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Florida and U.S. Virgin Islands Part B POE-AG minutes – July 25, 2024
Last Modified: 8/21/2024
Location: FL, USVI
Business: Part B
Jurisdiction N
Medicare Part B
July 25, 2024
Janice Mumma, supervisor, welcomed the members and reviewed current committee guidelines.
Janice advised the purpose of the 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.
Our contractor Medical Director, Dr. Jenny Davis, joined us today. She provided the group with her background, expertise, as well as current LCDs and/or billing and coding article updates. Positive feedback was received on this added segment.
The group discussed the attendance at the prior webinars. The top- and low-attended prior quarter activities were reviewed, and feedback was requested.
Feedback was received advising that for the podiatry webinars, debridement of nails is a very specific topic, which could explain why attendance was so low.
Feedback was also received on the Medicare Wellness Visits webinar. Attendance could have been so low due to the title or the time of the webinar.
It was asked if a webinar could be done in person or if it could be done in a Q&A setting. Janice advised that depending on the topic, number of attendees, etc., an in-person webinar could be possible. Janice advised to send her an email to see if we can get this on the calendar.
Feedback was received advising that after the Change Healthcare breach, some practices had to update their security, which caused them to be blocked from receiving emails. This could also be why the attendance was so low after the April/May timeframe. Janice advised that this is something that could possibly have affected attendance.
The upcoming activities for the remainder of July 2024 were reviewed. August calendar is posted, and the September calendar is in development.
Janice reviewed the redesigned CMS Education and Training site,
CMS Newsroom Press Release 
, and
2024 Transmittals . On July 10, 2024, CMS issued a Fact Sheet on the CY 2025 Medicare Physician Fee Schedule Proposed Rule. There is a 60 day comment period, which will end September 9, 2024.
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. Additionally, there is an all-MAC CERT education task force. This team has developed many educational articles, booklets, and videos to help you through the CERT process. You can access these materials on the CERT center of our website.
2024 education events will include: workshops, 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, etc.
We will continue to offer the StayConnected workshop series in 2024. StayConnected workshops consist of multiple webinars over a one-week span that are topic-specific. Part B topics for 2024 include: Care Management, New Provider, Pain Management, Medicare Coverage, Part B Billing, and Part B Post Payment.
Feedback was received asking for clarification on the Care Management workshop.
Our 2024 virtual symposium is coming soon! The dates for this event are September 17-19. We will be hosting 45 events over these three days. Our focus will be on Medicare compliance, risk mitigation, program integrity, and fraud prevention. Watch our website and email communications for registration information to be posted. Feedback was received advising that we should advertise that you will receive CEUs for completion of these webinars to further incentivize attendance.
This conference is hosted by CMS and will take place virtually on August 7-8, 2024. MACs and program integrity experts will provide information and tools needed to submit claims efficiently and effectively.
This conference will take place in San Diego, California, August 28-29. This program will provide information and tools needed to maintain compliance with enrollment requirements, as well as new and proposed provider enrollment regulations.
Register today.
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.
Medicare covers behavioral, mental, and psychiatric health services that may improve outcomes for Medicare patients. These services include:
A number of updates have been made to behavioral health services. These updates include: two new provider specialty codes for Marriage and Family Therapists (MFTs) specialty code E1 and Mental Health Counselors (MHC) specialty code E2, new codes for psychotherapy for crisis services, an increase in payment rate for office-based treatment for substance use disorder, and CPT codes for the Health Behavioral Assessment and Intervention (HBAI) services were finalized. Review our website for additional information.
A new benefit category for MFTs and MHCs has been created with an implementation date of February 12, 2024. All MFTs and MHCs billing Medicare will be required to enroll with Medicare. Review Change Requests (CRs)
13346 
and
13469 for more information.
CMS also finalized new coding and payment for the administration of SDOH risk assessments (G0136), which must be provided in conjunction with a qualifying visit, including an E/M visit, some behavioral health visits, or the annual wellness visit.
The evidence-based, standardized SDOH risk assessment tool used must cover domains such as housing insecurity, food insecurity, transportation needs, and utility difficulty, but practitioners may choose to add other domains if prevalent or culturally salient to their patient population.
SDOH is now an optional element of the annual wellness visits (AWV), HCPCS code G0136. When you provide the SDOH as an additional element of the AWV, we also require that the SDOH risk assessment is:
• Optional at the discretion of the clinician and patient
• Separately payable from the AWV with no applicable patient Part B coinsurance and deductible when part of the same visit with the same date of service (DOS) as the AWV, (modifier 33 should be placed on the SDOH)
• Subject to the same health professional eligibility and frequency limitations as the AWV
For more information, review MLN
MM13486.
One of the provisions in the 2024 physician fee schedule final rule is the creation of a new provider enrollment status labeled a "stay of enrollment." Stay of enrollment is a CMS action that’s less burdensome on providers and suppliers than a deactivation or revocation of your Medicare enrollment. A stay of enrollment (or “stay”) is a preliminary, interim status representing a pause in enrollment. Review the
MLN article for more information.
Medicare generally preludes payment under Medicare Part A and B for any expenses incurred for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.
The 2023 physician fee schedule final rule issued guidance to clarify that Medicare should make payment in circumstances where the dental services are so integral to other medically necessary services that they are inextricably linked to the clinical success of the medica service.
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.
Medical Affairs has published some new information as well as updated other already published information. New publications include:
“
Strength of Evidence”
chart provides guidance on the strength of medical literature that may be submitted to us for LCD reconsideration, new LCD requests, or proposed LCD comment.
Medicare Coverage Database is also a great tool. You can search for policy, and on the “report what's new page,” you can find documents being considered for medical policy – or revisions or changes recently done to policy.
Our next advisory group meeting will take place November 21.
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.
