POE Advisory Group Details

6/12/2024 J6/JK Part B POE Advisory Group Meeting

Meeting Minutes

Meeting Time: 10:00 a.m.-12:00 p.m. ET

Member Attendees: Moe Auster, Dawson Ballard, Doris Barnes, Brenda Bedard, Madelon Berger, Mollie Brooks, Eileen Conlan, Renay Coonan, Pam D’Apuzzo, Tracy Essling, Stephanie Fiedler, Liz Fitzgerald, Shannon Fairbanks Deleon, Deb Gregoire, Olga Gridin, Martha Harris, Christie Hewson, Stephanie Hirst, Allison Israelson, Kevin Kile, Cindy Kisselburgh, Jenny Kovich,  Lloyd Kupferman, Kathlynn Lawrence, Vera Loftin, Sara Luther, Jessica Marden, Kristen McCormick, Amanda Monger, Sheila Mulka, Joyce Neurenberg, Mark Polge,  Nikki Ramirez, Gilbert Rosenblum, Debra Rossi, Allie Ruffolo, Ken Ryan, Ekaterina Spirin, Stephanie Thebarge, Theresa Weiland, Katie Werner

National Government Services Associates: Laura Brown, James Bavoso, Melissa Cooper, Cathy Delli Carpini, Jennifer DeStefano, Arlene Dunphy, Heather Fitzmaurice, Nathan Kennedy, Linda Klug Lori Langevin, Jennifer Lee, Phyllis McAdams, Julia Meehan, Christine Obergfell, Carleen Parker, Michele Poulos, Jean Roberts, Nena Rodrigues, Paul Root, Susan Stafford, Gail Toussaint

Agenda

  1. Welcome, Introductions and Opening Remarks
  2. Dental Coverage
  3. New Tobacco Billing Guide
  4. Provider Enrollment
  5. NGS Collaboration with the Recovery Audit Program
  6. Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare - Tuesday Tutorials for Part B Providers (6/4 and 6/11/2024)
  7. Open Discussion
  8. 2024 Meeting Dates

I. Welcome, Introductions and Opening Remarks

Lori Langevin, POE Consultant, NGS

Lori welcomed the members to the meeting and advised everyone should have received an invite with a link to the meeting as well as an email with the agenda and handouts. Lori reviewed the meeting agenda and turned it over to Jim for opening remarks. 

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II. Dental Coverage

Jim Bavoso, POE Manager, NGS

Jim advised since 1966 only accident and injury to jaw/mouth were covered under dental when medically necessary. We discussed at a previous meeting that more dental services/situations would be added in the future. In 2023 as part of the Physician Fee Schedule Final Rule, CMS added medically necessary inextricably linked dental services, but there was no additional information on how to bill, etc. Moving forward, the MACs will be doing education on claim submission for dental services. Dental providers are not familiar with billing to Medicare. They use the 837D dental claim form. MACs are in the testing process of accepting these claims.

Beginning 7/1/2024, dentists can use the 837D, 837P and/or the CMS-1500 form to submit dental claims to Part B. Jim asked the members if anyone does or will be billing these services.

Member Feedback: One member advised they currently submit claims on a CMS-1500 and have received some payments. They have not received a lot of denials but haven’t submitted many claims. They would have to set up a system to use the 837D form but prefer the CMS-1500. They have also used the 837P format.

Another member indicated they do dental but have not yet submitted to Medicare. When asking if there will be a fee schedule for dental codes, Jim indicated the codes will be part of the regular fee schedule.

Jim shared we may reach out to members in the future to help advise us, and he reviewed our NGS website page on dental coverage, advising it has been out there for a while now and asked members to take a look and let us know what else they think should be added. 

We also shared a draft document on the KX modifier which will be needed on dental services inextricably linked. The members should review it and provide feedback to be sure we are hitting the mark. Christine added that we can add documentation requirements and inextricably linked examples to the article before posting. Christine also shared the CMS Medicare Dental Coverage page link with the group.

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III. New Tobacco Billing Guide

Jim Bavoso, POE Manager, NGS

Jim shared the Tobacco Cessation Billing Guide with members. It’s located on our website under the Education Tab then Medicare Topics. This specific web page was added because NGS was running a project in two of our rural states, Maine and Wisconsin, and also our other ten jurisdictional states. Tobacco counseling is also payable as a telehealth service. That information and more is included under this topic on our website. Jim asked the members for their feedback on the new page information and asked if we need to add anything else. 

Member Feedback: One provider indicated that it can’t be billed as an “Incident to” service and that is an issue that CMS needs to expand on. Jim shared we are having conversations with CMS on this. 

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IV. Provider Enrollment

Susan Stafford, POE Consultant, NGS

Lori shared a slide on Stay of Enrollment and asked the members if anyone has experienced this.  Lori also reminded members that Susan had explained this status previously to the group. Susan stated that we talked about the “Stay of Enrollment” and if claims are rejecting and the entity or provider was asked to revalidate and did not by the due date, then they will be on a “Stay.” 

CMS implemented a preliminary, interim status representing a pause in enrollment called a “Stay of Enrollment” or “Stay.” A stay is a CMS action that’s less burdensome on providers and suppliers than a deactivation or revocation of your Medicare enrollment when not in compliance. Susan recommended the following links to be sure you are in compliance with your enrollment status:  

Member Feedback: Katie stated she has noticed that it comes back on the claims reports to inform that the provider needs to revalidate, which should also help. 

Another member asked if your enrollment would be retroactive when in a “Stay?” Susan advised it’s the providers responsibility to keep their records updated and accurate. The “Stay” is a pause, not a deactivation. If additional information is needed/requested and not returned, then it will be deactivated and there will be a gap. Laura added they could put an article on the web pages when someone leaves a group, the provider needs to have that persons’ correspondence address updated so any future correspondence would no longer go to that address.

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V. NGS Collaboration with the Recovery Audit Program

Lori Langevin, POE Consultant, NGS

Lori wanted to get feedback from the POE AG members on the webinars that NGS has collaborated with the RAC. The sessions are called, Navigating the RAC Process – CMS Recovery Audit Contractor Activities. 

We had great participation on 2/28/2024 and 5/22/2024 and feedback during the Q&A portion of the webinars. The upcoming sessions have been scheduled for 9/11/2024, and 12/11/2024, each is from 12:00 – 1:00 p.m. ET. The presenter is Roxanne Cooksey, who is the Director of Healthcare Operations Support, Performant. 

Lori provided contact information for the members: 

Performant

Member Feedback: Liz commented that she has not attended; but will add these next dates on her calendar and thanked us for the reminder. Jim suggested having a Let’s Chat or Ask- the-Contractor with the RAC and Liz commented that was a great idea and she would love to sit in on the Ask-the-Contractor with the RAC.  

Katie stated that she just had one issue where they needed the records by mail and since there was a 30 day return she had to resend the claim again to get another letter. 

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VI. Medicare Part B 2024 Spring/Summer Virtual Conference: Mastering Medicare - Tuesday Tutorials for Part B Providers (6/4 & 6/11/2024)

Lori Langevin, POE Consultant, NGS

Lori reviewed the first two sessions of our Spring/Summer Virtual Conference and asked the members for their feedback. 

Week 1 – Tuesday, 6/4/2024

  • 9:00-10:00 a.m. - Overview of Evaluation and Management Services-Registration closed
  • 10:30-11:30 a.m. - Evaluation and Management Modifiers: When to Use Modifiers 24, 25 or 57
  • 12:00-1:00 p.m. - Critical Care
  • 1:30-2:30 p.m. - Let’s Chat about Evaluation and Management Services

Week 2 – Tuesday, 6/11/2024

  • 9:00-10:30 a.m. - Introduction to Appeals
  • 11:00 a.m.-12:30 p.m. - Medicare Physician Fee Schedule Database
  • 1:00-2:30 p.m. - Medical Necessity and the Advance Beneficiary Notice
  • 3:00-4:00 p.m. - Top Claim Errors

Remaining Sessions

Week 3 – Tuesday, 6/18/2024

  • 9:00-10:15 a.m. - Submitting Medicare Secondary Payer Claims
  • 10:45 a.m.-12:00 p.m. - Medicare Secondary Payer Provisions Group and Nongroup Health Plans
  • 12:30-2:00 p.m. - Learning Medicare Secondary Payer Interactively
  • 2:30-3:30 p.m. - Medicare Part B Secondary Payer Post-Pay Overpayments

Week 4 – Tuesday, 6/25/2024

  • 9:00-10:30 a.m. - Proper Part B Claim Submissions
  • 11:00 a.m.-12:30 p.m. - Reducing Unprocessable Claims
  • 1:00-2:00 p.m. - Incident to Billing
  • 2:30-3:30 p.m. - Utilizing Third Party Billing Companies

Member Feedback:

  • Shannon - The E/M session was great!
  • Doris - I attended the 9-10 E/M and it was great!
  • Liz -I will review the E/M since I missed it and was out of the office.  
  • Shannon - It would be good to know what types of errors NGS medical review is seeing on a regular basis
  • Shannon - Thank you! I had looked at this link but there is no specific findings related to E/M services.
    • Heather Fitzmaurice- I believe the only E/M services being reviewed by Medical Review currently is Routine Foot care billed with an E/M visit and the AWV with an E/M. 

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VII. Open Discussion 

Jim started off by saying that NGS offers many methodologies for providing education to our provider community like Medicare BLAST, YouTube and soon to be starting Podcasts. Jim asked for specific topics that members would like to hear about during a Podcast. This is new for us, once we publish podcasts we will ask for feedback. Maybe we will even ask members to join us! We just finished recording a Four-Part series on “Incident to” and next we are looking at Split/Shared Services.

Member Feedback:

  • Stephanie - Now that LMFTs and LMHCs can enroll in Medicare, we have more providers who have questions about billing Medicare for behavioral health. I would love to be able to direct them to a podcast or presentation. 
  • Liz – Teaching Physicians
  • Olga - The scope of service by provider type. For example, can an NP bill for 01996
  • Shannon - Teaching physician services relating to non-E/M services (i.e., radiology, surgery)
  • Kristen - I second Liz's request. There have been changes over the years to teaching physicians and would love to see a refresher.
    • Carleen Parker advised the members that Teaching Physicians is on the list for Podcasts. 
  • Debra - In teaching physician session - would be very helpful to explain the difference between incident to in a teaching setting and incident to in the office for APPS and physicians.
  • Liz - I love that idea! G2211 podcast.  
  • Joyce - Will expansion of nonphysicians to conduct tobacco counseling be something that has to go through rulemaking, first?  
  • OIG issues and what they are looking at.
  • Understanding G0136, it’s correct usage and the new community health integration services.
    • Nathan advised we do have YouTube videos created and recorded on these and are waiting for them to be finalized and published.
  • One member asked about Health Equity Services.

A member asked about Coordination of Benefit updates when a claim denies for other insurance primary? How do we get a claim reprocessed, that denied Medicare Secondary but the MSP records are now updated to show primary in NGSConnex. MSP reopenings cannot be done via NGSConnex. 

Carleen responded that is correct. If the MSP files now show primary, you may contact the TRU and ask that the claim be reopened. See Reopening versus Redetermination. If the patients record is not correct, they need to work with the Coordination of Benefits Contractor.

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VIII. 2024 Meeting Dates

  • 9/18/2024 (Wednesday) 
  • 12/12/2024 (Thursday)

Lori advised the members to send potential agenda items before the meeting as we are always looking for suggestions.

The members thanked us for a great meeting, and we thanked the members for their feedback and the meeting adjourned.

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Posted 7/8/2024