Provider Outreach and Education Advisory Group (POE-AG) Minutes: August 14, 2024

Published 08/27/2024

The Jurisdiction J and Jurisdiction M Part A POE Advisory Group (POE-AG) meeting was held on Wednesday, August 14, 2024.

Palmetto GBA Members

  • April Gause, Senior Education Consultant
  • Teresa Brown, Senior Education Consultant
  • David Mims, Senior Provider Relations Representative

Welcome

POE-AG members were welcomed by the facilitator.

POE-AG Charter

Review of Goals and Purpose — Part A POE-AG Charter

Old Business

Prior POE-AG Suggestions/Recommendations  

  • At the May 15, 2024, POE-AG meeting, it was suggested the Part A and Part B Claims Processing Issues Log (CPIL) and Event Calendar be combined. Palmetto GBA may consider for 2025 enhancement.

Past Education Events

  • Part A Virtual MayFest — May 29, 2024 
  • Direct Data Entry (DDE) Overview — June 12, 2024
  • IRF Education Week — Training and Navigation on June 21, 2024
  • IRF Education Week — CERT on July 18, 2024
  • Part A Quarterly Updates webinar — July 24, 2024
  • Day of Learning — July 31, 2024
    • Session one: Heart Failure DRG 291, DRG 292, DRG 293
    • Session two: J/M Part A Drugs and Biologicals

Feedback
Several members attended the Mayfest sessions and felt they were educational and informative.

New Business

Part A Education Events

  • Hot Topic Tuesday Teleconferences
  • Meet Your MAC Thursdays – Note: Sessions are for educational purposes and claim resolution will be referred to the PCC
  • Part A — Events Calendar
  • Part A Inpatient Rehabilitation Facility Education Week: Timely Filing Webinar: August 20, 2024, at 11 a.m. ET
  • Understanding Impacts of Improper Payments Webinar: August 26, 2024, at 11 a.m. ET
  • Day of Learning on August 28, 2024
    • Session one: J/M Part A Skilled Nursing Facility (SNF) HIPPS Code Denials and Billing Webinar at 9:30 a.m. ET
    • Session two: J/M Part A, Part B, and Home Health and Hospice Palmetto GBA Targeted Probe and Educate (TPE) Review Process at 11 a.m. ET
       
  • Part A 2024 Top 10 Claim Submission Error Quarterly Analysis Report Webinar: August 29, 2024, at 11 a.m. ET (Note: Date Change)
  • 2024 MACtoberfest® will be held in Columbia, S.C., on Sept. 23–25. A meet-and-greet will be held the evening of Sept. 23. The event will be held at the Pastides Alumni Center at the University of South Carolina. Registration will be required go to MACtoberfest®.

Feedback
Members had no feedback.
 

Website Self-Paced Learning

Web-Based Training (WBT) Report 

  • June 
    • JJ Part A: The most popular WBT was the EDI Enrollment Instructions Guide Module with 52 views, and the second most popular WBT was the Patient Discharge Status Codes & Hospital Transfers Module with 51 views.
       
    • JM Part A: The most popular WBT was the Direct Data Entry (DDE) Module 3 - Claims - (eLearn) with 38 views, and the second most popular WBT was the DDE Module - Quick Reference with 33 views.
  • July
    • JJ Part A: The most popular WBT was the, and the second most popular was the Hyperbaric Oxygen Therapy Module with 71 views, and the second most popular was the EDI Enrollment Instructions Guide Module with 60 views.
       
    • JM Part A: The most popular WBT was the Basics of Provider Level Balance (PLB) Reason Codes Module with 60 views, and the second most popular WBT was the Hyperbaric Oxygen Therapy Module with 55 views.

Feedback
Members had no feedback.
 

CMS Initiatives

Feedback
Several members reported using CMS initiatives in their staff training.
 

Comprehensive Error Rate Testing (CERT)
Palmetto GBA compiles resources and develops checklists to help guide you when responding to CERT documentation requests. The CERT information is used to build many of the POE presentations and articles. Healthcare providers retain responsibility to submit complete and accurate documentation upon request to Medicare.

Comprehensive Error Rate Testing (CERT) Question and Answer Fact Sheet

Feedback
Several members expressed gratitude to the Palmetto POE team and appreciate the hard work and information relayed to them.

Open Discussion

  • Suggestion: A member suggested further education concerning Transurethral Waterjet Ablation and Percutaneous left atrial appendage closure (LAAC). 
     
    • Response: A Provider Education Consultant is developing education and an article will be published in the near future.
       
  • Question: A member had a question concerning meeting a 48-hour timeline for getting medical records to Medicare when using the  Electronic Claims and Additional Documentation Form. 
     
    • Response: Part B providers have two options for submitting documentation for a NOC service. we have an article that lists the services that require additional documentation, Electronic Claims and Additional Documentation.
    • If you use the fax method, you do not need to include the ICN on the fax coversheet and must submit the faxed documentation on the same day the electronic claim is submitted or one to two days prior to claim submission. 
    • If you use the process of sending the documentation through eServices, you create your own unique control number for inclusion in eServices when you submit the additional documentation.
    • Once the provider goes to add their documentation into eServices, you do have to have the ICN of the claim so that the documentation can be matched up with the electronic claim once both claim and documentation have been received. (Page 42 and 43 of the eServices User Manual. 
    • It is a process, and the provider will have to create their own internal process and coordination with the entity or person that submits their electronic claim so that they can include the ICN when using eServices to send the documentation. Full details are in the document linked above and the eServices User Manual.   

Next POE-AG teleconference is November 13, 2024, at 11 a.m. ET.

We value your comments and opinions, and we look forward to a culture of continuous improvement in the way we conduct business and serve our providers. Palmetto GBA intends to demonstrate its commitment to our partnership by sharing with you the process improvements we implement based on your feedback.


Was this article helpful?

mln