Provider Outreach and Education (POE) Advisory Group Meeting Minutes: July 14, 2020

Palmetto GBA welcomed all POE-AG Members


Annette Kaisar TELIOS
Beth Barnett Riverside Medical Group
Beth O'Donnell Virginia Cancer Institute
Bobbi Cook Huntington Internal Medicine
Debbi Hogg PPCM Healthcare (onsite)
Duan Frye Radiology Incorporated
Jackie Keese Radiology Incorporated
Jane Lutz

US Radiology

Karen Mullins Radiology Incorporated
Mark Thayer Thayerapy Chiropractic
Miriam Weber

Trident Dermatology (onsite)

Pat Cox Riverside Medical Group
Robin Drummond MED3000

Palmetto GBA Associates
Bonnie Miller
Jazz Harrison
Shannon Chase      
Yoshiko White Dimes


Our Goals

  • Establish and maintain strong relationships with Palmetto GBA staff and the provider community
  • Meet with Palmetto GBA and the provider community on a quarterly basis
  • Provide the communication tools to facilitate thorough and prompt transfer of information to and from each representative
  • Coordinate the issues within the provider community to adequately reflect the concerns of the majority

Palmetto GBA’s Intent

  • Promote an atmosphere that facilitates an exchange of ideas and information to service the best interests of Medicare providers and Palmetto GBA’s Medicare program administration
  • Provide educational forums that address various global provider concerns
  • Allow the provider community an opportunity to communicate with Palmetto GBA’s staff on any areas that may need additional education activities
  • Assist in making the Medicare program more understandable for providers
  • Enhance providers’ understanding of the role and responsibilities of Palmetto GBA as their A/B Medicare Administrative Contractor (MAC)

Old Business

  • COVID-19 Education Suggestions (update in notes)  
    • Accelerated Payments

Note: Since our last POE-AG meeting, we have held three webinars addressing education the POE-AG deemed beneficial to the provider community. The recordings were added to the website after each session; however, several have been removed as the information is fluid and has been subject to change and updates. We continue to post the most recent CMS information to include frequently asked questions (FAQ) on the website.

Special Agenda Topics

  • Palmetto GBA Website Links (Presentation by Bonnie Miller, POE Communications Specialist)
    • Listservs, email updates and newsletters are all interchangeable names used to describe messages sent out to providers to inform them of the latest Medicare Program changes
    • We try to avoid having broken link on the website. We run broken link reports to help identify them. But if you find one, please report the broken link using the Feedback tab on the right side of the browser window. Please include the page title so we can identify the article.
    • If you find a broken link in the Palmetto GBA listserv, your email server may be adding unnecessary characters to the link. If your technical area is unable to resolve this issue, you can change from the HTML listserv version to the text version. You can change this option using the information at the bottom of each listserv message.
    • Listservs are sent out each weekday around 8 p.m. ET. Special listservs are sent out during the day usually containing hot topic information.
    • We will be deploying a new website design in next couple of months. POE requested feedback earlier this year and we thank you for all the suggestions you shared. Here are some benefits and enhancements regarding the new websites:
      • Uniform look to the JJ and JM websites
      • Fully ADA 508 compliant
      • Easier registration for listserv, email update, newsletter messages — select groups instead of one by one
      • Easy-to-understand navigation
      • Easier-to-identify where you are on the website
      • Promote links within navigation from Topics and Tools
      • Tools are separated by type from the top navigation
      • All forms display from the top navigation bar and customer still has access to Form Finder
      • Less intrusive critical alerts, banners and news items
      • Less intrusive License & Notice pop-ups, which are required per our copyright agreement with the AMA, CDT and AHA
      • Added an “Important Update” section to the home pages
      • Integrated Chat System
      • Enhanced search system that focuses on accuracy rather than quantity
      • Smartphone friendly

Note: Suggestions were requested from the group and no feedback was shared.

  • Social Media
    • Members were encouraged to promote and follow us on Twitter and Facebook
    • We are ramping up education and notifications via social media. Joining these platforms will put more information at the fingertip of providers
  • Ambulance Prior Authorization Reminder: Updates by Shannon Chase — POE Senior Provider Relations Representative
    This language is from a CMS FAQ (PDF, 54 KB) that was referenced in the article we published about the ambulance prior authorization pause.
    • Effective March 29, 2020, certain claims processing requirements for the Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model were paused in the model states of Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia because of the COVID-19 pandemic. During the pause, claims for repetitive, scheduled non-emergent ambulance transports submitted on or after March 29, 2020, were not stopped for pre-payment review if prior authorization had not been requested by the fourth-round trip in a 30-day period.
    • During the pause, CMS (through the MACs) continued to review any prior authorization requests that were submitted. Given the importance of prior authorization activities to CMS’ program integrity efforts, CMS expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency. CMS will resume full model operations and prepayment review will resume for repetitive, scheduled non-emergent ambulance transport claims submitted in the model states on or after August 3, 2020, if prior authorization has not been requested by the fourth-round trip in a 30-day period.
    • Following resumption of the model, the MAC will conduct postpayment review on claims that were subject to the model that were submitted and paid during the pause. CMS will work with affected providers to develop a schedule for postpayment reviews that not does significantly increase provider burden. Claims that received a provisional affirmation prior authorization review decision and were submitted with an affirmed Unique Tracking Number (UTN) will continue to be excluded from most future medical review
  • Mayfest Virtual Symposium
    • Palmetto GBA thanked members for attending. We had successful symposium and it was received well by providers.
    • Action Item Update: In the previous meeting, members two 90-minute sessions spread over two days as opposed to all on one day due to COVID-19
      • Providers responded favorably
      • Covered topics included Critical Care as well as Part B Problem List
  • MACtoberfest
    • MACtoberfest will be held October 20–21
    • Will be held virtually as we have suspended travel for the remainder of the year
    • Being that we will not be attending any of the Society and Association meetings during that time, members were asked to submit topics thy would like covered

Calendar of Events – Educational Needs

  • Palmetto GBA Scheduled Events
    • Top denials webinar w/ cataract removal focus
      • Today at 11 a.m., right after this webinar
    • Lunch and Learn: On the Dotted Line – Medicare Signature Requirements webinar
      • July 21 at 12 p.m. ET
    • Part 4 JJ/JM Part B Top Denial/Rejection Reason Code
      • July 22 at 11 a.m. ET
    • MR Denials webinar with Surgical debridement as focus
      • July 28 at 11 a.m. ET
    • Part 5 of Top Denial/Rejection Reason Codes Part B
      • July 30, 2020 at 11 a.m. ET
    • Quarterly Webinar
      • August 4, 2020 at 10 a.m. ET
  • Future Event Suggestions
    • ACT Topics — August 11, 2020 (no topic yet)

CMS Educational Events

  • Reduce Provider Burden: Participate in Medical Documentation Interoperability Pilot
    • In support of the health care industry’s Health IT movement towards interoperability, CMS encourages providers to participate in an interoperability pilot to test specific medical documentation use cases. The Electronic Medical Documentation Interoperability (EMDI) program is designed to reduce provider burden by assembling a robust network of stakeholders willing to:
      • Pilot test use cases
      • Participate in gap analysis
      • Contribute to resource documentation for new adopters
    • Participants will have an opportunity to test interoperable solutions by piloting one or more of three use cases:
      • Ordering
      • Requesting additional medical documentation from another provider
      • Requesting physician signatures
      • If you are interested in partnering with us or learning more about our program, email
  • COVID-19: Alternate Care Site Toolkit, Third Edition
    • The Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) released the Third Edition of the Federal Healthcare Resilience Task Force Alternate Care Site (ACS) Toolkit, providing enhanced guidance, including:
      • Updated directions
      • Funding sources
      • Guidance on providing dialysis support
      • New temperature screening protocol and updated glossary of terms
      • Information on retaining a warm site, including funding strategies
      • Updated supply lists
  • ABN Form Renewal (We will include a breakdown specific instructions on the August Quarterly Webinar)
    • The Office of Management and Budget approved the Advance Beneficiary Notice of Noncoverage (ABN) (Form CMS-R-131) and instructions for renewal. You must use the renewed form with the expiration date of June 30, 2023, beginning August 31. There are no other changes to the form. Visit the ABN webpage for more information.
      • ABN Changes
        • The ABN is a formal information collection subject to approval by the Executive Office of Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (PRA). As part of this process, the notice is subject to public comment and re-approval every three years. With the latest PRA submission, a change has been made to the ABN. In accordance with Title 18 of the Social Security Act, guidelines for Dual Eligible beneficiaries have been added to the ABN form instructions.
  • Medicare Enrollment Application Fee Refunds through EFT
    • CMS is now issuing application fee refunds through Electronic Funds Transfer (EFT), rather than paper checks. We will request new information if you need an application fee refund for your CMS-855A, CMS-855B, CMS-855S, or CMS-20134 submitted via an automated clearinghouse.
    • Complete and return the EFT form issued by your Medicare Administrative Contractor, including your account information. This process will expedite your refund processing time.

Hot Topics

  • Partnering Opportunity — eServices Focus Group
    • Focus Group 
      • Palmetto GBA will be holding a virtual focus group in August. We are currently soliciting participants and are requesting two volunteers from each line of business (LOB).
      • Topic — Inbox Filtering
      • Survey — eComm will be placing a survey in the portal during the latter part of this month to solicit feedback. Please fill out.
  • Special Notification: New Hospital Outpatient Department (OPD) Prior Authorization (PA) Requirement
    • This is a Part A function, but we are also educating Part B providers as they will be allowed to submit the PA
    • Centers for Medicare & Medicaid Services (CMS) has established a nationwide prior authorization (PA) process and requirements for certain hospital outpatient department (OPD) services. This process serves as a method for controlling unnecessary increases in the volume of these services and to ensure that medical necessity is met. Providers can submit a PA request as early as June 17, 2020, for date of service on or after July 1, 2020, for the following:
      1. Blepharoplasty
      2. Botulinum toxin injections
      3. Panniculectomy
      4. Rhinoplasty
      5. Vein ablation
    • Members were advised to watch our website for upcoming education regarding OPD PA. You may go to the CMS website external link to view a full list of HCPCS codes that require a PA.
    • Palmetto GBA held a teleconference last Friday, please watch out for additional educational opportunities.
      • We have a page dedicated to the authorization
      • Affirmed/non-affirmed decisions returned to submitting provider. If you a Part B provider submitting the PA facility, you will need to alert the Part A facility that you are submitting. It is imperative that you work together.
      • If the facility submits (which is most likely), you must contact them for approval notice and updates. The information will not be housed in Part B claims system and the Provider Contact Center (PCC) will not be able to advise.

Agenda Items Submitted by Members

  • CR Modifier (COVID-19)
    • Providers expressed it has been challenging to keep up with the changes
    • Coders are experiencing the most confusion
    • Provider expressed they understand the CS modifier, but requested we carve out a separate space for CR updates, so it stands out

Open Discussion Questions

Question: Has Palmetto GBA heard if the waiver will be extended or if telehealth rules will change? Providers are anxious to know the answer because if affects their scheduling as they schedule a month ahead of time.

Response: Palmetto GBA has not heard anything as it relates to updated waiver/telehealth extension guidelines. Once CMS issues direction, we will promptly relay information to provider community.

Announcement of Next Meeting Date
October 13, 2020


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Last Updated: 07/27/2020