JM Part A Provider Outreach and Education Advisory Group (POE-AG) Minutes: July 14, 2020

Wendy Weary, POE Supervisor

Palmetto GBA welcomed all the POE-AG Members

David Sweet
Cape Fear
Debbie Lee
Mary Washington Healthcare
Jill Fountain
Carilion Clinic
Matilda Jarrett-Davis
Sentara Health
Melanie Parks
Self-Regional Health Care
Mike Womack
Lexington Hospitals
Natalie Hefner
Mary Washington Hospital
Nicole McKinney
Roper St. Francis
Regina Weeks
Princeton Community Hospital
Roderick Walker
University of Virginia (UVA)
Samuel Clark
N.C. Health Care Facilities Association
Stephanie Elliott
Sentara Halifax Regional
Tracy Turner
S.C. Dept. of Mental Health

Review of Goals and Purpose: Part A POE-AG Charter

Old Business
In our last POE-AG meeting on April 14, 2020; members asked for a Claims Payment Issues Log (CPIL) update for:

OIG Audit Adjustment Process
Adjustment Claims are in Process
CPIL Update 6/10/20

New Business

  • POE-AG Education Suggestions and Recommendations 
    • Virtual JM/JJ A/B MACtoberfest® October 20–21, 2020
    • MCG and C2C Partnership Sessions will be presented

A member asked for clarification on MCG and C2C PAE partnership. It was explained:

  • CMS Medicare Contractors support the use of all criteria sets that are evidence-based, and MCG care guidelines are used in quality and appropriateness audits. MCG guidelines form a common basis for care planning decisions between payers and providers. Palmetto GBA partners with MCG to present several eCBRs focused webinar, such as Reducing Inpatient Acute Myocardial Infarction (AMI) Readmissions.
  • The Qualified Independent Contractor (QIC) processes second-level Appeals — Reconsiderations for CMS. In April 2019, CMS expanded DME Demonstration activities into the Part A East (PAE) C2C QIC Jurisdiction. Providers who elect to participate have the opportunity for direct interaction with the QIC concerning their Reconsiderations. Palmetto GBA has partners with C2C to provide education concerning these telephone discussions and reopening process. The C2C PAE Demo Presentation on June 9 2020 Springing into Summer workshop handout is available on our website.

Member Education Suggestions for MACtoberfest®

  •  MSP education — with liability billing
    • Timeliness — options and resources for recoupment after Medicare timeframes
    • Include Medicaid paid and recoupments after wrongful dismissals
  • Audit and Reimbursement: Offsets with new Medicare Number
    • Resources and how to identify
    • Include Center for Medicare and Medicaid Innovation (CMMI) to bank as there is no documentation as to how to identify
  • OIG audit education on patient discharge status and skilled care guideline
  • COVID-19 Accelerated payment
  • Clinical Trials A and B
    • Include Medicare Advantage (MA) Plans
  • Outpatient Prior Authorization (OPA) Services

New and Revised Self-Paced Learning

  • Top Time-Saving Tools for Palmetto GBA Providers
  • Top Claims Submission Errors
  • eServices and Google Authenticator Module  
  • MSP Basics Modules
  • eServices: COVID-19 Transition Module
  • CMS Continuing Education (CMSCE) Website
  • Claim Overlap Module
  • Skilled Nursing Facility (SNF) Basics Training Modules 
  • PC-ACE Pro32 Training Modules  
  • Appeals and Clerical Error Reopenings Module
  • EDI Enrollment Instructions Guide Module 

Top Five Pages Viewed in May 2020

  • Claims Payment Issues Log — 936
  • Emergency and Disaster Instructions — 477
  • Medicare FFS Claims: 2% Payment Adjustment Suspended (Sequestration) — 463
  • LCDs and Related Articles — 319
  • Claims Submission Error Help — 315

The Most Popular WBTs in June 2020

  • MSP Coding Module (43 views)
  • Appeals & Clerical Error Reopenings Module (40 views)
  • Patient Discharge Status Codes & Hospital Transfers Module (28 views)
  • Basics of Provider Level Balance (PLB) Reason Codes Module (27 views)
  • DDE Module — Quick Reference and DDE Module 3 — Claim (27 views each)

Feedback: None
Upcoming Part A Education Events

  • Reason Codes in Review webinar on July 21, 2020, at 11 a.m. ET
  • Accelerated /Advance Payment Refund webinar on August 3, 2020, at 2 p.m. ET
  • Part A Ask the Contractor Teleconference (ACT) — Outpatient Prior Authorization on August 13, 2020, at 11 a.m. ET
  • DRG 885 webinar on August 18, 2020, at 11 a.m. ET

CMS Initiatives 

CERT A/B MAC Outreach & Education Task Force

Open Discussion
The next POE-AG meeting was planned as a live event on October 13, 2020, at 11 a.m. ET. This was scheduled prior to COVID-19. Members unanimously approved to have the teleconference at the regular 10 a.m. time.

Thank you for joining today’s meeting. Our next POE-AG meeting is October 13, 2020, at 10 a.m. ET. The meeting will be held telephonically. An agenda will be distributed two weeks prior to the meeting.

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Last Updated: 07/22/2020