Last Modified: 11/28/2022
Location: FL, USVI
Business: Part B
Raul Alicea, CMS
Davia Bailey, CMS
Lisa Ball, Conviva
Teresa Beard, Mayo Clinic Florida
Sandy Bertrand, PhyBill Inc.
Brian Brijbag, Corin USA
Holly Cassano, Forensic Healthcare Partners
Nancy Farrington, Foundational Health Center-Dr. John Young
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
April Hicks, Baptist Medical Center
Deborah Hogg, Healthcare Management Consulting
Bryce Hollinger, CORA Health Services Inc.
Michelle Jennings, Medical Insurance Services/Consultants, Inc.
Tera Jennings, Norman H. Anderson MD PA
Jim Lennie, Florida Pain Physicians
Kimberly Mendez- McGee, Emerald Coast Rheumatology
Christina Negron, Radiology Associates of Venice, and Englewood
Cathy Picillo, Raul Rodriguez, MD PA
Antoinette Puricelli, USF Health PIO
Eric Riker, Gulf Coast Cardiothoracic Surgeons
Carin Smith, Lakeview Center Inc.
Donna Smith, Lorraine Molinari & Associates, Inc.
J. Sotelo, USF Health
Brenda Tuohey, HealthFirst
Anna Valdes, Dermatology Medical Partners
Allison Wakeland, Small Surgery Practice & ASC
Linda Zane, PTPN of Florida, Inc.
Gloria Franceschini, Provider Relations Representative (PRR), 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 Update (ERRP)
4. Evaluation and management (E/M) Updates
5. Prior Authorization Program: Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT)
6. Coronavirus (COVID-19)
8. Cognitive Assessment & Care Plan Services
9. Upcoming events
10. YouTube updates
11. Open discussion
12. Verify all action items and process out: Next meeting – Oct. 13, 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 CERT error rates in our jurisdiction and provide education to reduce error rates and claim denials. POE meets monthly with the medical review staff to collaborate on the best approaches to education.
The project topics of focus this year are:
• Diagnostic/clinical laboratory – Subject matter expert (SME) Stephanie Scott:
• Psychiatric services – SMEs Stephanie Scott and Cesar Hernandez
• Ambulance services– SMEs Robert Lewis and Cesar Hernandez
• Outpatient therapy – SMEs Terri Stanton and Gloria Franceschini
Anesthesia services – SMEs Gloria Franceschini and Ursula Weaver
• Echography/ultrasonography – SME Charles Johnson
Thus far for the calendar year through June 2022, the POE team has facilitated 12 events on these topics, with more come through the end of the calendar year. In addition to the events, we also publish articles, videos, FAQs and maintain provider specialty pages to help ensure a reduction in claim denials on topics of focus.
Terri also shared that some of the topics on our project team are on targeted probe and educate (TPE) review and we’ve conducted or scheduled events for inpatient rehabilitation facility services, ophthalmology services and cataract surgery coverage requirements, and TPE. You can find the list of review topics and service codes on the medical review page, TPE review topics
, on our provider website. The service-specific reviews
are completed and listed under the medical review page. Results of those reviews are posted.
Robert Lewis provided an update on E/M. Robert stated that this topic and code category continues to be at the top of the list when it comes to our plans for outreach and education. Since our last meeting we’ve had multiple updates and events. In March there was a webinar addressing the nursing facility LCD, and in April webinars addressing critical care. During our Medicare Documentation Virtual Conference in April, we covered office and outpatient services, along with a session on the Final Rule updates for 2022, where we addressed split or shared service updates. We have a class specifically addressing split or shared services scheduled for next month’s Medicare Speaks conference. Also, regarding split or shared, we recently posted a helpful article on our E/M webpage addressing the split/shared Medicare updates.
For the remainder of the year, we’ve planned events addressing Cognitive Assessment and E/M modifiers in August, Chronic Care management and ER in September, Observation services in October and an “ER to discharge scenario” webinar slated for December.
Throughout these events, topics such as split or shared, prolonged services, modifiers, annual wellness visits are included. The CMS PFS Proposed Rule has been submitted (filed on July 7, scheduled for publication on July 29th) and is open for comments. Later this year when the MPFS Final Rule is published, we’ll provide outreach and education accordingly.
Robert Lewis provided an update on RSNAT. Since our last meeting in March, this program was effective April 1 and has been impacting the ambulance provider community.
The RSNAT prior authorization means providers will submit a coversheet for these services and within 10 days will receive a response with a unique tracking number or UTN that will be assigned to indicate whether it’s affirmed or non-affirmed, and 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. We offered six separate webinars over the past six months in English and Spanish, and recordings are available on our website. And we have a page devoted to RSNAT
with helpful links on our provider website.
The Prior Authorization team as provided feedback relating to data that’s available so far, and this relates to common issues that have been identified with submissions for prior authorization and responses to documentation requests. The team has asked me to reinforce that with ambulance documentation for RSNAT, a physician certification statement is required, but that alone is not sufficient. All documentation relating to the service must be submitted, and this applies to initial submissions and additional documentation requests or ADRs when more information is requested, meaning with a re-submission, don’t just submit what was missing. The initial submission in addition to what was missing should be re-submitted the second time.
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. The number of referrals has continued to decrease each month since the task force began. We also provide guidance on our website and in widespread education for billing these services that are posted to our Coronavirus (COVID-19)
webpage. Also, as new information is released from CMS and new vaccines and mAbs are approved for Emergency Use Authorization, we update our COVID-19 billing resources.
Stephanie Scott 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 July 15. 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.
Charles Johnson provided information on the Cognitive Assessment & Care Plan Services. The services can be provided by any provider who provides primary care evaluation and management of patients. He shared details including how to get started, how to bill for the services, where the services can be performed and the patient responsibility. He also shared where to get additional information, including a section on the First Coast E/M page and where to learn more about cognitive assessment & care plan services
on the CMS site. You can also access a CMS video
for basic information on coverage, eligibility, and billing for the services.
Charles also informed the group that POE would be hosting a webinar August 31 to provide the details and take provider questions.
Ursula Weaver provided a highlight of the upcoming virtual conference Medicare Speaks August 9-10 and Medicare te Informa August 16-17. Ursula also highlighted several webinars from the events calendar. We are constantly adding new webinars to the calendar
so be sure to bookmark the calendar of events and sign up for eNews
which highlights our events as we post them.
Kim provided updates on our YouTube videos. The YouTube page was shared during the highlights. Kim shared that the goal is to have 1,000 subscribers and shared the different playlists. We achieved close to 11,000 views since launching our YouTube channel. Our goal of these videos is to create time effective education on topics in demand.
Kim asked members for insight on outsourced billing vendors and why they may contact Medicare Customer Service with inquiries that can be easily answered via self-service meetings if the information was needed.
No action items from the meeting.
Kim concluded the meeting at 3:10 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.