Jurisdictions J and M Part B Provider Outreach and Education Advisory Group Meeting Minutes: May 8, 2024

Published 05/21/2024

Welcome and Introductions

Palmetto GBA Associates

  • Yoshiko White Dimes
  • Shelly Dailey
  • Shannon Chase
  • Kathy Boehm
  • Belinda Marin
  • Wendy Weary
  • Kim Jeter
  • Keiona Henry

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) 

Old Business

None.

Special Agenda Topics

  • MayFest — Registration is now open; Part B sessions will be held on May 30 
    • If you work in a facility that provides both Part A and Part B services, Part A sessions will be held May 29
       
  • MACtoberfest
    • Save the Date: MACtoberfest will be held in Columbia, S.C., at the University of SC Alumni House September 24–25, 2024
    • Palmetto GBA solicited session topics from members
    • We aim to make these conferences worth your time and travel dollars and want to bring you the topics that are of most interest to you. This is the time to hear directly form the functional areas on the topics that are of most interest to the provider community. I will send out an email after this meeting with the areas we have so far. Please respond with topics you would like addressed.
    • Confirmed departments: Provider Enrollment, Appeals, MR, Finance, Medical Affairs, RRB, EDI
       
  • Change Healthcare Incident
    • The Centers for Medicare & Medicaid Services (CMS) and Palmetto GBA are aware that Change Healthcare recently experienced a cyberattack
    •  Change Healthcare is a clearinghouse that connects providers with insurance payers and has operations that impact the submission of Medicare claims, including claims submitted to Palmetto GBA and Railroad Medicare. At this time, there is no indication that Medicare systems have been compromised. This is not a CMS or Palmetto GBA incident
    • We understand the need to make sure your patients have continued access to care, and the ability to submit Medicare claims. Palmetto GBA takes these matters very seriously and will provide additional updates should they become available
    • If your EDI clearinghouse is impacted, we recommend you check directly with them for further instructions
    • Affected parties should be aware of the following flexibilities in place
      • Accelerated and Advance Payment Requests
      • Submission of electronic claims
      • Submission of paper claims

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.)

  • Directed providers to the following hot topic MLNs
    • Marriage and Family Therapists & Mental Health Counselors
    • Updates to several preventive services booklet to include diabetes supplies covered under Part B
    • Stay of Enrollment
    • Social determinants of health risk assessment as an optional annual wellness visit element
    • Community health integration and principal illness navigation when covered as mental health services
    • Two new HCPCS codes for psychotherapy for crisis services
    • 2025 in-person visit requirements for mental health services provided by telehealth
    • Annual wellness visit being a community health integration initiating visit
    • Caregiver training services
    • Intensive outpatient program services
    • Exception to the direct supervision requirement for “incident to” services and supplies
    • HCPCS code G0136
    • Marriage and family therapists and mental health counselors providing telehealth services
    • Frequency for partial hospitalization program plan of care certification
    •  Updated payment rates
      • Telehealth non-facility
      • Clinical social workers

eServices Enhancements/Updates

  • New Tools: Second Quarter
    • Dental additional documentation form
    • Greenmail module — in works
       
  • eComm Update/Reminders
    • Access letters sent to you online — Via eDelivery any user can view, download, or print many letters that Palmetto GBA sends instead of waiting on the U.S. mail to deliver the letter to one person
    • View and respond to Outstanding ADRs — Retrieve a list of claims with outstanding ADRs. Then click the link to the ADR Response form to send in the requested documents
    • Roster Billing for Vaccines — If you give vaccines for flu, pneumonia and/or COVID-19, consider using Roster Billing to upload your patients on a single spreadsheet instead of creating each claim separately
    • Financial Tools
      • Cash Flow Snapshot — Access payment information such as the last three payments, payment floor and payment history
      • Overpayment Data — Access current detailed overpayment information such as balances and interest
      • eCheck — Submit an eCheck to have your checking or savings account debited overnight for the amount you want to return
      • eOffset — Send offset information to request an immediate offset when you receive an overpayment demand letter or make a permanent request for all future overpayment demands
         
  • Focus Group
    • Two new eServices focus groups
    • Palmetto GBA solicited members at our recent Spring Tour. Want to always give our POE-AG an opportunity to participate. Please mail me if interested

Agenda Items Submitted by Members

  • PECOS Issues/Training
    • Member has several new staff members who sometimes have questions about PECOS. Wanted to know if Palmetto GBA comes out to train on PECOS.
      • The PECOS contract is a separate CMS government contract, so Palmetto GBA does not conduct PECOS training as CMS has tasked PECOS education to the PECOS contract
      • POE does educate on the forms that may be needed and Provider Enrollment issues/guidelines that affect the provider community as mandated by CMS
      • The PECOS site has a robust education library that includes step by step processes for the various PECOS functions
      • Palmetto GBA does have a dedicated Provider Enrollment area who has access and are able to handle PE related questions to PECOS
      • For providers that have PECOS questions specific to their applications, Our Provider Enrollment department holds a monthly open house that you are able to register for. Please note this is not a training session, but a session designed to assist you with actually submitting your information or working through any credentialing issues or questions you may be having
         
  • Unspecified J Codes
  • Remote Physiologic Monitoring (RPM)/Remote Therapeutic Monitoring (RTM)
    • Provider wanted to know if Palmetto GBA plans to publish any formal guidance on the requirements for these services
      • Update: per Medical Affairs, there is no formal guidance at this time. If provider, would like to request guidance through either an LCD or article, please submit to Medical Affairs for consideration
      • Request Guidelines

Open Discussion Questions

None.

Announcement of Next Meeting Date

August 14, 2024.

Adjournment


Was this article helpful?

mln