skip to content
Thank you for visiting First Coast Service Options' Medicare provider website. This website is intended exclusively for Medicare providers and health care industry professionals to find the latest Medicare news and information affecting the provider community.
To enable us to present you with customized content that focuses on your area of interest, please select your preferences below:
Select which best describes you:
Select your location:
Select your line of business:

By clicking Continue below you agree to the following:

LICENSE FOR USE OF "PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY" (CPT), FOURTH EDITION End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2022 American Medical Association (AMA).

All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.
You, your employees, and agents are authorized to use CPT only as contained in the following authorized materials:
Local Coverage Determinations (LCDs),
Local Medical Review Policies (LMRPs),
Bulletins/Newsletters,
Program Memoranda and Billing Instructions,
Coverage and Coding Policies,
Program Integrity Bulletins and Information,
Educational/Training Materials,
Special mailings,
Fee Schedules;

internally within your organization within the United States for the sole use by yourself, employees and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS), formerly known as Health Care Financing Administration (HCFA). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA website. Applicable FARS/DFARS restrictions apply to government use.

AMA Disclaimer of Warranties and Liabilities CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this agreement.

CMS Disclaimer: The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

AMA - U.S. Government Rights

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a )June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

ADA CURRENT DENTAL TERMINOLOGY, (CDT)
End User/Point and Click Agreement: These materials contain Current Dental Terminology (CDTTM), Copyright © 2016 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING ON THE BUTTON LABELED "ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK ON THE BUTTON LABELED "DECLINE" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the ADA website.

Applicable Federal Acquisition Regulation Clauses (FARS)\Department of restrictions apply to Government Use.

ADA DISCLAIMER OF WARRANTIES AND LIABILITIES: CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third party beneficiary to this Agreement.

CMS DISCLAIMER: The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

End Disclaimer


This website provides information and news about the Medicare program for health care professionals only. All communication and issues regarding your Medicare benefits are handled directly by Medicare and not through this website. For the most comprehensive experience, we encourage you to visit Medicare.gov or call 1-800-MEDICARE. In the event your provider fails to submit your Medicare claim, please view these resources for claim assistance.
Join eNews       En Español
Text Size:
YouTube LinkedIn Email Print
Send a link to this page
[Multiple email addresses must be separated by a semicolon.]
Last Modified: 2/12/2024 Location: FL, USVI Business: Part A

MEETING MINUTES

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

(POE AG)

October 31, 2023

2-3:30 p.m.

External participants
Davia Bailey, Centers for Medicare & Medicaid Services (CMS)
Margaret Gil, Baptist Health South Florida
Donna Hamilton, Goldstein Management
Luci Hendrickson, Davita
Shirley Knoll, TLC Rehab
Ana Navarrete, Baptist Health South Florida
Brenda Touhey, Health First
Internal participants
Bradley Bohner, Provider Education Specialist (PES), POE
Charles Johnson, PES, POE
Kimberly Karnes, MAC JN Project Manager
Robert Lewis, PES, POE
Janice Mumma, Supervisor, POE
Brad Plevyak, Manager, Provider Websites
Stephanie Portzline, Manager, Provider Engagement
Ursula Weaver, PES, POE

Agenda

1. Welcome and introductions
Review of minutes and action items from prior meeting
Special announcement
Request for feedback: Enhancements to eNews
1. First Coast educational strategy
2. Provider enrollment news
3. Appeals education campaign
4. Prior authorization program updates
5. Coming soon! – Secure Provider Online Tool (SPOT) enhancements
6. Medicare Spotlight: Behavioral health services
7. Activation of systematic validation edits for Outpatient Prospective Payment System (OPPS) providers with multiple service locations
8. CMS.gov website enhancements
9. Upcoming events
10. Open forum
11. Verify all action items and process out

Welcome and introductions

Kim Karnes welcomed everyone to the meeting, and First Coast staff and POE AG team members introduced themselves.

Review of minutes and action items from prior meeting

Kim reviewed the previous meeting's minutes which the group approved.
Ursula Weaver addressed a previous inquiry regarding return to provider (RTP) reason code 34963, which indicates the attending physician on the claim is invalid or not present in the Provider Enrollment, Chain, and Ownership System (PECOS). Based on the inquiry regarding whether a middle initial is required with enrollment, she explained if not required, it's best not to use the middle initial with enrollment.

Special announcement

Kim advised the POE team will begin reporting to Stephanie Portzline and Janice Mumma, the manager and supervisor from the Novitas POE team. Stephanie and Janice introduced themselves.

Request for feedback: enhancements to eNews

Brad Plevyak explained a new process and format with eNews will be implemented soon, with a change to the layout of eNews. Updates will be made to avoid multiple and repeated emails being sent. He displayed the new layout and requested feedback.

First Coast educational strategy

Kim reviewed the 2023 POE provider satisfaction survey results and explained this feedback has been reviewed for future education topic suggestions. These five topics were identified:
§ Provider enrollment
§ Physical therapy
§ Radiology
§ Medical policy
§ Part A Medicare 101

Provider enrollment news

Brad Bohner reviewed separate updates relating to provider enrollment:
Regarding the 855I application, there is a new Physicians and non-physician practitioners (including clinical psychologists) CMS-855I external pdf file paper application. The revised form was effective September 1, 2023, and expires May 2026. The new form combines the old CMS-855I and 855R paper applications. CMS is expiring the 855R paper application effective November 1, 2023. First Coast will not accept any 855R forms received after this date. CMS added section 4F to the new CMS-855I application to replace the 855R form. Other items and sections were added to the 855I form including two new specialties and acupuncture questions. Brad showed how to access the form via the First Coast website.
While on the First Coast website, Brad showed access to the new "simple guide" tutorials for completing the most common CMS forms, via the 'Tips & Tutorials' section of the Provider Enrollment page.
Brad notified attendees of upcoming enhancements to the Provider Enrollment home page, including new areas and widget boxes on the landing page as well as updated content to improve users’ experience.

Appeals education campaign

Brad explained in September, an Appeals educational campaign for Medicare Parts A and B was initiated. This included new redetermination request forms, tutorials, and a tip sheet on medical documentation submission. He demonstrated links to the documents on the Appeals page of the First Coast website.

Prior Authorization program updates

Robert Lewis provided an update on the outpatient department (OPD) prior authorization (PA) program, reviewing a new category of services included in the PA process starting in July: facet joint interventions. Multiple webinars have been provided to cover this recently added service, including review of the LCD guidelines relating to facet joint interventions.
Based on recent data, attention has been given to assisting providers to make sure their submissions for prior authorization are affirmed. The PA process is specific regarding submission of coversheets and related documentation, and identification of the point of contact if a response is needed. A helpful article is available on the Prior Auth webpage. Robert demonstrated the pathway to the article and additional resources on the First Coast Prior Authorization page for OPD services.
Additional webinars are planned with the next OPD webinar scheduled for December 7.

SPOT enhancements

Cesar Hernandez announced the new redesigned SPOT will be implemented December 4. A new claim submission feature is also coming soon, providing the ability to submit electronic claim files through SPOT. To prepare for this feature, existing users should complete the SPOT claim submission agreement today if you have not done so already. For anyone not yet enrolled, you can access the SPOT webpage to learn more.

Medicare Spotlight: behavioral health services

Charles Johnson shared that Medicare covers behavioral, mental, and psychiatric health services which may improve outcomes for Medicare patients and provided an overview.
Overview of Behavioral Health Integration (BHI) Services, Psychotherapy for Crisis, and Opioid Use Disorder (OUD) Screening & Treatment
BHI is a model of care incorporating behavioral health care into other care, like primary care, to improve mental, behavioral, or psychiatric health for many patients. These BHI services may be particularly helpful for patients who aren’t improving under other models of care.
BHI includes Psychiatric Collaborative Care Model (CoCM) and general BHI services.
These services are appropriate for patients in high distress with life-threatening, complex problems requiring immediate attention. These services can help reduce a patient’s mental health crisis (including substance use disorder [SUD])
Includes Screening, Brief Intervention & Referral to Treatment (SBIRT) external pdf file [an evidence-based, early intervention approach for people with non-dependent substance use before they need more specialized treatment], office-based SUD services and Opioid Treatment Program (OTP)
New education campaign
Letters were recently mailed to all active physicians and non-physician practitioners to help promote these covered services and provide details and resources available to assist with more information. The letter details were included in change request (CR) 13389 external pdf file.
First Coast published an article detailing each of these services with links to resources, including valuable information and references for your patients.
First Coast will include information on these services in upcoming education throughout 2024.

Activation of systematic validation edits for OPPS providers with multiple service locations

Ursula reminded providers it is imperative they keep their enrollment records up to date to prevent claim rejections. Be sure ownership information is consistent across all enrollment records under one tax identification number (TIN). If an individual or organization has 5% or more partnership or indirect or direct ownership in your organization, they must be listed on all enrollment records under your TIN. If you need to perform a change of information to update your ownership information, you can update it online through PECOS or download a paper-based application.
Verify your practice addresses in PECOS. If any locations are not in PECOS, submit the CMS-855A enrollment form to add locations. Ensure your enrollment information is up to date and claim submissions reflect practice locations exactly as they appear from the practice location address screen received from PECOS and viewed in the Fiscal Intermediary Standard System (FISS) under 'Short Cut 1D Provider Practice Address'. Ensure claims are submitted with the practice location listed in direct data entry (DDE) and PECOS (e.g., Road vs. Rd, Suite vs. Ste. etc.). Include special characters if listed in the address.

CMS.gov website enhancements

Ursula advised CMS is committed to easing providers’ burdens and heard requests to make the website more user friendly. CMS enhanced the search feature on the website and the redesign is more appealing. Ursula demonstrated the CMS website enhancements.

Upcoming events

Ursula highlighted upcoming 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.

Open forum

No additional discussion.

Verify all action items and process out

Follow up to inquiry regarding ESRD compounded drugs: do they fall into a functional category and composite rate (i.e., are related claims separately payable or are they included in a bundled rate?)
The next meeting is March 19, 2024. 
Kim concluded the meeting at 3:30 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.