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

Published 02/23/2024

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

Facilitator — Tyrekia Barden, Senior Provider Relations Representative

Palmetto GBA Members

  • Wendy Weary, Supervisor
  • April Gause, Senior Education Consultant
  • Areka Freeman, Senior Provider Relations Representative
  • Jamela Hillary-Harris, 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:

Education  Actions Taken
Outpatient Prior Authorization (OPD) Communications: Semi-Annual and Annual Results

Feedback — Members had no further feedback.

New Business

  • Members were advised that they shall no longer contact the Benefits Coordination & Recovery Center (BCRC) to create or update MSP records. Providers may contact the Provider Contact Center (PCC) for assistance.
  • Spring Tour will kick off will take place on April 2, 2024, in Columbia, S.C., for N.C. and S.C. providers
  • PalmettoGBA is partnering with CGS in a collaborative effort to provide live symposium events on a quarterly basis
    • A SNF Symposium was held in Greensboro, N.C., on January 11, and 12 for the first quarter
    • The next quarter’s collaboration is designed for Part B providers and is currently in development
  • Survey feedback is very important in the development of education. Providers are asked to continue providing feedback to inform us on what needs improvement as well as what you like

POE-AG Education Suggestions and Recommendations were provided as follows:

Feedback
Members had no further feedback.

Website Updates

Latest Articles and Self-Paced Learning 

  • How to Use the Office and Outpatient Evaluation and Management Visit Complexity Add-on Code G2211 Appeals Overview for Providers Module

Feedback
Members had no further feedback.

Upcoming Part A Education Events

  • Inpatient Rehabilitation Facility Education Week: Self-Service Tools Overview Webinar: February 16, 2024 
  • JJ Provider Enrollment Open House: February 20, 2024 
  • Inpatient Rehabilitation Facility Education Week: IRF-Billing Overview Webinar: March 22, 2024 
  • Inpatient Psychiatric Facility Billing Overview Webinar: March 28, 2024 
  • Part A Quarterly Updates Webinar: March 28, 2024 
  • Meet with Your MAC — Thursday Sessions

Feedback
Members had no further feedback.

CMS Initiatives

Feedback
Members had no further feedback.

CERT Education Resources
We are increasing our concentration on reducing the CERT error rate and partnerships with all MACs, CERT and other medical review contractors. For 2024, CMS designated Palmetto GBA’s April Gause, Education Consultant, as the Leader of the A/B CERT MAC Task Force (palmettogba.com). As the A/B CERT Task Force members work together to develop education material it will be shared when it becomes available.

Feedback
Members had no further feedback.

Open Discussion

Members were invited to participate in an IVR focus group.

  • One member agreed to participate during the call
  • An email was issued with additional detail requesting additional participation

The questions listed below were posed during the meeting:

1. Question: Medicare Advantage plans are not following suit with the “Two Midnight Rule.” How is Palmetto GBA addressing this?

Answer: The Federal Register, advises that a MA plan must provide coverage, by furnishing, arranging for, or paying for an inpatient admission when, based on consideration of complex medical factors documented in the medical record, the admitting physician expects the patient to require hospital care that crosses two-midnights (§ 412.3(d)(1), the “two midnight benchmark”); when admitting physician does not expect the patient to require care that crosses two-midnights, but determines, based on complex medical factors documented in the medical record that inpatient care is nonetheless necessary (§ 412.3(d)(3), the “case-by-case exception”); and when inpatient admission is for a surgical procedure specified by Medicare as inpatient only (§ 412.3(d)(2)). However, it is important to clarify that the “two-midnight presumption” (the presumption that all inpatient claims that cross two midnights following the inpatient admission order are “presumed” appropriate for payment and are not the focus of medical review absent other evidence) does not apply to MA plans. 
Reference: Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

2. Question: Medicare Advantage (information only) claims submitted to Palmetto GBA are not processing due to the beneficiary having primary insurance. How can this issue be resolved?

Answer: Specific claim examples were previously submitted for review by the provider and an update will be provided once complete. Additional examples provided will be addressed. 
 

Next Teleconference
The next POE-AG Teleconference is May 15, 2024, at 11 a.m. ET. Please send any agenda items Tyrekia.Barden@palmettogba.com prior to the meeting.


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