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Last Modified: 8/21/2024 Location: FL, USVI Business: Part A

Florida and U.S. Virgin Islands Part A POE-AG minutes – July 23, 2024

Jurisdiction N
Medicare Part A
July 23, 2024

Welcome and introductions

Janice Mumma, supervisor, welcomed the members and reviewed current committee guidelines.
Janice advised that the purpose of the POE-AG is to assist the contractor 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.

Contractor medical director introduction

Our contractor Medical Director, Dr. Patrick Mann, joined us today. He provided the group with his background, expertise, as well as current LCDs and/or billing and coding article updates. Positive feedback was received on this added segment.

Prior quarter activities

The group discussed the attendance at the prior webinars. The top- and low-attended prior quarter activities were reviewed, and feedback was requested.

Next quarter activities

The upcoming activities for the remainder of July were reviewed. August calendar is posted, and the September calendar is in development.

CMS activities

Janice reviewed the CMS website Training and Education site, CMS Newsroom Press Release, external link, and 2024 Transmittals external link. On July 10, CMS issued a fact sheet on the CY 2025 Hospital Outpatient Prospective Payment System and ASC Payment System Proposed Rule. There is a 60-day comment period, which will end September 9.

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. 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.
A question was received asking about a change of address and how they go about doing that. Janice advised that to change your address for where you receive information regarding ADRs, etc., you will need to update your provider file in PECOS.

2024 education

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.

StayConnected workshops

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 A topics for 2024 include: care management, new provider, pain management, Medicare coverage, Part A billing, and Part A post-payment.

2024 virtual symposium

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. Positive feedback was received on this symposium.

CMS 2024 Virtual National Provider Compliance Conference

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 efficiently and effectively submit claims.

National Provider Enrollment Conference

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 external link A question was received asking if they will be providing the material from this conference after it concludes. Janice advised that she will look into this. She also advised that we have a new education specialist that specializes in enrollment, so look for more enrollment-specific webinars in the near future.

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.

Hospital Outpatient Prospective Payment System (OPPS) July 2024 update

The July 2024 Hospital OPPS update included many changes for the new year. A few of the key changes included an update for the COVID-19 Monoclonal Antibody Therapy Product and Administration code, coding changes for CPT proprietary laboratory analysis (PLA), OPPS device pass-through category coding changes, new CPT category III codes, just to list a few. For complete details of the July 2024 OPPS update review Change Request (CR) 13632. external pdf file

July 2024 Integrated Outpatient Code Editor (I/OCE) Version 25.2

The July 2024 I/OCE update has been released. This update provides instruction and specifications for the I/OCE under OPPS and non-OPPS outpatient departments, CMHC, and all non-OPPS providers. For complete details on these updates as well as the full data files for this version, review Change Request (CR) 13626. external pdf file

Medicare claims processing manual update: Inpatient rehabilitation facility

Updates have been made to the Medicare claims processing manual for IRFs. These updates were made per the FY 2024 IRF Prospective Payment System (PPS) final rule. An MLN article external pdf file was released to assist you with these updates.

July 2024 quarterly update to the End-Stage Renal Disease Prospective Payment System (ESRD PPS)

The Transitional Drug Add-on Payment Adjustment (TDAPA) is a payment adjustment under the ESRD PPS for certain new renal dialysis drugs and biological products. Effective July 1, 2024, HCPCS code J0911 is on the list of drugs paid for using the TDAPA under the ESRD PPS. ESRD facilities should report the AX modifier (item furnished in conjunction with dialysis services) with the HCPCS code to get payment for the TDAPA-eligible drug. While this drug is eligible for the TDAPA, it doesn’t qualify toward outlier calculations. Note: ESRD facilities should only use the AX modifier for a drug or biological product that qualifies for the TDAPA.
There is also an updated list of outlier services under the ESRD PPS: Effective July 1, 2024, we'll make the routine changes to the list of ESRD outlier services as shown in Attachment A external pdf file of CR 13608.

Stay of enrollment

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 external pdf file for more information.

Medicare dental coverage

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.
Details are found on our Dental Services webpage.

Medical review policies for signature requirements

Updates were made to the medical review signature requirements. external pdf file These updates added information for electronic signatures, provided additional information for attestation statements, and signature date requirements and potential fraud referrals. Review Change Request (CR) 13556 external pdf file for complete details on these updates.

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.

New LCD references

Medical Affairs has published some new information as well as updated other already published information. New publications include:
Strength of Evidencepdf file chart provides guidance on the strength of medical literature that may be submitted to us for LCD reconsideration, new LCD requests, or proposed LCD comments.
LCD Development Process flowchartpdf file provides a visual flow of the LCD development process.
Local and National Coverage Reference Guide” provides more details about LCDs, local coverage articles, NCDs, and other CMS guidelines that customers often ask about.

Medicare Coverage Database (MCD)

Medicare Coverage Database external link 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.

2024 Medicare Participating Physicians/Suppliers Directory (MEDPARD)

Find a physician via MEDPARD. Our MEDPARD has been updated for 2024, and this can be accessed via our MEDPARD page.

Open discussion

A question was received asking if the I/OCE is for all bill types. Ursula advised that it is for all bill types specific to Part A.
A question was received asking if the stay of enrollment can be done through PECOS. Ursula advised that this is the system to utilize.
Suggestions on topics, dates, and times can be emailed to Janice.Mumma@novitas-solutions.com.
Our next advisory group meeting will take place November 19.
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.