Provider Outreach and Education Advisory Group (POE-AG) Minutes: October 13, 2020

Wendy Weary, POE, Supervisor

Palmetto GBA Members
Marlene Frierson, POE Senior Provider Relations Representative
Sandra Booker, Senior Provider Education Consultant
Tionna Washington, Senior Provider Education Consultant
Tamika Woodard, Senior Provider Education Consultant

Palmetto GBA Welcomed POE-AG Members

 Name  Company
Debbie Lee Mary Washington Healthcare
Jill Fountain Carilion Clinic
Matilda Jarrett-Davis Sentara Health
Fred Jones S.C. Department of Mental Health
Quiana Anderson S.C. Department of Mental Health
Natalie Hefner Mercury/Mary Washington Hospital
Roderick Walker University of Virginia (UVA)
Samuel Clark N.C. Health Care Facilities Association
Stephanie Elliott Sentara Halifax Regional


Review of Goals and Purpose
Part A POE-AG Charter

Old Business: Prior POE-AG Suggestions/Recommendations
2020 MACtoberfest® October 20 and 21

In our last POE-AG meeting on July 14, 2020, members discussed MACtoberfest education needed during 2020 Virtual MACtoberfest event.

 FeedbackAction TakenDate 
 MSP education with liability 2020  MACtoberfest 10/20–21/2020
 Audit and reimbursement    MACtoberfest 10/20–21/2020
 OIG audit education on patient discharge status    MACtoberfest 10/20–21/2020
 COVID-19 and updates    MACtoberfest 10/20–21/2020
 Outpatient Prior Authorization (OPA) services    MACtoberfest 10/20–21/2020

New Business
As a POE-AG member what is your process for disseminating Palmetto GBA information?

A member stated she takes the top highlights and gets them to other areas and departments right away. Most are signed up for listserv and there are dedicated individuals who identify different information to disseminate to their entire organization.

A member stated their corporate compliance, Appeals and RAC team disseminates information. They encourage all departmental heads to sign up for listserv and share with their staff.

Part B Pilot Program: Innovation to Improve Beneficiary Care Deficit Initiative

*Both articles will proceed to self-paced learning modules.

Facilities will share information with physician and professional staff.

POE-AG Education Suggestions and Recommendations

In regard to salient hospital issues, a member suggested to collaborate with smaller workgroups to ensure the needs of their billing staff are addressed in upcoming education.

Members discussed the need for education pertaining to:

  1. How to void a claim with medically denied lines. Example: Outpatient lab was billed in error and received a medical denial when processed. The lab should have been combined to an inpatient claim for 72-hour rule.
  2. For claims rejecting into a B7516 location and we have confirmed that it is not related to any other prior record on the common working file CWF), how do we get these processed/ resolved? Most of the feedback has been given regarding removing dx codes that are hitting the record on the CWF. However, our feedback is that we have confirmed that all dx are related and appropriate for our current admission and not to a previous admission.
    • In order for a claim to be rejected to the B7516 status/location, the CWF has edited the claim according to the MSP data on file at the time of adjudication. If the CWF is correct, the provider must correct the claim, add the correct condition code, add remarks and resubmit after 75 days. If the CWF is incorrect, the provider must work with the beneficiary to ensure the CWF is updated, append the condition code, add remarks and resubmit the claim after 75 days.
  3. Claims with Ongoing Responsibility for Medicals (ORM) are processing with payment.
    • The CWF may not have the applicable information to apply the utilization edits U6816, U6817 or U6818. An example should be brought to the attention of the Provider Contact Center (PCC) for review and/or action.
  4. Any Medicare Secondary Payer (MSP) education is welcomed. Such as, what to do when the patient isn’t providing information, the CWF is not updated, or when the payment is issued to patient. There is an issue where patients won’t return calls, attorneys will not tell what the payment is or a worker's compensation won't tell what was paid in order to report with the value code.
  5. Education pertaining to Credit Balance Reports is needed. We send our quarterly reports and notice it may take two or three cycles and then some of those accounts are still on the report. At what point should we send a check?
  6. Clarification is needed in reference to CMS IOM 100-4, 4, Section 240-2 (PDF, 1.24 MB)— Editing of Hospital Part B Inpatient Services: Other Circumstances. This is a gray area. It does not direct to file the 110 type of bill prior to submitting the 121 type of bill. Some chargemasters favor reporting all services (allow and not allowed) to be listed on the claim. The claim then processes the not allowed line items as non-covered. However, with a limitation of 450 lines; this also creates a problem with splitting the claim into two bills. If the claim is billed with only the allowed/covered charges, it creates havoc for the staff to account for the other monies. It also causes an issue with primary payers and contractual costs.

Website Updates

Latest Articles and Self-Paced Learning

  1. Intensity-Modulated Radiation Therapy (IMRT) Webcast: September 24
  2. Medicare Part A 2020–2021 Influenza Season Webinar — October 1
  3. DDE Training Modules — Revised
  4. eServices and Google Authenticator Module
  5. October 2020 JM Part A Medicare Advisory (PDF, 9.33 MB)

Top Five Part A Tools Viewed in September

  1. Forms: 555
  2. Claims Submission Error Help: 307
  3. Outpatient Prior Authorization Status Tool: 294
  4. Credit Balance Report Status Tool: 241
  5. Appeals Status Tool: 208

Most Popular WBTs in September

  1. MSP Coding Module: 74
  2. EDI Enrollment Instructions Guide Module: 59
  3. DDE Modules: 140

Upcoming Part A Education Events

CMS Initiatives: Medicare Learning Network (MLN) Products

CERT A/B MAC Outreach and Education Task Force Education Resources

Open Discussion
Tamika Woodard was welcomed and introduced as the new Palmetto GBA JM Part A Education Consultant. She is looking forward to working with the POE-AG members!

Our next POE-AG Teleconference
January 12, 2021, at 10 a.m. ET. 

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Last Updated: 10/27/2020