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Last Modified: 7/12/2018 Location: FL, USVI Business: Part B


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

Thursday, November 9, 2017

2:00-3:30 p.m.

External participants
Jean Acevedo, Acevedo Consulting Incorporated
Angela Amey, Trident USA
Shelly Asbury, Advize Health
Davia Bailey, Centers for Medicare & Medicaid Services (CMS)
Shane Carter, Palmer College of Chiropractic
Philip Choung, Nature Coast Orthopaedics
Rosanna Crawford, Mobile Imaging of St Lucie Co. Inc.
Tiffany Drake, Orthopedic Specialists of SW Florida
Alan Duretz, Phybill,Inc.
Jennifer Erskin, Florida Medical Reimbursement Services
Nancy Farrington, Foundational Health Center
Michelle Flowers, Oncology Managers of Florida
Gianni Gonzalez, Healthcare Management Solutions
Cindy Hambidge, Atlantic Orthopaedic Group
April Hicks, Baptist Primary Care
Deborah Hogg, Navigant
Shirley Knoll, TLC Rehab Inc.
Rachel Lewis, Henry Schein Micro MD
Susan Lukens, UF Shands
Holly Martin, Nature Coast EMS
Barbara McIntyre, High Springs Medical Center
Tom McNeil, Premier Dermatology LLC
Celia Myres, Excel Hospitalist Partners
Kim Norris, Family Care Partners
Lillian Omalley, Act Corporation
Donna Osso, Alliqua BioMedical
Jill Paiva, Medicomp Inc
Valarie Prusia, Prusia Medical Practice Consulting
Jeannie Randhan, CPC, Orlando Health Physician Partners
Eric Romanelli, Physical Therapy 4 U Inc.
Pamela Schulman, Halifax Health
Samir Shah, Accumax Systems, Inc.
Wilma Torres, Coleman Consulting Group, Inc.
Brenda Tuohey, Health First
Allison Wakeland, Riverwalk Ambulatory Surgery Center
Kessem Winger, CORA
Linda Zane, Physical Therapy Institute
Internal participants
Charles Johnson, Provider Relations Representative (PRR), Provider Outreach and Education (POE)
Gloria Franceschini, PRR, Triple-S
Kimberly Karnes, Manager, POE
Cara Page, PRR, Data Analysis and Compliance (DAC)
Mary Pita Carrazana, PRR, DAC
Stephanie Scott, PRR, POE
Terri Stanton, Sr. PRR, POE
Robert Stroud, eCurricula Development Specialists, Learning Solutions Center
Ursula Weaver, PRR, POE
Mark Willett, Manager, Medicare Websites and Provider Self-service Technologies
Leslie Brinson, Supervisor, Provider Customer Service


1. Welcome and introductions
2. Review of minutes and action items from prior meeting
3. Hurricanes Harvey, Irma and Maria and administrative relief efforts
4. First Coast’s self-service technologies
5. Education Action Team (EAT)
6. Customer Service update
Qualified Medicare Beneficiary (QMB) Program
Tips on calling Customer Service
7. Provider Outreach and Education Strategy
Year in review for improper payment reduction, evaluation and management, provider enrollment
Suggestions for 2018 – evaluation form
8. Open discussion and announcements
New Medicare card project – Terri Stanton
Targeted Probe and Educate (TPE) Process – Kim Karnes
Upcoming educational events – Ursula Weaver
9. 2017 Medicare Administrative Contractor Satisfaction Indicator
10. Verify all action items and process out
Next meeting March 8, 2018

Welcome and introductions

Kim Karnes welcomed everyone to the meeting and completed the review of the agenda.

Review of minutes and action items from March 9 meeting

Kim showed participants where the previous meeting’s minutes can be found. She also reported out about the action items:
The beneficiary eligibility and claim status frequently-asked question was updated with the timeframes information reverts back.
Medicare secondary payer prior year’s recoupment timely filing denials can only be resolved through the appeals process.
Kim asked for feedback about how we can improve our service to the provider community and all the comments given were shared with the appropriate departments.

Hurricanes Harvey, Irma and Maria and administrative relief efforts

First Coast and CMS responded rapidly to the recent natural disasters that hit our jurisdiction. Kim shared the administrative relief efforts orchestrated by CMS and First Coast. To read more about the available waivers and relief provisions, visit our disaster information webpage.

First Coast’s self-service technologies

Mark Willett provided some important dates to be aware of for the Secure Provider Online Tool (SPOT):
Beginning January
First Coast will be scheduling interactive, face-to-face presentations to providers’ offices that have an interest in getting their staff members signed up for SPOT. The presentation will detail the advantages of using SPOT to reduce administrative costs through efficiencies. Additionally, the facilitators will assist office staff through the registration process as needed. These sessions will be conducted with both Part A and Part B providers.
April 1, 2018
The health insurance claim number (HICN) field will be replaced with Medicare ID. The value used on the claim submission, HICN or Medicare beneficiary identifier (MBI), will displayed under this heading on all claims-associated displays on SPOT.
April 16, 2018
Users will be able to track and see the status of their additional documentation requests (ADR) that are associated with medical review. This additional functionality is being implemented to support the Target, Probe and Educate (TPE) approach.
June 1, 2018
An MBI/HICN lookup will be available on SPOT. Users will be able to submit a beneficiary's HICN and have the associated MBI returned to them if one has been issued.
Mark concluded by providing a demonstration of the new local coverage determination (LCD) search features available on the English and Spanish provider websites.

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. She reminded the members that anyone interested in joining the provider enrollment POE-AG subcommittee may notify her via email at
The project team will continue to focus on education regarding Internet-based Provider Enrollment and Chain Ownership System (PECOS) as well as the Identity & Access (I&A) system. The option for requesting appointments is still available on our events calendar. On October 25, she conducted a webcast that focused on getting started with PECOS and registering in I&A. If you were not able to attend the webcast, the recording is currently available from our website.
We’ve continued to educate on revalidation, as necessary, and will continue to educate on any issues we see as a constant problem with those applications, based on trends with the applications received.
Also, we have the Provider Enrollment section of the First Coast provider website that we have continued to review and enhance as we receive feedback or as changes are released from CMS.
Medical documentation
Terri Stanton provided an update for the medical documentation project team.
Since our last meeting the medical documentation project has focused on specialties based on our strategy that have a high error rate nationally, as well as within our jurisdiction, that contribute most to the Comprehensive Error Rate Testing (CERT) program error rate. Most of the errors are due to insufficient documentation.
Continuing with a focus on the specialty clinical laboratory, specifically drug assays and substance abuse screening, Stephanie facilitated a webcast on September 6 that focused on specific drug screening codes with high error rates and the LCD requirements for controlled substance monitoring and drugs of abuse testing. The event was marketed publically; however, more than 150 invitational letters were mailed to the top ordering or referring providers of the drug monitoring codes recommending they attend the webcast. And as always, the recording of the event is posted to our website for those that were unable to attend.
For our ambulance services specialty, our educators in Puerto Rico hosted an ambulance services webcast in Spanish on September 15. The webcast addressed the documentation requirements for non-emergency ambulance services, specifically the ADR process, the LCD sections for indications and coverage guidelines, medical review data, and an overview of the emergency services requirements. Invitational letters were mailed to the ambulance suppliers in Puerto Rico requesting they attend the event.
The project team also continues to monitor the outpatient hospital type of bill 13X; concentrating on the specific types of insufficient documentation errors we are seeing for those services in our CERT feedback files. Also with a Part A focus, one of the outlier topics of the team is inpatient rehabilitation facilities or IRF. Ursula facilitated a webcast on October 4 that focused on the medical documentation IRFs must obtain and sustain in the patient’s medical record such as the preadmission screening, post-admission physician evaluation, overall plan of care, admission order, and the IRF patient assessment instrument (IRF-PAI).
Another topic included at Medicare Speaks in Jacksonville was Safeguarding the Integrity of Electronic Health Records (A/B). Topics of the class included OIG report findings on vulnerabilities in EHR, benefits and features of EHR, amendments, corrections and industry suggestions to managing audit trails, as well as recommendations for maintaining integrity of medical records. A CMS case study was also included in the class discussion to relate inappropriate access to PHI back to the key elements of the presentation.
And our ADR campaign still continues this year with education on ways for providers to respond to an ADR effectively, efficiently, and timely. In addition to including material about responding to an ADR in our events, we also included a class on Responding to Requests for Medical Records (A/B) at our Medicare Speaks last month. Topics of the class included an overview of Medicare improper payments (CERT), Medicare review contractors, methods and timeframes for responding to ADRs, how to be proactive in your practice or facility in the event of a review, and additional helpful online resources.
Lastly, the project team’s efforts are continuing to show progress with most specialties showing an error rate reduction and we’re on target to exceed error rate projections overall for our jurisdiction. The final CERT 2017 report should be out soon.
Evaluation and Management (E/M) subgroup
Charles Johnson reported that this year, the E/M project team focused on reduction in errors that was reported on our medical review (MR) strategy for 2017. We approached this reduction through widespread education by hosting webcasts, concentrating on those key areas within E/M that were most challenging or problematic.
We've hosted four webcasts and have two more scheduled before the end of the year, with a focus on nursing facility visits, office visits and hospital care, documenting office visits and emergency room services, as well as selecting and documenting critical care and hospital care services. To date, we have reached approximately 300 provider organizations through the live webcasts and recordings.
On November 16, we will hold our POE AG E/M subcommittee meeting, where we will discuss our goals for next year, how we can enhance our current offerings, and create or improve our additional E/M training and website tools. If you are not currently a member of the subcommittee and would like to have more information on it, please email Charles directly at

Education Action Team (EAT)

The Education Action Team (EAT), led by Christine Cubillan, is one component of First Coast’s data driven education strategy. It is comprised of a cross divisional group of representatives that analyzes current data trends, to identify the root cause for the top 10 non-medical review claim submission errors and the telephone/written inquiries. The goal of the EAT is to develop and implement educational plans in an effort to reduce these billing errors and inquiries.
Cara Page gave an update regarding the EAT’s educational plans for 2017, explaining that the team will continue to deliver focused education to providers with a significant non-MR claim error rate, via mail and phone calls. Each month EAT reviews data and continues to find our top denials are consistently related to the National Correct Coding Initiative (NCCI) and other types of procedures classified as “bundled codes”. In addition, our top return unprocessables (RUCs) are due to billing invalid procedure codes and entitlement issues for beneficiaries that are enrolled in Medicare Advantage Plans. We see approximately three million claim submission errors each year for these reasons alone. Duplicate billing is still the top denial with nearly two million claim submission errors each year.
Since our last POE AG meeting held on July 20:
We finished up the year conducting face to face education at our annual Medicare Speaks events in Tampa (end of July) and right here in Jacksonville in (mid-October). Based on the data, which drives the education we provide, our focus this year was on how to recognize and prevent the top Part B claim submission errors, with an emphasis that prevention does start with you-you the provider, billers, coders, front end to back end staff in your office practice.
We’ve also focused on the importance of using the self- service tools on our website to aid in error prevention. As mentioned by Mark, get registered for SPOT and see for yourself all the great information it provides and of course being signed up for First Coast eNews to keep up with the latest Medicare news and upcoming educational events.
We would appreciate any feedback you may have today for enhancing any of our educational products, or we welcome any suggestions for any upcoming education you feel would benefit our provider community in collaborating together in this educational effort to help drive down these significant claim error volumes.
To submit ideas regarding topics or suggestions on reducing related errors, please email Christine at

Customer Service update

CMS has issued two MLN Matters Article SE1128 and MM9911. MM9911 implemented a change in the remits for QMBs.
Providers cannot bill QMB patients for deductible nor coinsurance (regardless of whether Medicaid pays or not).
OA 209 will print on remits instead of patient responsibility.
Make sure billing companies/clearinghouses/vendors are aware of this change to the remits.
The ESRD Network Support Adjustment (CO 118) that stopped printing on remits with the implementation of CR9911 will be corrected next month.
The IVR has been updated to not release deductible information for QMBs.
A concern that a couple providers brought up was QMBs that also have a supplemental insurer. The provider has to manually calculate the patient’s deductible and coinsurance so the supplemental insurer will process the claim. This concern has been brought to CMS’ attention.

Provider Outreach and Education Strategy

2016 MAC Satisfaction Indicator (MSI) action plan

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.

Open discussion and announcements

2017 Medicare Administrative Contractor Satisfaction Indicator
Kim thanked all that participated in the survey and announced that First Coast’s overall satisfaction score increased by two points from last year to 65 and this score was three points higher than the national average for all contractors. The POE team scored the highest of all contractors with 76 points.
New Medicare card project
On October 2, First Coast as well as other contractors mailed out the provider notification letters along with a brochure about the new Medicare cards. In a September press release, CMS unveiled the first view of the new Medicare card that no longer contains the gender or the signature line of the recipient. To learn more about the new Medicare card project, our Provider Outreach & Education will be hosting a webcast on November 14, 2017, from 11:30 to 12:30.
POE has been educating on this topic since the fall of last year and Terri reported that information on the new Medicare cards has been included in 38 events thus far, and the topic will be included in nine more events through to the end of the year, including the webcast.
CMS is also ramping up its beneficiary outreach which began with the “Guard your card” campaign that you may have seen on television prior to open enrollment, as well as announcing the new Medicare cards inside the front cover of the new Medicare & You handbook for 2018. CMS will be publishing materials for providers to order and hand-out to their patients as well as posters to hang in your offices to bring awareness to your patients. You’ll learn more about those materials in the November 14 webcast as well as other ways you can be helping your Medicare patients and help your offices or organization be prepared.
Targeted Probe and Educate Process
Kim provided an overview of the TPE initiative and the goal to reduce provider burden.
Kim explained that the TPE review and education process includes a review of 20-40 claims followed by one-on-one, provider-specific, education to address any errors with in the provider’s reviewed claims. Providers with moderate and high error rates in the first round of reviews will continue on to a second round of 20-40 reviews, followed by additional, provider specific, one-on-one education. Providers with high error rates after round two will continue to a third and final round of probe reviews and education.
Providers with continued high error rates after three rounds of TPE may be referred to CMS for additional action. Providers may be removed from the review process after any of the three rounds of probe review, if they demonstrate low error rates or sufficient improvement in error rates, as determined by CMS.
Upcoming educational events
Ursula reported on upcoming events through the remainder of the year by reviewing our events calendar.
On November 14, Terri will be facilitating a webcast on the new Medicare cards making sure you are ready for the transition. On November 15, Stephanie will be providing information on “How to register for PECOS I&A system.” On December 6, POE is collaborating with KEPRO, the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO) to facilitate a webcast to help you better help our Medicare beneficiaries. On December 6, POE has a webcast on MSP for institutional providers. On December 12, POE will have the quarterly Medicare Changes and Regulations Part A webcast. And lastly, December 14, Stephanie is facilitating a webcast on the Targeted Probe and Educate (TPE) strategy. All of these events are free of charge but you must register to attend.

Verify all action items and process out

Action items
Kim noted providers interested in SPOT training
One member will contact Mark Willett if she has issues pulling CBR at the provider level
Kim to send link to QMB articles
Kim will follow-up with one member regarding ideas for MSP education in addition to what is currently available
Kim concluded the meeting at 3:30 p.m. The next Part B POE AG meeting is scheduled for March 8, 2018.
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.