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Florida and U.S. Virgin Islands Part A POE-AG minutes -- March 19, 2024
Last Modified: 7/23/2024
Location: FL, USVI
Business: Part A
Jurisdiction N
Medicare Part A
March 19, 2024
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.
The most and least attended prior quarter activities were reviewed, and feedback was requested. The group discussed the attendance at the prior webinars.
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.
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 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.
First Coast is active in social media. LinkedIn and YouTube are live. Subscribe today and please promote these social media tools to your colleagues.
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.
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.
The 2024 MEDPARD information is now available on our
website.
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.
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.
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.
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:
CMS has issued the
2024 Physician Fee Schedule final rule.
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.
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.
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.
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.
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.
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.
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.