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Last Modified: 7/23/2024 Location: FL, USVI Business: Part A

Florida and U.S. Virgin Islands Part A POE-AG minutes -- March 19, 2024

Jurisdiction N
Medicare Part A
March 19, 2024

Welcome and introductions

Janice Mumma, supervisor, welcomed the members and reviewed current committee guidelines.
Janice advised the purpose of the Provider Outreach and Education Advisory Group (POE-AG) is to assist the contactor in the creation, implementation and review of provider education events. We conduct this meeting to allow provider feedback on training topics, provider education materials, and dates and times of provider education events.

Prior quarter activities

The most and least attended prior quarter activities were reviewed, and feedback was requested. The group discussed the attendance at the prior webinars.

Next quarter activities

The upcoming activities for the remainder of March 2024 were reviewed. April calendar is in development and will be posted soon. A question was received asking about dental services, and if Medicare is starting to cover more than they used to. Janice and Cesar Hernandez advised that dental services may be covered if they meet the requirements and they must be linked to another service/situation.

CMS activities

Janice reviewed the redesigned CMS website. Janice reviewed the CMS homepage, search feature, Medicare dropdown, CMS Newsroom Press Release, external link and Transmittals external link. Please email Janice Mumma at Janice.mumma@novitas-solutions.com if you would like any additional information or would like to see education regarding any of the items listed on either of these pages.

Comprehensive error rate testing (CERT)

The CERT information on the First Coast website was reviewed. First Coast has compiled resources and developed checklists to help guide you when responding to CERT documentation requests. The CERT information is used to build many of the POE presentations and articles. Health care providers retain responsibility to submit complete and accurate documentation upon request to Medicare.

2024 education

2024 education events will include: workshops, a virtual symposium, and additional topics. We gather our education topics from a number of different sources such as new Medicare initiatives, LCD/NCD revisions, Medicare fundamentals, medical review data, provider suggestions, survey comments, etc.
We will offer the Stay Connected workshop series in 2024. The Stay Connected workshop webinars occur over a one-week span and are topic-specific. Part A topics for 2024 include: care management, new provider, Part A billing, Part A post-payment, and pain management. Additional topics planned for 2024 include but are not limited to: modifier of the month, SPOT portal, Medicare compliance, behavioral health, Medicare secondary payer, self-service tools, and preventive services.

Social media

First Coast is active in social media. LinkedIn and YouTube are live. Subscribe today and please promote these social media tools to your colleagues.

On-demand training

First Coast has a wide array of on-demand learning resources. These resources are intended for you to participate in Medicare education at your own pace, on your schedule.

Journey to LCD Coverage tool

First Coast published a new tool in our medical policy center titled Journey to LCD Coverage. This tool provides steps to better understand how LCDs work.

2024 MEDPARD

The 2024 MEDPARD information is now available on our website.

2024 Medicare deductible, coinsurance, and premium rates

The 2024 deductible, coinsurance, and premium rates have been posted. The Part A deductible is $1,632. Coinsurance is $480 a day for days 61-90, $816 a day for days 91-150, and $204 a day for skilled nursing facilities days 21-100. Additional information is available on our website.

2024 annual update of the per-beneficiary threshold amount

For calendar year 2024, the KX modifier threshold amounts are $2,330 for physical therapy and speech language pathology services combined and $2,330 for occupational therapy. The medical review process threshold is $3,000 until 2028 at which time it will be updated by the Medicare Economic Index.

Hospital Outpatient Prospective Payment System (OPPS): January 2024 update

The January 2024 OPPS update included many changes for the new year. A few of the key changes included updates to the COVID-19 CPTs for vaccines and administration, coding changes for CPT proprietary laboratory analysis (PLA), OPPS device pass-through category coding changes, updates for drugs, biologicals, and radiopharmaceutical, as well as skin substitutes. For complete details of the January 2024 OPPS update review the MLN MM13488. external pdf file

Billing requirements for Intensive Outpatient Program (IOP) services

Effective January 1, 2024, section 4124 of the Consolidated Appropriations Act of 2023 (CAA, 2023) establishes Medicare coverage and payment for Intensive Outpatient Program (IOP) services for individuals with mental health needs when furnished by hospital outpatient departments, Community Mental Health Centers (CMHCs), Rural Health Clinics (RHCs), and Federally Qualified Health Centers (FQHCs).
An IOP is a distinct and organized outpatient program of psychiatric services provided for individuals who have an acute mental illness, which includes, but is not limited to, conditions such as depression, schizophrenia, and substance use disorders. 
An IOP provides treatment at a level more intense than outpatient day treatment or psychosocial rehabilitation, but less intense than a partial hospitalization program (PHP).
Hospitals (including CAHs) and CMHCs must use condition code 92 on all claims for IOP services.
The patient must be under the care of a physician who certifies the need for IOP services, and the patient must need a minimum of nine hours of services per week as per the plan of care.
Information relating to the coverage criteria and billing requirements can be found in the following:

Medicare Physician Fee Schedule final rule summary: CY 2024

CMS has issued the 2024 Physician Fee Schedule final rule. external link This rule updates payment policies and Medicare payment rates for services that we pay providers under the MPFS in CY 2024. We encourage you to review the MLN Connects for future updates.

Behavioral health initiatives (BHI)

Medicare covers behavioral, mental, and psychiatric health services that may improve outcomes for Medicare patients. These services include BHI, psychotherapy for crisis, and opioid use disorder (OUD) screening and treatment. For more information, please visit our website.

Appropriate use criteria (AUC) for advanced diagnostic imaging: CY 2024 update

CMS has decided to pause the AUC program for re-evaluation, and rescinded the current AUC program regulations. Effective January 1, 2024, providers should no longer include AUC consultation information on Medicare FFS claims. Claims containing AUC-related codes with DOS 2023 and 2024 will continue to process. CMS plans to end AUC related G-codes and associated modifiers effective December 31, 2024.

Claim submission options for impacted providers of the Change Healthcare cyber incident

Providers impacted by the Change Healthcare cybersecurity incident should check with them first for further instruction. First Coast offers multiple options for claim submission: SPOT (Secure Provider Online Tool) portal, PC-ACE, Part A DDE, or you can select a different third-party biller, convert to a direct billing vendor, or submit paper claims.
This incident can also affect the ways you retrieve your remittance advice. Paper remittances are not sent through the mail for providers who are set up for electronic billing, even if paper claims are submitted. You may use the options above for remittance advice options, but you will need to obtain access to any of the above systems. There are a number of references on our website for assistance.

Change Healthcare/Optum Payment Disruption (CHOPD) accelerated and advanced payment request

Providers experiencing disruption in Medicare claims processing may request accelerated payments to Medicare Part A providers. Use the request for CHOPD Accelerated Payments to Part A Provider and Provider B suppliers template located on our website. Review the CMS CHOPD Accelerated Payments to Part A providers and Provider B suppliers fact sheet on our website.

Open discussion

A question was received regarding reporting discarded drugs using JW/JZ modifiers asking if it is only required for Medicaid patients. Janice advised that this is a requirement for all Medicare providers/suppliers providing services to Medicare beneficiaries.
Suggestions on topics, dates and times can be emailed to Janice.Mumma@novitas-solutions.com.
Our next advisory group meetings will take place on July 23, 2024 and November 19, 2024.
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.