overriding a timely filing denial also available for Part B? Are there any other options available?
Kim will provide members’ suggestions regarding ways First Coast’s PCSP can reduce provider burden to appropriate representatives at First Coast.

Verify all action items and process out

Kim concluded the meeting at 3:30 p.m. The next Part B POE AG meeting is scheduled for November 9, 2017.
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.