Provider Outreach and Education (POE) Advisory Group Meeting Minutes: January 12, 2021

Palmetto GBA welcomed all POE-AG Members


Andrea Bridges Z Therapy Center
Beth O'Donnell Virginia Cancer Institute
Bobbi Cook Huntington Internal Medicine
Darlene Shanahan Piedmont Triad
Duan Frye Radiology Incorporated
Jackie Keese Radiology Incorporated
Jeff Matheny Positions Business
Karen Mullins Radiology Incorporated
Mary Lindsey White Virginia Academy
Melanie Davis

West Virginia Medicine

Miriam Weber

Trident Dermatology (onsite)

Pat Cox Riverside Medical Group

Palmetto GBA Associates
Jazz Harrison
Kathy Boehm
Paula Motes
Shannon Chase
Swandra Miller
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
No old business for this quarter.

Special Agenda Topics

  • Two Percent Sequestration
    • The sequestration suspension has been extended through at least March 31, 2021
  • Home Infusion Therapy (HIT) Enrollment and Billing
    • If you are a HIT provider, your applications started processing on January 4. Once approved, you are able to bill for the HIT services. 
    • If you are affiliated DME, HHH or Part A provider groups, please encourage them to view the OnDemand webinar
  • Benefit Deficit Initiative
    • IBT for CVD Teleconference today at 11 a.m. ET.  Please join after this meeting.
    • As a Medicare contractor, Palmetto GBA has launched a project to better understand and ultimately help improve the performance and reporting of services for Annual Depression Screening (G0444) and Cardiovascular Disease with Intensive Behavioral Therapy (G0446). We view this innovation project as an opportunity to improve beneficiary outcomes by bridging gaps in patient care.
    • We would like to enlist the help of the provider community as our partner in this endeavor. Our goal, in the upcoming months, is to raise awareness of these covered services and increase the appropriate utilization of the respective HCPCs.
    • Studies of depression in older adults have found that many of these patients were experiencing their first episode of major depressive disorder, which had gone unrecognized and untreated.
    • To facilitate beneficiaries getting the care and support they need, Medicare covers “Annual Depression Screening” – HCPCS code G0444. This service can be provided and billed separately during the subsequent Annual Wellness Visit, G0439. The AWV is an excellent opportunity to provide this screening, in addition to the other services you are providing.
    • Cardiovascular disease, known as CVD, is the leading cause of mortality in the United States. CVD, which comprises hypertension, coronary heart disease, heart failure and stroke, is also the leading cause of hospitalizations.
    • The Centers for Medicare & Medicaid Services determined that the evidence is adequate to conclude that Intensive Behavioral Therapy, IBT, for CVD is reasonable and necessary for the prevention or early detection of illness or disability, and is appropriate for individuals entitled to benefits under Medicare Part A or enrolled under Medicare Part B
    • HCPCS code G0446 is used to report IBT for CVD services
    • To assist providers, Palmetto GBA has developed training modules for these two services which are available on both Palmetto GBA Part B websites. The modules can be found under Education, then select self-paced learning and you will see a list of Latest Articles.
    • We are also conducting monthly teleconferences on each service through March. The teleconference for Annual Depression Screening is on the first Tuesday of the month and the teleconference addressing IBT for CVD is on the secondTuesday of the month. Please join us if these services might apply to your practice.
  • 2021 E/M Update and Education
    • 2021 E/M Update/Education — Palmetto GBA E/M webinar on January 14, 2021, at 11 a.m. ET. We will cover:
      • Part B 2021 Medicare Final Rule: Evaluation and Management Changes
      • History and exam will no longer be used to select the level of code for office/outpatient evaluation and management (E/M) visits.  Instead, an office/outpatient E/M visit will include a medically appropriate history and exam when performed.
      • The history and exam components will be performed when they are reasonable and necessary and clinically appropriate
      • We will also review Time /MDM/Prolonged Office/Outpatient E&M Visits services
  • Ambulance Prior Authorization Update
    • In September, CMS announced that it will expand the Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Model nationwide, as the model met all expansion criteria under section 1834 of the Social Security Act (as added by the Medicare Access and CHIP Reauthorization Act of 2015)
    • The model’s program integrity, patient safety and cost-savings elements continue in the existing states (JM for Palmetto GBA). CMS will release more information on the national expansion and implementation dates for additional states as it becomes available. The national model will follow the same design as the current model. CMS is continuing to monitor the COVID-19 Public Health Emergency and will take that into account when determining the timeframe for expansion into additional states.
    • Palmetto GBA will share information as directed in the Palmetto GBA email updates. There is also an Ambulance PA section on the Prior Auth Prior Authorization Hub.
    • Emergency Triage, Treat, and Transport (ET3) Model Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call
    • To support the community of organizations that responded to the public health emergency stemming from the Novel Coronavirus Disease (COVID-19), CMS decided to delay the start of the ET3 Model from May 1, 2020, until January 1, 2021. The new date was communicated directly to selected applicants and through the ET3 Model Listserv on September 16, 2020. The first performance period will now begin on January 1, 2021.
  • Opioid Treatment Program
    • Value in Opioid Use Disorder Treatment Demonstration. CMS, and the Center for Medicare and Medicaid Innovation (Innovation Center) has announced the Request for Application (RFA) for a new initiative that aims to increase access to opioid use disorder (OUD) treatment services to eligible Medicare Fee-For-Service (FFS) beneficiaries, including those dually eligible for Medicare and Medicaid. This is one of a number of new initiatives required under The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (the SUPPORT Act).
    • Value in Opioid Use Disorder Treatment (Value in Treatment) is a four-year demonstration that creates two new payments to participating providers: 1) a per beneficiary per month care management fee (CMF) and 2) a performance-based incentive payment. These new payments will be made in addition to the OUD treatment services Medicare currently covers.
    • Value in Treatment participants may use these payments to furnish certain patient-centered OUD treatment services and have a reasonable expectation of improving or maintaining the health or overall function of participating beneficiaries
    • The demonstration is open to a wide range of eligible participants, including:
      • Individual physicians
      • Group practices comprised of at least one physician or nurse practitioner
      • Hospital outpatient departments
      • Federally qualified health centers
      • Rural health clinics
      • Community mental health centers
      • Certified community behavioral health clinics (CCBHCs)
      • Opioid treatment programs (OTPs)
      • Critical access hospitals (CAHs)
  • CMS encouraged eligible participants to apply to the demonstration by January 7, 2021. This date is the result of an extension. Selected participants are expected to implement the demonstration by April 1, 2021, at which point demonstration payments will also start.
  • COVID-19 Vaccine/Updates
    • The COVID-19 vaccine and the monoclonal antibody infusion therapy are two of the hottest topics right now
    • CMS has provided direction and you may have noticed throughout since March. Palmetto GBA is not creating new educational material if CMS has released the information in one of their publications. It's important for all the providers across the country to get the same guidance and instructions.
    • We have continued to add things as CMS has put them out there. We did take the opportunity to organize MLN Matters articles. Our communications team has been adding a description of what the primary focus of each of those MLNs are.  So that it's a little bit easier for providers to find that information.
    • CMS has provided some very specific information about who can bill for the COVID-19 vaccine and the monoclonal antibody therapy. We held the webcast at the end of December to assist providers that perhaps have never billed Medicare before but are going to be furnishing the vaccine or the monoclonal antibody therapy. Providers who want to do this will need to enroll as a mass immunizer
    • Palmetto GBA has been detailed in educating about how providers can enroll using the quick version. We should have information published by the end of the week in the form of a mass immunizer or roster billing packet for the COVID-19 vaccine and for the monoclonal antibody therapy. The document is for providers that will be doing mass immunizers and are already enrolled in Medicare, but is also for brand new providers that have never billed Medicare before.
    • One of the biggest topics right now is that initially the government is going to be providing the vaccine itself, the supply of the vaccine at no cost to providers.  There should never be a claim that comes into Medicare for the supply of a vaccine that was given to the provider community for free. The only thing that should be on the claim should be the administration code and the administration charge.
    • We will know which vaccine you gave the patient because there are different administration codes for each of the different vaccines, whether it's a first vaccine or a second, if it's a two-part vaccine
    • Your software vendor may have edits in place that tell you, you have to bill for the supply. You need to work with them and tell them that that CMS doesn't want you to bill even a penny for that. They want you to not bill for that supply at all. The same information applies for the monoclonal antibody. You shouldn't be billing for the antibody itself. It is provided to you at no cost by the government
  • COVID Action Item
    • Members were asked to discuss the layout of Palmetto GBA’s COVID webpage and provide feedback on user friendliness. We want to ensure providers are able to find what they need and not getting lost among the cast amount of information. We also don’t want to delete anything providers feel they still may need.  Members will report back to POE-AG lead.
  • CERT
    • In addition to these initiatives, we will still maintain a heavy focus on CERT as well as any topics that remain or will appear on our Part B problem list

Calendar of Events – Educational Needs

  • Palmetto GBA Scheduled Events
    • Part B 2021 Medicare Final Rule: Evaluation and Management Changes — January 14, 2021, at 11 a.m. ET
    • Medicare Part B Jurisdiction J and M Modifier Series: Modifier 59 and Medical Review Postpayment Review Top Denial — January 28, 2021, at 2 p.m. ET
    • Jurisdiction J and M Part B Medicare Diabetes Prevention Program (MDPP) Resource Review and Question and Answer Webinar — January 28, 2021, at 11 a.m. ET
  • Future Event Suggestions
    • ACT topics (no topic yet)

CMS Educational Events/Topics

  • Importance of Proper Documentation: Provider Minute Video
  • Don’t run out of time. Remember to complete your Web-based Training (WBT) courses and save your certificates by January 31. The Medicare Learning Network (MLN) Learning Management System won’t be available starting February 1. All content will be moving to CMS.GOV soon.
  • To further support clinicians during the COVID-19 Public Health Emergency (PHE), CMS extended the 2020 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances Exception application deadline to February 1, 2021
  • The Medicare Intravenous Immune Globulin (IVIG) Demonstration was scheduled to end on December 31, 2020, but it is now extended through December 31, 2023
  • An audio recording, transcript, and clarification are available for the December 16 Medicare Learning Network listening session on the Improving Prior Authorization Processes and Promoting Patients’ Electronic Access to Health Information Proposed Rule. Learn about the proposed requirements.

Hot Topics

  • Spring Workshop Series/Travel
    • At this time we have been given no indication of when we will be able to resume travel due to the public health emergency, so our spring workshop will follow the same format as MACtoberfest and will be conducted virtually
  • Upcoming Enhancements for eServices
    • Roster Billing
      • We are currently working on adding roster bill capabilities to the eServices portal. With the upcoming mass vaccinations for COVID-19, we are sure this will be a welcome addition for our provider community. We have a target date of late January or early February.
    • Find my administrator enhancements
      • Since we had our last meeting, we have added an enhancement to the “My Account” section of the portal “Find My Admin” which allows users who need user access to certain areas of the portal, to be able to bypass contacting the PCC to retrieve administrator information
      • The “My Account” tab providers will now see up to three administrator names
      • The names will appear in blue as hyperlinks. Clinking on the links will enable you to send an email directly to the admin with your question or request. Please be mindful that the email address listed is the email address given by the admin at the time they signed up. If you are an admin and that info needs to be updated, please do so.
      • Since then, we are working to enhance the feature to provide a way for users to locate their admins without having to log into the account
    • Re-Openings
      • We are also working to expand the simple claims correction re-opening option to make it easier for providers to request re-openings within the claim at the exact place they need to do the re-opening. This is in the early stages and we are exploring options.

Agenda Items Submitted by Members

Open Discussion Questions
No open discussion items.

Announcement of Next Meeting Date: April 13, 2021


Your Opinion Matters

Please take a moment to complete our satisfaction survey.

Launch survey

Last Updated: 02/04/2021