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Last Modified: 7/10/2022 Location: FL, USVI Business: Part B


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

Thursday, November 4, 2021

2-3:30 p.m.

External participants
Jean Acevedo, Acevedo Consulting, Inc.
Olivia Hope Acosta, ARMA
Teresa Beard, Mayo Clinic Florida
Pamela Butler, Sarasota Memorial Health Care System
Shane Carter, Palmer College of Chiropractic
Lea Castelli, BHSF
Kim Corkins, Watson Clinic, LLP
Mary Beth Ferrando, Ph.D., Edward S Walker MD PA
Susan Fulton, Fulton Medical Billing LLC
Deborah Hogg, Healthcare Management Consulting
Shelli Johnson, FLASCO
Brad Lemmer, Mayo Clinic
Sandra Miller, Tampa General Hospital
Phyllis Murray, AAPC/University of Florida Jacksonville Physicians Inc
Christina Negron, Radiology Associates of Venice and Englewood
Jill Paiva, Medicomp, Inc.
A Puricelli
Eric Riker, Gulf Coast Cardiothoracic Surgeons
Eric Romanelli, Physical Therapy 4U
Angie Shaw, Mayo Clinic
Donna Smith, Lorraine Molinari & Associates, Inc.
Rachel Spade, Henry Schein Medical Systems Inc.
Catherine Todorovich, Innovative Healing Systems
Wilma Torres, Coleman Consulting Group, Inc.
Brenda Tuohey
Allison Wakeland, FYZICAL LLC
Linda Zane, PTPN of Florida, Inc.
Internal participants
Gloria Franceschini, Provider Relations Representative (PRR), Provider Outreach and Education (POE)
Cesar Hernandez, Sr PRR, POE
Charles Johnson, PRR, POE
Kimberly Karnes, MAC JN Project Manager, POE
Robert Lewis, PRR, POE
Stephanie Scott, PRR, POE
Terri Stanton, Sr PRR, POE
Ursula Weaver, PRR, POE


1. Welcome and introductions
2. Review of minutes/action items from prior meeting
3. Error Rate Reduction Project
4. Coronavirus (COVID-19)
5. Provider enrollment update
6. Cognitive assessment and care plan services (B)
7. Prior authorization program updates
8. What’s new with SPOT
9. Recommendations to Billing and Claims Resource website pages
10. New campaign! Avoid the Wait
11. Virtual conference, upcoming events and recommended topics for next year
12. Open discussion
13. Verify all action items and process out: Next meeting – March 24, 2022

Welcome and introductions

Kim Karnes welcomed everyone to the meeting and First Coast staff introduced themselves.

Review of minutes/action items from prior meeting

Kim reviewed action items from the previous meeting. There were no outstanding action items from the previous meeting.

Coronavirus (COVID-19)

Stephanie Scott provided the COVID-19 update. She advised that First Coast continues to have the task force with Novitas. Under the task force, we receive referrals for education on vaccine and mAb infusion claims and provide focused education to the providers experiencing billing issues; however, the number of referrals has decreased over the past two months. We also provide guidance on our website and in widespread education for billing these services that are posted to our Coronavirus (COVID-19) webpage.
We received notification of two processing issues under Part A. The first issue was related to mAb infusion claims returning for reason codes 32415 or 31498. The second issue was related to reason code 32287 on inpatient claims with 12X specifically for HCPCS code Q0249 when billed with more than one unit. These issues have been resolved and providers can resubmit the claims for processing. We have not received notification for recent processing issues under Part B. As we are notified of processing issues or the need for education, we’ll continue to add this to our website and distribute via eNews.

Provider enrollment update/data project

Stephanie Scott provided an update on the topics of provider enrollment. POE continues to have the POE AG provider enrollment subcommittee and the next meeting is scheduled for November 5. If you’re interested in joining the subcommittee, let Stephanie know by sending an email to Stephanie will include you on all future communications and invitations.
Stephanie continues to work on the data project. Our current focus is on provider enrollment videos on each enrollment application and the overall process. The first two video scripts, CMS-855O and enrollment process, have been sent to the production company for creation. Stephanie is starting to work on three more scripts for the CMS-855A, 855B, and 855I. She will share these with the subcommittee during the draft process for their feedback.

Cognitive assessment & care planning services

Charles Johnson informed the members about a section recently added to our Evaluation and Management (E/M) Center webpage titled "Cognitive Assessment & Care Planning Services." If a Medicare patient shows signs of cognitive impairment during a visit, Medicare covers a separate visit to assess the patient’s cognitive function more thoroughly and develop a care plan, using CPT code 99843 to bill for this service.
Charles provided an overview of the services external link including how to get started, how to bill for the services, where the service can be performed, what the patient financial responsibility is and where to get additional information and answers about these services external link. Charles asked the members to share this information and resources with their peers and colleagues.

Prior authorization for certain outpatient department (OPD) services

Cesar Hernandez provided an update on Prior Authorization. Within the last six months, effective July 1, two new service categories were added to the program: cervical fusion with disc removal and implanted spinal neurostimulators. There are now seven separate service types that require a prior authorization request or PAR to be submitted for affirmation before the procedures are performed in the hospital outpatient department.
Our prior authorization webpage has detailed information and links to items such as the coversheet examples and instructions, documentation guidelines and local coverage determinations that can assist in avoiding errors.
Also, over the last year, an exemption process has been developed to allow providers that have proven, and maintained, based on their affirmation rates, that they can be exempted from having to submit PARs. Please note that the exemption requirements, timeframes, and deadlines are currently undergoing a review and may be changed to facilitate the exemption process soon. The current timeframes are available on our website.
A webinar will be presented soon to review these updates once they’re finalized. Be sure to stay turned to our eNews to know when.

What’s new with SPOT

Cesar briefly spoke about what is on the horizon for SPOT. The first change going into place before the end of the year is a HIGLAS application programing interface or API. This communication channel with the national CMS financial system will allow our SPOT users to review in real time details on accounts receivables and related transactions. You will be able to download copies of demand letters. These functions will be available in the current payment data menu.
The other change, that is very exciting, is the redesign of the user interface look and feel. This change will enhance your experience using SPOT, the interface will be more intuitive and easier to use. It will provide new capabilities such as claim submissions, the retrieval of EDI reports like the 277CA and your remittance advice. We expect this enhancement to go into production by the end of the first quarter in 2022.

Recommendations to billing and claims resource website pages

Cesar also shared with the group is regarding the possible modifications of our billing, coding, and claim webpages. There are lots and lots of information on these pages, and we wanted to hear from you relative to frequency of use, ease of navigation and what do you think should change. Are you able to find the information you need using the current formatting or would you prefer to see a more graphical design that may help you find the things you need quicker? Julie issued a communication to the members few weeks ago asking you to review these pages. Cesar asked the group for recommendations. None were provided.

New campaign! Avoid the Wait

Stephanie discussed the new Avoid the Wait campaign. First Coast has a goal of reducing the hardcopy mailings that we receive while promoting all the electronic transactions available for our providers. We created new Avoid the Wait Part A and Part B infographics on our website listing the different types of correspondence providers may need to submit. Each icon is a hyperlink taking you to an article which lists all the electronic options for the topic. You can access the infographics from the banner on the homepage and we’ve included icons on several related pages, including the webpages for Appeals, LCDs/Medical Affairs, Medical review, and Provider enrollment news. As we move forward with the campaign, we’ll highlight a specific topic each month and continue to send the information out in eNews.

Virtual conference, upcoming events and recommended topics for next year

Ursula Weaver spoke about our virtual conferences and what type of classes we will offer for next year. This year’s conferences were a great success, and we are hoping the same for next year. We sent a survey out to all members and asked for your input on topics for next year. We received some great responses back and we will take them under consideration as we begin our planning. Thank you to all that responded. She highlighted some of the upcoming webinars on the events calendar. So, if you haven’t had a chance to review the calendar or sign up for these upcoming webinars, don’t hesitate. We appreciate your attendance and feedback for each of our sessions.

Open discussion and announcements

Terri advised the group that we will be facilitating a webinar on the final rule December 16. Marketing will be available soon on the website. A provider spoke about an issue they are seeing with claim denials for diagnosis code Z184 for COVID testing. Cesar asked the provider to submit claim samples for review. Kim asked everyone on the call to become a subscriber to our YouTube external link channel.

Verify all action items and process out

No action items from the meeting.
Kim concluded the meeting at 3:00 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.