Last Modified: 6/23/2022
Location: FL, USVI
Business: Part B
Jean Acevedo, Acevedo Consulting
Teresa Beard, Mayo Clinic Florida
Sandy Bertrand, PhyBill Inc.
Brian Brijbag, Corin USA
Pamela Butler, Sarasota Memorial Health Care System
Holly Cassano, Forensic Healthcare Partners
Kim Corkins, Watson Clinic, LLP
Marina Diaz, CMS
Mary Beth Ferrando, Ph.D., Edward S. Walker MD PA
Samantha Fowler, Clearway Pain Solutions Institute
Susan Fulton, CPC, CPB, Fulton Medical Billing LLC
Gianni Gonzalez, HealthCare Management Solutions
Deborah Hogg, Healthcare Management Consulting
Brian Hollinger, CORA Health Services Inc.
Michelle Jennings, Medical Insurance Services/Consultants, Inc.
Tera Jennings, Norman H. Anderson MD PA
Shelli Johnson, FLASCO
Shirley Knoll, TLC Rehab
Brad Lemmer, Mayo Clinic
Kimberly Mendez- McGee, Emerald Coast Rheumatology
Denise Molloy, CMS
Tara Montgomery, Ascension Sacred Heart Hospital
Jill Paiva, Medicomp, Inc.
Karen Perry, Compulink Healthcare Solutions/Vision Health Institute
Cathy Picillo, Raul Rodriguez, MD PA
Antoinette Puricelli, USF Health PIO
Eric Riker, Gulf Coast Cardiothoracic Surgeons
Donna Smith, Lorraine Molinari & Associates, Inc.
Rachel Spade, Henry Schein Medical Systems Inc. MicroMD
Catherine Todorovich, Innovative Healing Systems
Wilma Torres, Coleman Consulting Group, Inc.
Brenda Tuohey, HealthFirst
Mary Valcoff, Chapters Health
Anna Valdes, Dermatology Medical Partners
Allison Wakeland, Small Surgery Practice & ASC
Linda Zane, PTPN of Florida, Inc.
Charles Johnson, Provider Relations Representative (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 Update
4. Evaluation and management (E/M) Project Updates
5. Prior Authorization Program: Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)
6. Coronavirus (COVID-19)
8. Avoid the Wait campaign
9. New website enhancements: denials pages, PWK
10. CMS video: Cognitive Assessment
11. Upcoming events
12. YouTube updates
13. Open discussion
14. Verify all action items and process out: Next meeting – July 14, 2022
Kim Karnes welcomed everyone to the meeting and First Coast staff introduced themselves.
Kim reviewed action items from the previous meeting. There were no outstanding action items from the previous meeting.
Terri Stanton provided an update on the topics of the ERRP for this contract year. The goal of the project team is to focus on the topics with the highest error rates in our jurisdiction and provide education to reduce the error rates and claim denials. We meet monthly with the medical review staff to collaborate on the best approaches to education.
The topics of focus this year are:
• Diagnostic/Clinical laboratory (carryover) – subject matter expert (SME) Stephanie Scott:
• LCD coverage for drug screenings at the virtual conference April 20-21, 2022
• Psychiatric services (carryover) – SME Stephanie Scott
• Your medical documentation matters virtual conference April 20-21, 2022.
• Ambulance services (carryover) – SMEs Robert Lewis and Cesar Hernandez
• Outpatient therapy (carryover) – SMEs Terri Stanton and Gloria Franceschini
• Physical therapy services (B) at the virtual conference April 20-21, 2022.
New topic: Anesthesia services – SME Gloria Franceschini and Ursula Weaver
• New topic: Echography/ultrasonography – SME Charles Johnson
• Your medical documentation matters virtual conference April 20-21, 2022.
reminded POE AG members to check out the Learning On Demand
, specialty services page for recorded webinars and videos that are posted.
Targeted Probe and Education (TPE) reviews resumed in Sept. 2021. Terri shared that some of the topics of focus on our project team are on TPE review. You can find the list of review topics and specific codes on the medical review page, TPE review topics
, on our provider website. The service-specific reviews
are also listed under the medical review fly-out.
Robert Lewis addressed how revisions to E/M were implemented via the 2022 Final Rule updates, and in May, 2021, certain sections of the CMS internet-only manuals (IOMs) were withdrawn as these updates were being finalized. Updates regarding split or shared services, critical care services, teaching physicians and physician assistants were implemented and the IOMs were updated in February 2022. First Coast will be offering webinars addressing the new guidelines and IOM updates in April during our upcoming virtual conference.
As an example, one update indicates split (or shared) services are not allowed in place of service (POS) 11 (office); instead, ‘incident to’ applies in this location. Over the course of the next year, First Coast will be offering webinars addressing separate categories of E/M (e.g., critical care, nursing facility care) and our Events Calendar
will have these dates and times.
Robert Lewis explained there’s been a change effective April 1, 2022, for RSNAT prior authorization now applies. Providers will submit a coversheet linked on First Coast’s website
, and within 10 days, will receive a response with a unique tracking number (UTN) assigned, whether affirmed or non-affirmed. This UTN should be submitted with the corresponding claim.
The standard process would be for 40 roundtrips (which equals 80 one-way trips) over a 60-day period, with other options and timeframes available at First Coast’s discretion. A webinar is scheduled for March 29th, with additional webinars in the upcoming months.
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 monoclonal antibody (mAb) infusion claims and provide focused education to providers experiencing billing issues; however, the number of referrals have decreased since the task force began. We also provide guidance on our website and in widespread education for billing these services posted to our Coronavirus (COVID-19)
She discussed two specific articles posted in January and February 2022. The first article is Billing Veklury (remdesivir) antiviral medication in outpatient settings
. Following a recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding therapies for the COVID-19 Omicron variant, CMS created HCPCS code J0248 for Veklury (remdesivir) antiviral medication when administered in an outpatient setting. This code is effective for dates of service on or after December 23, 2021, when administered in outpatient settings.
The second article is Billing COVID-19 convalescent plasma in outpatient setting
. On December 28, 2021, the Food and Drug Administration (FDA) revised the emergency use authorization
for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. It’s authorized for treatment of COVID-19 in patients with immunosuppressive disease or getting immunosuppressive treatment, in the outpatient or inpatient setting. CMS created the new HCPCS code C9507 for use in billing the service in the outpatient setting. The article discusses how to bill for this code.
Stephanie provided an update on the topic of provider enrollment. POE continues to have the POE AG provider enrollment subcommittee and the next meeting is scheduled for March 25. If you’re interested in joining the subcommittee, let Stephanie know by sending an email to Stephanie.Scott@fcso.com
. Stephanie will include you on all future communications and invitations.
For provider enrollment, our focus this year will be to update and promote our educational resources. We have discussed at previous meetings the videos being developed. We recently released two videos: Completing the CMS-855O to order and refer Medicare services
and Enrolling in the Medicare Program
. Stephanie completed three scripts for the CMS-855A, 855B, and 855I. These are being sent to the production company and will be posted to our YouTube channel soon.
Stephanie discussed the Avoid the Wait campaign. First Coast has a goal of reducing hardcopy mailings we receive while promoting all the electronic transactions available for our providers. We released the Avoid the Wait Part A
and Part B
infographics in October, 2021, listing different types of correspondence providers may need to submit. Each icon in the infographic is a hyperlink to an article listing the electronic options for the topic. To promote this campaign, we’re holding a webinar series. In January, we hosted a webinar on the overall campaign, highlighting each topic. In February, we hosted a webinar on appeals and claim corrections. The webinar recordings can be found on the Learning On Demand – Basics of billing and appealing
page. We have upcoming webinars on March 31 for provider enrollment and April 28 for claims and financial correspondence. You can register for these webinars from our Events calendar
Charles Johnson provided an update on recent website enhancements.
Paperwork (PWK) segment page
There is a new, enhanced PWK webpage
available in the Medical Documentation section
of our website. PWK is an easy and proactive option for you to submit documentation with your initial electronic claim when you are certain medical records will be requested. This dedicated page
will help you navigate this process.
PWK (Paperwork) is a segment within the 2300/2400 loop of the X12N version 5010 837 Professional and Institutional electronic transactions. PWK allows you to indicate on a Part A or Part B electronic claim that you’re submitting additional documentation via mail or fax. If you know your service will typically result in an additional documentation request (ADR) from us, PWK can help you be proactive and submit the documentation along with your claim.
Please share these resources and pages with your colleagues and peers.
Charles provided information on the CMS Cognitive Assessment video.
Providers eligible to report E/M services can offer Cognitive Assessment & Care Plan Services. If during an annual wellness visit or other visit your patient shows sign of a cognitive impairment, Medicare covers a separate, comprehensive clinical visit for a more detailed assessment and written care plan. CPT code 99483 is for assessment of and care planning for patients with a cognitive impairment like dementia, including Alzheimer's disease, at any stage of impairment
. You will perform and bill CPT code 99483 separately from an annual wellness visit or other E/M service. This service can be provided in an office or other outpatient setting, home, domiciliary or rest home or via telehealth.
Ursula Weaver provided a highlight of the upcoming virtual conference “Your Documentation Matters” scheduled for April 20-21, which focuses on ensuring your medical documentation conforms to Medicare’s requirements and preparing you for claim reviews. We are also planning another virtual conference August 9-10 and our annual Medicare te Informa virtual conference will be held August 16-17. Mark your calendars for those events as well. Marketing and registration for those events will be posted in June. Ursula also highlighted several 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.
Ursula gave a summary of the multiple options and upcoming plans for First Coast’s YouTube platform.
During discussion, a point was made by a POE AG member regarding how events covering billing topics will be most beneficial to provider participants if they are not scheduled at the end of the month, rather mid-month – to avoid conflicting with month end duties within the practice(s). This will be taken into consideration by POE for future event planning.
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.