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Last Modified: 7/26/2022 Location: FL, USVI Business: Part A


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


July 12, 2022

2-3:30 p.m.

External participants
Melissa Burns, Memorial Healthcare Systems
Robinta Calixte, Orlando Health
Marina Diaz, CMS
Dale Gibson, Azalea Health
Margaret Gil, Baptist Health South Florida
Luci Hendrickson
Kayla Morse
Ana Navarrete, Baptist Health
Brenda Tuohey, Health First
Jamille Winters, Orlando Health
Internal participants
Cesar Hernandez, Sr. Provider Relations Representative (PRR), POE
Charles Johnson, PRR, POE
Gloria Franceschini, 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
Review of minutes/action items from prior meeting
2. Error Rate Reduction Project Update
3. Prior Authorization Program (RSNAT)
4. Coronavirus (COVID-19)
5. Provider Enrollment
6. Upcoming events
7. YouTube videos
8. Open discussion
9. Verify all action items and process out: Next meeting – October 11, 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 was one outstanding action item from the previous meeting for providing educational videos on cost outlier claims. Ursula Weaver discussed the request and advised we are working on producing a series of videos to address the various billing scenarios for cost outlier claims.

Error Rate Reduction Project (ERRP) update

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, 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.

Prior Authorization program: RSNAT

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. The UTN will be assigned to indicate whether it’s affirmed or non-affirmed and 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.

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. 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.
One topic we wanted to highlight is the coverage of the over-the-counter tests. This information as released by CMS in MLN Connects that was distributed on May 5. CMS also has created the COVID-19 Over-the-Counter Tests webpage external link where you can locate information on coverage and billing.

Provider enrollment

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 July 15. 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.
For provider enrollment, we continue to update and promote our educational resources. We have discussed at previous meetings the videos being developed. We released three new videos at the end of June: Completing the CMS-855A Enrollment Form to Bill Medicare Part A Services external link, Completing the CMS-855B Enrollment Form to Bill Medicare Part B Services external link, and Completing Medicare's CMS-855I Enrollment Form for Individual Physicians and NPPs external link. Stephanie has completed the script for Enrolling and Submitting Electronic Transactions in the Medicare Program. It has been sent to the production company and we hope to have it posted to our YouTube channel soon.

Upcoming events

Ursula 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 this page and sign up for eNews which highlights our events as we post them.

YouTube videos

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.

Open discussion and announcements

SPOT updates
Cesar Hernandez provided an update on the redesign of SPOT this fall. The redesign will provide users with a more modern look and feel including several feature enhancements. The biggest enhancement is the introduction of a new Claim Submission feature.
This new Claim Submission feature will allow you to upload electronic claim files directly to First Coast through SPOT. The claim files must be created in a separate program and be in the current ANSI X12N 837 5010 format. The PC-ACE software program is also available for free from First Coast to create those files.
With the addition of the new Claim Submission feature, it will require organizations to agree to the provisions for submitting Medicare claims electronically. Organizations that already have access to the SPOT will be required to complete this agreement to access the claim submission feature. Existing SPOT approvers will receive an email that will include a link to the online agreement. This agreement is only needed once for each SPOT submitter ID and can be completed entirely on the website. All existing SPOT organizations must complete this online form to receive access to the new claim submission feature. Also, the current SPOT enrollment form will be updated to include the agreement for any new user requests.
Please stay tuned for additional information that will be communicated soon regarding the updated agreement and when existing SPOT organizations may complete the agreement.
If you are not currently experiencing the benefits of SPOT, access our website for the details on how to register today.
Education suggestions
POE AG members suggested topics for future education including:
Organ transplants
Program changes and implementations
How to export listing of SPOT users
Cesar addressed this question during the meeting and referred to the IDM annual certification article

Verify all action items and process out

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