Jurisdictions J and M Part B Provider Outreach and Education Advisory Group Meeting Minutes: August 14, 2024

Welcome and Introductions

Palmetto GBA Associates: 

• Yoshiko White Dimes
• Shelly Dailey
• Kathy Boehm
• Belinda Marin
• Kim Jeter
• Jazz Harrison
• Keiona Henry

Goals/Purpose

Our goals are:

•  Establishing and maintaining strong relationships with Palmetto GBA staff and the provider community 
• Meeting with Palmetto GBA and the provider community on a quarterly basis 
• Providing the communication tools to facilitate thorough and prompt transfer of information to and from each representative 
• Coordinating the issues within the provider community to adequately reflect the concerns of the majority 

It is Palmetto GBA’s intent to: 

• 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

None

Special Agenda Topics

• MACtoberfest
  • Registration is now open.
  • The Provider Outreach and Education team at Palmetto GBA invites Part A and Part B Medicare providers from Jurisdictions J and M to the 2024 MACtoberfest® education event in Columbia, S.C., on September 24 and 25, with a meet-and-greet on the evening of September 23. Representatives from Railroad Medicare will also be present. The event will be held at the Pastides Alumni Center at the University of South Carolina.
    • The cost for the two-day event is $250, but Palmetto GBA is offering a discounted early-bird rate of $200.
    • Accommodations are not included, but a block of rooms will be available at the Hilton Columbia Center Hotel, next to the Pastides Center. You will have the opportunity to book your discounted room after registering for your event admission.
    • On Monday, September 23, Palmetto GBA will hold a networking meet-and-greet at the Pastides Center at 4 p.m. Sessions will begin Tuesday morning and conclude Wednesday afternoon, September 25.
    • This live event includes education for physicians, nonphysician clinical staff, and administrators. More than 20 educational sessions are scheduled over a two-day period, presented by more than two dozen speakers. 
    • Registered attendees will also have an opportunity to participate in iCafé, one-on-one sessions with Palmetto GBA. Registration for these will be available via the downloadable Attendee Hub app closer to the time of the event.
       
• ACE Smart Edits Decommissioning
  • Beginning August 31, 2024, ACE Smart Edits and 277CA notifications will no longer be provided for electronically submitted claims. The ACE Smart Edit Tool on the Palmetto GBA websites will be decommissioned.
  • Palmetto GBA has created this 60-day notification period in order to address provider and billing concerns prior to the decommissioning of the Smart Edit Tool.
  • Smart Edits serve as considerations for appropriate claims processing based upon the information submitted on the claim. For claims that receive smart edits, informational messages related to appropriate billing procedures are returned on the 277CA. The 277CA tells the provider whether or not a claim has been rejected or accepted.

Calendar of Events (Educational Needs)

Hot Topics

Upcoming change requests and MLNs
(please be advised, this is not an educational session. We will discuss MLNs, then give members an opportunity to advise what additional education may be needed for provider community)

• 2025 Proposed Final Rule- Calendar Year (CY) 2025 Medicare Physician Fee Schedule Proposed Rule
  • On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that announces and solicits public comments on proposed policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2025.
  • CMS will accept comments on the proposed rule through September 9. see the proposed rule for details on how to submit them. I did not see a link to the proposed rule in that article, but I did go out to the CMS.GOV website. Physician Fee Schedule
  • Topics included in the proposal are as follows:
    • Improving Ambulatory Specialty Care
    • Caregiver Training Services (CTS)
    • Services Addressing Health-Related Social Needs (Community Health Integration Services, Social Determinants of Health Risk Assessment, and Principal Illness Navigation Services)
    • Office/Outpatient (O/O) Evaluation and Management (E/M) Visits
    • Telehealth Services under the PFS
    • Advanced Primary Care Management Services (APCM) 
    • Cardiovascular Risk Assessment and Management
    • Strategies for Improving Global Surgery Payment Accuracy
    • Behavioral Health Services 
    • Opioid Treatment Programs (OTPs)
    • Hospital Inpatient or Observation (I/O) Evaluation and Management (E/M) Add-on for Infectious Diseases
    • Supervision Policy for Physical Therapists (PTs) and Occupational Therapists (OTs) in Private Practice
    • Certification of Therapy Plans of Treatment with a Physician or NPP Order
    • Dental and Oral Health Services
    • Drugs and Biological Products Paid Under Medicare Part B (Next two together)-Requiring Manufacturers of Certain Single-dose Container or Single-use Package Drugs to Provide Refunds with Respect to Discarded Amounts, Approach to Payment Limit Calculations when Negative or Zero ASP Data is Reported to CMS, Payment for Radiopharmaceuticals in the Physician Office
    • Immunosuppressive Therapy
    • Blood Clotting Factors
    • Medicare Part B Payment for Preventive Services
    • There are also some proposals in there for RHCs and FQHCs ad Part D services
       
• Guiding an Improved Dementia Experience (GUIDE) Model Implementation Change Request 13412
  • The purpose of this Change Request (CR) is to implement the GUIDE Model, a demonstration testing alternative payment models and support for people with dementia and their caregivers.
  • Providers are encouraged to review the Change Request 13412 under Medicare News on the website for full details.  As a background, the Center for Medicare and Medicaid Innovation (the Innovation Center) established this model for the purpose of testing innovative payment and service delivery to reduce Medicare and Medicaid expenditures while preserving or enhancing the quality of care furnished to beneficiaries of such programs.
  • The Innovation Center is seeking to test an alternative payment model for Medicare Fee-for-Service (FS) beneficiaries with dementia. Through the model, CMS aims to promote a broad package of care management and coordination, caregiver education and support, and respite services. The model is designed to reduce Medicare and Medicaid expenditures primarily by reducing long-term nursing home care, and secondarily by reducing hospital, emergency department, and post-acute care utilization. 
  • GUIDE will be an 8-year voluntary national model that may be offered in all states, U.S. territories, and the District of Columbia. Eligible providers and suppliers will need to apply for participation in GUIDE. Target participation is 300-400 model participants.
  • The model will pay participants a Per Beneficiary Per Month (PBPM) amount, known as a Dementia Care Management Payment (DCMP), for providing care management and coordination and caregiver education and support services to beneficiaries and caregivers. DCMP rates will be adjusted by a Health Equity Adjustment (HEA) and a Performance Based Adjustment (PBA) to incentivize high-quality care. The HEA and PBA adjustments will not begin until the second Performance Year (PY2). GUIDE will also pay for a defined amount of respite services for a subset of model beneficiaries. Model participants will use a set of new G-codes created for the GUIDE model to submit claims for the monthly DCMP and the respite codes. Each model tier will have a different DCMP rate to reflect the fact that covered services and care intensity will vary across the tiers. Rates will vary based on tier, demographics and other factors included in the model. 
     
• Electronic Comparative Billing Reports (CBRs/eCBRs)
  • eCBR/CBR letters are mailed to providers based on the data analytics for jurisdictions JJ/JM.
  • Reasons providers receive these reports may include:
    • Your billing is different than your peers in your state/jurisdiction and/or in the nation.
    • Your payment patterns are different than your peers. 
    • Keep in mind that your payments could be higher or lower than your peers. 
    • You may be providing these services differently than your peers, meaning your utilization is different
  • Please remember that the eCBR/CBR is not an audit and it does not indicate any wrong-doing on your part. 
  • CBRs are simply an educational and informational tool that we want you to use to see how you can improve your billing and utilization.
  • We encourage providers to view the education provided in the letters.
  •  Our current list of eCBR/CBR letters include:
    • Goniotomy services-eCBR 
    • Medicare Part B in Hospice setting with GV/GW modifier- eCBR 
    • Emergency Department services -CBR
    • Epoetin administration services-CBR
       
• Part B IVR Changes
  • Get ready for a more streamlined IVR process! We are busy making improvements to our existing IVR process. Stay tuned for upcoming  changes designed to enhance your user experience.
  • Your feedback is important to us and has been beneficial in helping Palmetto GBA streamline your upcoming IVR interactions.
  • As a reminder, when calling into the Provider Contact Center, ePass makes it easier for you to communicate the the PCC. If you call the PCC multiple times as day, ePass makes the process faster. ePass is issued, per each NPI and PTAN combination, following your first-time authentication during a given day. Request the ePass, which can then be used for the remainder of the day in order to authenticate. We want to remind providers this code only applies when you use the same NPI, PTAN and TAX ID combination. Additional combinations will require a separate ePass code.

eServices Enhancements/Updates

• Third Quarter Website Updates and Enhancements
  • New EOB Narrative
    • eServices will soon begin to display claim line messages that give further claim details.  We are in the process of adding high level EOB narratives to the claim tab so providers can see the high level remarks codes that appear on their remittance advice
    • Note: There may be additional messages on your remittance advice.  Please download a copy of your remittance advice from the Claim Status information page.
  • Checking Eligibility and Claim Status
    • As a reminder to all providers, please use the eServices portal as the quickest way to obtain eligibility and claim status
  • Account Lockout
    • We have created an enhancement to prevent 30 day lockouts for providers that don’t utilize the eServices portal on a regular basis. 
    • Providers will no longer need to login.
    • When you get the email, “.. to prevent ACCOUNT SUSPENSION” just use the link in the email and your account will stay active. 
    • Providers will get a message after using the link that your action was successful.  No need to do anything else.
    • The link will expire so be sure to use it before the date in the email title. 
    • If for some reason, something goes wrong you will be prompted to the next action to take.
    • The enhancement is set to go live on the 20th of this month.

Agenda Items Submitted by Members

No items submitted

Open Discussion Questions

None

Announcement of Next Meeting Date

November 13, 2024

Adjournment