Florida and U.S. Virgin Islands Part A POE-AG minutes -- March 18, 2025
Jurisdiction N
Medicare Part A
March 18, 2025
Welcome and introductions
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, dates, and times of provider education events.
Contractor Medical Director introduction
Contractor Medical Director, Dr. David Sommers, joined us today. He provided the group with an overview on Local Coverage Determinations (LCD) which included the role of the Medicare Administrative Contractor (MAC), process of LCD development, and the Journey to LCD Coverage tool.
Prior quarter activities
The group discussed the attendance at the prior webinars. The highest and lowest attended prior quarter activities were reviewed, and feedback was requested. No feedback was received.
Next quarter activities
The upcoming activities for the remainder of March 2025 were reviewed. April calendar has been posted. The May calendar is in development and will be posted. No feedback was received.
CMS activities
Janice reviewed the CMS website Education and Training page. This page offers information on CMS national training program, partner outreach resources, Medicare Learning Network, CMS open door forums, look up topics, and find provider type.
Comprehensive error rate testing (CERT)
First Coast has complied two new resources to help providers navigate the CERT program: CERT Insider’s Guide and CERT Fast Facts. The Insider’s Guide will be issued quarterly, and the Fast Facts will be issued monthly. Both publications can be accessed from the CERT page on our website.
Education strategy
The 2025 education strategy was reviewed. The strategy includes topics presented in a workshop series, monthly, bi-monthly, and quarterly events on a variety of topics, and the annual virtual symposium. We are continuing the StayConnected workshop series in 2025, as well as introducing a new workshop series, Medicare Navigator. The Medicare Navigator series is a series of events that are focused on assisting providers to navigate to, identify, perform, submit, etc. necessary Medicare tasks. Topics are chosen from various sources: provider suggestions and surveys, CERT data, MR, data, and claim submission errors to name a few. Watch our events calendar for monthly updates.
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 Perspective Payment System October 2024 Update
The October 2024 OPPS update included many changes for the new year. A few of the key changes included coding changes for CPT proprietary laboratory analysis (PLA), Multianalyte Assays with Algorithmic Analyses (MAAA) CPT coding changes, OPPS device pass-through category coding changes, updates for drugs, biologicals, and radiopharmaceutical as well as skin substitutes, just to list a few. For complete details of the April 2024 OPPS update review Change Request (CR) 13784.
Medicare Deductible, Coinsurance, and Premium Rates: CY 2025 Update
The 2025 Deductible, Coinsurance, and Premium Rates have been released. The 2025 Part A deductible is $1676, and the 2025 Part B Deductible is $257 with Coinsurance being 20%. For complete details, please review Change Request (CR) 13796.
2025 Annual Update of Per-Beneficiary Threshold Amounts
The PT and SLP combined threshold is now $2,410 and OT is $2,410. The medical record threshold amount they are as follows: PT and SLP services combined remains at $3,000 and OT services remains at $3,000.
Note: These threshold amounts will remain in place until CY2028 at which time will be updated by the Medicare Economic Index (MEI) review. For more information, review Change Request (CR) 13826.
2025 Annual Update to Therapy Code List
Updates have been made to the list of codes that sometimes or always describe therapy services. The additions, changes, and deletions to the therapy code list reflect those made in the CY 2025 HCPCS/CPT. This list allows physicians and certain non-physician practitioners (NPPs), including nurse practitioners, physician assistants, and clinical nurse specialists, to provide these services outside a therapy plan of care when appropriate and when furnished under a plan of care. A modifier must be used (GP, GO or GN) to reflect that it’s under a physical therapy, occupational therapy, or speech-language pathology plan of care. For complete details, please review Change Request (CR) 13823.
Provider Enrollment Application Fee: CY 2025
Effective January 1, 2025, the application fee is $730 for institutional providers who are:
Initially enrolling in the Medicare or Medicaid programs or the Children's Health Insurance Program (CHIP)
Revalidating their Medicare, Medicaid, or CHIP enrollment
Adding a new Medicare practice location
CMS has defined an “institutional provider” as any provider or supplier that submits a paper Medicare enrollment application using the CMS-855A, CMS-855B (except physician and non-physician practitioner organizations), or CMS-855S or an associated Internet-based PECOS enrollment application.
CMS requires this fee with any of these enrollment applications reasons submitted from January 1 – December 31, 2025.
This information was included in the December 12, 2024, edition of the MLN Connects Weekly Newsletter, which contains a link to the Federal Register.
New Procedures for Quarterly Credit Balance Report Submissions
Starting December 1, 2024, providers aren’t required to submit Credit Balance Reports (PDF) (CMS-838) on a quarterly basis. Providers are still required to report self-identified overpayments, but Credit Balance Reports should only be used when they occur. When there are no credits to report, zero-balance certifications are no longer required to be submitted. For more information, review Credit Balance Reports No Longer Required.
Medicare Change of Status Notice (MCSN) Manual Instructions
When a hospital reclassifies eligible Medicare patients from an inpatient to an outpatient observation services, the patient has the right to appeal their status change to a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO).
To be eligible for the expedited determination process, the reclassification must happen while the patient is still in the hospital and 1 of the following applies:
The patient has Medicare Part B and their hospital stay was at least 3 days
The patient doesn’t have Part B
This expedited determination process was implemented through the regulation titled Medicare Appeals Rights for Certain Changes in Patient Status Final Rule (CMS-4204-F), effective November 15, 2024. The related regulations are available at 42 CFR 405.1210--405.1212. The implementation date for the MCSN and new appeals process is February 14, 2025. For complete details, please review Change Request CR 13846.
2025 Medicare Participating Physicians/Suppliers Directory (MEDPARD)
The 2025 MEDPARD is now available. Please visit our website for the entire listing.
Pre-Exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV
Beginning September 30, 2024, Medicare covers PrEP for preventing HIV in individuals at an increased risk of getting HIV, without cost sharing. This drug can be billed by a pharmacy, physicians, health care practitioners, and institutional settings.
Medicare will cover the following as an additional preventive service:
Up to 8 individual counseling visits every 12 month
Up to 8 HIV screening tests every 12 months
Single screening for hepatitis B virus
Effective January 1, 2025, CMS added a new HCPCS code, Q0521, for pharmacies billing for PrEP for HIV drugs. If a physician or health care practitioner prescribes PrEP, at least one valid ICD-10 diagnosis code should be included to help pharmacies submit their claims. CMS has a number of resources and references on their website that can assist you.
Open discussion
Suggestions on topics, dates and times can be emailed to Janice.Mumma@novitas-solutions.com.
Our next POE AG meetings will be July 22, 2025, and November 11, 2025.