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


Palmetto GBA welcomed all POE-AG Members

Name

Company
Beth Barnett Riverside Medical Group
Beth O'Donnell Virginia Cancer Institute
Bobbi Cook Huntington Internal Medicine
Darlene Shanahan Piedmont Triad
Duan Frye Radiology Incorporated
Jackie Keese Radiology Incorporated
Karen Mullins Radiology Incorporated
Mark Thayer Thayerapy Chiropractic
Miriam Weber

Trident Dermatology (onsite)

Pat Cox Riverside Medical Group
Robin Drummond MED3000

Palmetto GBA Associates
Belinda Marin
Jazz Harrison
Kathy Boehm
Shannon Chase      
Yoshiko White Dimes

Goals/Purpose

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
No old business for this quarter.

Special Agenda Topics
Improve Beneficiary Care Deficits Initiative Pilot

  • Medical Affairs and POE Part B has implemented an Innovation to Improve Beneficiary Care Deficits Initiative Pilot. The project’s goal is to increase Annual Wellness Visits (AWV) and Annual Depression Screenings in professional (Part B) practices.
  • Currently, there are two related articles published on the JJ/JM B websites
    • Annual Depression Screening: HCPCS Code G0444
    • Cardiovascular Disease (CVD) and Intensive Behavioral Therapy (IBT)
  • These screening are important for our beneficiaries. Under this pilot we have several main objectives. They are to:
    • Increase rate of CVD risk-reduction visits over 12 months in JJ and JM
    • Increase rate of AWV at the JJ and JM level
    • Increase the rate of depression screening
    • Reduce the percent of PCPs reporting no CVD risk-reduction visits JJ and JM
  • Our goal is to increase services and awareness by utilizing multi-tiered layers of education to include:
    • Advanced Communication Engine (ACE) eCompare messages
      • An ACE Editing Option will be set to fire on beneficiaries with no recent AWV or screening. The edits will be informational only and will provide educational messages and links to eCBR stats.
    • Electronic Comparative Billing Reports (eCBRs)
      • eCBR will link to the appropriate educational materials
    • Webinars and teleconferences
    • Direct provider contacts
      • We have incorporated targeted education as there are some states that we will need to target more where the numbers are lower
    • Website articles

Questions for POE-AG

  1. Are there any additional methods of education you feel may be needed to increase these services?
  2. What obstacles or barriers may providers have that have caused a decrease in these screenings?

MACtoberfest

  • Jurisdictions JJ and JM — October 20–21, 2020
  • If you have not registered, please visit our website and go to the event portal
  • The event is virtual — Shelter in Place, We are Coming to You!
  • There was a bit of confusion as to whether the event was free. It is absolutely free and there are two days of sessions
  • Great opportunity to sign up office staff for training. The material is beneficial to new hires, veteran employees and providers who just want to brush up on the latest Medicare information.
  • The workshop will feature sessions on Evaluation and Management (E/M), eServices, Appropriate Use Criteria (AUC), Provider Enrollment, Ambulance, Medicare Secondary Payer (MSP) and more
  • For your convenience, we have set up each presentation as a separate session.  This allows you to select only those sessions you are interested in attending and can work into your schedule.
  • We are excited and look forward to interacting with you all

Calendar of Events – Educational Needs

  • Palmetto GBA Scheduled Events
    • MACtoberfest — October 20–21, 2020
    • Ask the Contractor (ACT) — November 10 at 11 a.m.
    • Jurisdiction J an M Part B Medicare Diabetes Prevention Program (MDPP) webinar — MDPP suppliers are invited to join Palmetto GBA for a 90-minute MDPP webinar on December 1, 2020, at 11 a.m. ET
    • Preparing for 2021 Initiatives
  • Future Event Suggestions
    • ACT Topics: No topic yet

CMS Educational Events
Reduce Provider Burden: Participate in Medical Documentation Interoperability Pilot — Refund processing time.

Hot Topics
Upcoming Enhancements:

  • eServices — TPE Greenmail
    • Starting October 10, 2020, Palmetto GBA will be adding TPE notification letters to our secure online portal, eServices. With the addition of the notification letter, providers will now have access to all three letters associated with the TPE process delivered right to their inbox via eDelivery.
    • Providers do not need to sign up for eDelivery to take advantage of this option. Palmetto GBA automatically registers all active eServices provider accounts to receive the following TPE letters.
      • Initial Notification Letters (starting October 10, 2020)
      • Additional Documentation Requests (ADR)
      • Results Letter

Note: TPE Reviews are currently on hold due to COVID-19. Providers will be notified when TPE resumes.

Agenda Items Submitted by Members
Non-Covered Charge Reduction

  • Submitted Question: When a patient has a same-day non-covered preventive service and E/M on the same day, I know I am to “carve out” the cost of the covered service from the preventive service. Is this reflected by lowing my charge on the claim form, or are you expecting to see an adjustment?
    • The carve-out is addressed in CMS Internet Only Manual (IOM) Chapter 12, Section 30.6.2. and includes specific billing instructions on how the services need to be reduced
    • From a Medicare standpoint, a denied service, with statutorily excluded service, providers set their charges for services and submit to Medicare. Palmetto GBA will deny as appropriate and the patient is then responsible for the charge.
    • When submitting a covered preventive service, in addition to a medically necessary service, there would be different guidelines and the carve out would apply. Providers would bill the covered screening service with their charge for that covered screening service, Medicare will consider charges and cover appropriately. If the patient also has a symptom, complaint or disease that's being evaluated on the same day, outside of all your documentation to cover that screening service, you would see what you have leftover and bill the appropriate E/M code level based on the documentation that is outside of that covered screening or preventive service. Providers should bill appropriately for services based on what they charge other patients for services.
    • Upon discussion it was determined that the issue was an internal one with the provider. The office will need to determine how to flag those claims to bill them appropriately to Medicare. The language in the IOM has not changed and outlines the rules providers should follow. Provider expressed understanding.

Open Discussion Questions
No open discussion items.

Announcement of Next Meeting Date: January 12, 2021

Adjournment


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Last Updated: 10/29/2020