Provider Outreach and Education Advisory Group (POE-AG) Minutes: August 18, 2021

Published 09/07/2021

Palmetto GBA welcomed all POE-AG Members

Debbi Hogg

PCM

Pattie Douglas

Tennessee Oncology

Peggy Palmer

PPC

Joann Cook

AASC

Kim Walker

Northside Hospital

Crystle Wright

GI Associates of Cleveland

Patricia Dykes

Neurological Institute of Savannah

Stephanie Smith

Southern Wellness

Palmetto GBA Associates 

  • Swandra Miller
  • Belinda Marin
  • Shannon Chase 
  • Kathy Boehm

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) 
     

Special Agenda Topics/Hot Topics

MayFest 2021
We thanked our members for assisting with advertising and participating in our 2021 MayFest virtual event. The event was a success and attendance was great. We educated over 1,300 Part B providers over the two-day event and we credit the extra attendance to each provider’s willingness to allow more employees to attend because it was virtual. 

MACtoberfest 2021 Virtual Symposium
MACtoberfest 2021 will also be a virtual event this year and the dates are October 19-21, 2021. Members were encouraged to mark their calendars and be on the lookout for additional information about registration and available training sessions.

Appeal Submission
Members were encouraged to submit first level redetermination (appeal) requests through eServices. Our appeals department has been contacting the top providers that submit appeals requests manually to talk with them about using our online portal (eServices). Benefits of submitting the redetermination requests electronically include:

  • Uploading documents versus faxing or mailing them
  • Confirmation from us that we’ve received your documents once the upload is complete
  • Faster processing times

CERT Review
CERT program activities resumed in August 2020. Members were reminded to make sure that their CERT contact information is current to ensure that the CERT letters and documentation requests get to the right area timely. Members were also told to appeal any CERT denials that they were not in agreement with by following the normal redetermination process.
 

Hot Topics

eServices Enhancements

  • On June 17, 2021, changes were made to the Outpatient Prior Authorization Form to add two new services (Cervical Fusion with Disc Removal and Implanted Spinal Neurostimulator). We also posted an on-demand webinar to the website.
  • On June 25, 2021, the MR ADR Response Form was updated to pre-populate with the submitter’s name

We’re constantly improving and making updates to the online portal to make it the best experience for our provider community. We are open to any feedback and suggestions, to improve provider’s experience with the portal

  • Member asked if there could be an enhancement that allows large medical groups the opportunity to see providers impacted by CERT, TPE, etc. without having to look at each individual provider’s NPI (e.g., a report based on the provider’s TIN)

Website Layout
We’re still getting positive feedback on the new website layout. However, with any new website there may be things that aren’t working as they should. Providers were asked to notify us if they encounter broken links or missing information.
 

Agenda Items Submitted by Members

Repayment of Accelerated/Advanced Payments

  • Repayment began on March 30, 2021
  • Beginning one year from the date of the first payment and continuing for 11 months we’ll recover payments at a rate of 25 percent
  • For six months after the 11- month period we’ll recover payments at a rate of 50 percent
  • Unpaid balances remaining after the six - month period must be paid in full 
  • Balances not paid in full will be subjected to an interest rate of four percent
  • Medicare Learning Network Article: SE21004
  • Recoupments appear on the remittance advice as an adjustment in the Provider-Level Balance section (CVDA)
  • JJ.Financialrelief@PalmettoGBA.com

Calendar of Events: Palmetto GBA Scheduled Events
Providers can register for all events on our website.

  • August 19, 2021: Palmetto GBA eServices Webinar Series Session 3 at 11 a.m. ET 
  • August 24, 2021: Combined Intensive Behavioral Therapy for Cardiovascular Disease and Annual Depression Screening Teleconference at 1 p.m. ET
    • Time: 1–1:30 p.m. ET; 12 p.m. CT 
    • Teleconference number: 877–789–3907 
    • Conference ID: 6872136 
  • September 17, 2021: Referring, Monitoring and Certifying Home Health and Hospice Services Webcast at 12 p.m. ET 

Future Event Suggestions

  • ACT topics – Our next ACT call will be on November 9, 2021. Members were asked for topic suggestions.

CMS Updated Publications

  • Medicare Parts A and B Appeals Process Booklet: 2021-05
  • Medicare Preventive Services Educational Tool: 2021-05
  • Skilled Nursing Facility, 3-Day Rule Billing Fact Sheet: 2021-04
  • Medicare Secondary Payer Booklet: 2021-04
  • Collaborative Patient Care Is a Provider Partnership Fact Sheet: 2021-04
  • Medical Record Maintenance & Access Requirements Fact Sheet: 2021-04
     

Open Discussion

There was a request to add access to the outpatient prior authorization form to the portal for Part B. POE responded by instructing the members that at this time, the form can only be submitted through the portal by Part A providers, because it’s a Part A function. Part B providers can manually submit the form either by fax or mail. Part B providers can also check the status of the prior authorization if they have the submitters PTAN and NPI through the status tool.

Members were reminded that CMS approved the ambulance prior authorization program nationally. Currently, there is no start date for JJ, but it’s coming. The prior authorization module doesn’t change the documentation requirements already in place for ambulance services. Ambulance providers and referring physicians were told to start reviewing the documentation requirements to ensure that they are compliant.

Announcement of Next Meeting Date: November 17, 2021.


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