Florida and U.S. Virgin Islands Part A POE-AG minutes -- November 19, 2024
Jurisdiction N
Medicare Part A
November 19, 2024
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.
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 November 2024 were reviewed. December calendar is posted, and the January 2025 calendar is in development. No comments were received.
CMS activities
Janice reviewed the CMS website homepage, search feature, CMS Newsroom Press Release, and 2024 Transmittals. 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 any of the pages discussed.
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. Healthcare 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 a lot of educational articles, booklets, and videos to help you through the CERT process. You can access these materials on the CERT center of our website.
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 the remainder of 2024 include New Provider in December.
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. We recently added new videos on PC-ACE.
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.
October 2024 Integrated Outpatient Code Editor (I/OCE) Version 25.3
The October 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) 13572.
Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2025
CMS issued the FY 2025 IPF final rule effective October 1, 2024. Make sure your billing staff knows about the system updates for October including refinements to IPF PPS Adjustment Factors and ECT payment per treatment, market basket update, FY 2025 Wage Index Update, and Inpatient Psychiatric Facilities Quality Reporting Program (IPFQR). For complete details, please review the Medicare Learning Network (MLN) Article: MM13766 – Inpatient Psychiatric Facilities Prospective Payment Systems: FY 2025.
Inpatient and Long-Term Care Hospital (LTCH) Prospective Payment System Fiscal Year (FY) 2025 Changes
The purpose of this article is to announce the changes to inpatient and long-term care hospitals effective for discharges occurring on or after October 1, 2024 - September 30, 2025, unless otherwise noted. Please read the entire article or the final rule for full details. MLN13734 was released to assist you with these updates.
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) and Update to the Appropriate Use Criteria (AUC) Program
A CR was released advising of the maintenance updates of ICD-10 conversions and other coding updates specific to NCDs. The delayed termination of the AUC Program modifiers was also removed. The new effective date of the AUC modifier removal is now January 1, 2025. Please review the MLN13706 for additional information.
ICD-10 & Other Coding Revisions to NCDs: October 2024
CMS has updated 12 NCDs with ICD-10 and other coding revisions. Please make sure you billing staff is aware of these newly available codes, recent coding changes, and NCD coding information. An MLN13596 was release to assist with these changes.
ICD-10-CM Diagnosis Codes: FY 2025
Effective October 1, 2024, 2025 ICD-10-CM codes are to be used for discharges and patient encounters from October 1, 2024 through September 30, 2025. More details can be found on our website.
Changes to the Laboratory National Coverage Determination Edit Software: October 2024 Update
The October 2024 quarterly release of the edit module for clinical diagnostic laboratory services has been released. 26 NCDs are affected with relevant updates due to this CR. For complete details on these updates, review the related MLN13672 article.
Medicare Dental Coverage
Payment under Medicare Parts A and B can be made for dental services that are inextricably linked to, substantially related and integral to the clinical success of, a certain covered medical service. Providers should include the GY modifier on claims when the service or item does not meet the definition of a Medicare benefit or if a denial is needed to submit the claim to a secondary insurance. For these claims, bill the KX and the GY modifier on the same claim line for correct processing. Details are found on our Dental Services center. Details on covered dental services are found in MM13452.
Skilled Nursing Facilities (SNF) Revalidation
October 1, 2024, CMS updated the CMS-855A enrollment application that now contains an attachment 1: Skilled Nursing Facility. All SNFs that are initially enrolling, revalidating, reactivating, or undergoing a change of ownership must submit the new version with the SNF attachment completed.
Open discussion
A comment was received regarding the number of pages in NCD, LCDs, and Articles. For example, there is too much paperwork to provide a lifesaving drug such as EPO. Additionally, a recommendation to highlight changes NCDs and LCDs.
A question was received asking for the results of the blood product pricing survey. Dr. Mann indicated no comments have been received.
A question regarding Medicare beneficiaries a Skilled Nursing Facility (SNF) Part A stay that are enrolled in a Medicare Advantage (MA) and the patient switches to Medicare fee-for-service during the stay. The MA plan does not require a three day acute care hospital inpatient stay. Will a three day acute care hospital inpatient stay be required for coverage under Medicare fee-for-service? Yes, a three day acute hospital inpatient stay will be required if the beneficiary switches insurance coverage to Medicare fee-for-service.
Suggestions on topics, dates and times can be emailed to Janice.Mumma@novitas-solutions.com.
Our 2025 POE AG meeting dates are in development.