Provider Outreach and Education Advisory Group (POE-AG) Minutes: February 12, 2025

Published 02/25/2025

The Jurisdiction J and Jurisdiction M Part B POE Advisory Group (POE-AG) meeting was held on Wednesday, February 12, 2025.

Palmetto GBA Members

  • Yoshiko White Dimes
  • Belinda Marin
  • Shannon Chase 
  • Kimberly Jeter
  • Shelly Dailey
  • Jazz Harrision
  • Chaquita Bandy
  • Cecil Morrell

Welcome

POE-AG members were welcomed by the facilitator.

Old Business

We will be conducting our annual POE-AG membership review for the remainder of the year. Members who do not meet the POE-AG requirements of attending three consecutive meetings will be rotated off the roster.

Update: We are working to remove inactive members. We are reaching out to members that have sent requests to add additional staff members. 

Special Agenda Topics

Eligibility Removed from Interactive Voice Response (IVR)

Alerted members that the provider community is no longer able to access patient eligibility information from the MAC’s IVR system. Provided members with current guidelines and shared resources for obtaining eligibility to share within their affiliated groups.

  • Palmetto GBA disabled IVR beneficiary eligibility information on January 31, 2025, at 7 p.m. ET
  • The most efficient way of validating beneficiary eligibility is via eServices, Palmetto GBA’s internet portal
  • You must check your patient's eligibility using the eServices portal, the HIPAA Eligibility Transaction System (HETS), billing agencies, clearinghouses, or software vendors

Resources

Introducing SAGE

  • Friday, January 17, 2025: Palmetto GBA is pleased to introduce Sage, our newest chat self-service tool, Part B Claim Status, to the JJ and JM provider communities
     
  • Informed members Part B claim status can now be obtained through our chat application with the help of our automated digital assistant
     
  • Chat Claim Status tool information can be accessed through our chat links available through eServices or any of the JJ or JM website pages for Part B by clicking on the Chat Now button in the lower right corner of the page
     
  • All entries (e.g., provider, patient, claim) must match the information submitted on your claim exactly
     
  • Sage will give you an opportunity to connect with a live agent if you have question regarding the information returned on your claim
     
  • Covered full article details with members and asked for feedback. No feedback given.
     
  • Link: Meet Sage: Your New Part B Chat Assistant for Claim Status Inquiries

Calendar of Events (Educational Needs) and Palmetto GBA Announcements

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.

Telehealth

  • Telehealth Flexibilities Extended until March 31
     
    • Recent legislation extended the waiver of the geographic, site of service, and practitioner type restrictions. Medicare patients in non-rural areas and in their homes can continue to get telehealth services from this extended range of practitioners until March 31, 2025.
    • CMS.GOV telehealth page has the most comprehensive education. Recommended members review CMS fact sheet and FAQ at telehealth-faq-1-8-25.docx
       
  • CMS Telehealth MLN
     
    • CMS will make any additions or deletions to the services defined as Medicare telehealth services effective January 1
       
    • The annual physician fee schedule proposed rule published in the summer and the final rule (published by November 1) is used as the vehicle to make these changes. The public has the opportunity to submit requests to add or delete services on an ongoing basis.
       
    • Because CMS intends to use the annual physician fee schedule as a vehicle for making changes to the list of Medicare telehealth services, requestors should be advised that any information submitted, are subject to disclosure for this purpose
       
    • Guidance includes a list of services payable under the Medicare Physician Fee Schedule when furnished via telehealth, how to submit requests for additions, CMS review criteria and changes, and deletion of services
       
    • Resources: Telehealth

Revisions to Medicare Part B Coverage of Pneumococcal Vaccinations Policy

  • Effective October 23, 2024, CMS updated the Medicare coverage requirements to align with ACIP recommendations
     
    • ACIP recommends that adults age 50 or older who haven’t previously gotten a Pneumococcal Conjugate Vaccine (PCV), or whose earlier vaccination history is unknown, should get 1 dose of PCV (either PCV21, PCV20, or PCV15)
    • Advised members of the guidance contains a listing of underlying medical conditions or other risk factors as well as Immunocompromising conditions

MBI Lookup Tools: CMS Seeks Input by February 17

  • Informed members, CMS is soliciting comments to inform future decision-making regarding how we can best protect MBIs and Medicare beneficiaries
  • MBIs have been targeted by individuals seeking to commit Medicare fraud, including the use of MBI lookup tools to commit MBI theft
  • CMS MBI lookup tool topic areas of interest:
     
    • How organizations operate externally-controlled MBI lookup tools
    • How individuals or organizations use both CMS-operated and externally-controlled MBI lookup tools
    • Potential benefit or impact of prohibiting or restricting externally-controlled MBI lookup tools
    • Safeguards or best practices from inside or outside health care that we should consider for preventing MBI theft and misuse
    • Fill out the survey to provide comments by Monday, February 17, 2025

Ambulatory Surgical Center (ASC) Payment System — January 2025 Update

MLN Matters Number: MM13934 (PDF) Updates included:

  • New device categories, CPT®, and HCPCS codes — fiive new devised approved for pass-through status under OPPS
  • Drugs and biologicals 
    • 33 new drug, biological, and radiopharmaceutical HCPCS codes on January 1, 2025
    • Deleted several old HCPCS codes on December 31, 2024
       
  • Skin substitutes 
    • CMS packages the payment for skin substitute products that don’t qualify for hospital Outpatient Perspective Payment System/OPPS passthrough status into the OPPS payment for the associated skin substitute application procedure. CMS also implement this policy in the ASC payment system.
    • Divided the skin substitute products into two groups for packaging purposes: 
      • High-cost skin substitute product 
      • Low-cost skin substitute products
         
  • Non-opioid treatments for pain relief — CMS established the eligibility criteria for temporary additional payments for certain non-opioid treatments for pain relief, and finalized the payment policy in the CY 2025 OPPS/ASC final rule
     
  • Revisions to Repetitive, Scheduled Non-Emergent Ambulance Transport Prior Authorization Model 

Provider Enrollment — Change of Ownership (CHOW)

  • Both Parties Must Submit Enrollment Applications Within 30 Days
     
    • Providers and suppliers must report a change of ownership (CHOW) within 30 days of the change. 
    • For certified providers undergoing a CHOW, 42 CFR 424.550 states:
       
      • Both the seller and the buyer must submit enrollment applications to report the CHOW
      • If the seller fails to submit an enrollment application to report the CHOW, the seller may be sanctioned or penalized (even after the date of the ownership change)
      • If the buyer fails to submit an enrollment application containing information about the buyer within 30 days of the CHOW, the provider’s billing privileges may be deactivated

Action Item

Member asked for clarification on whether or not both parties are required to submit the application as there are times when the other party isn’t available.

Response from Provider Enrollment (PE): If the Tax ID is changing, then two 855B applications are needed. An application must be submitted to terminate the old enrollment and another application is needed to enroll with the new information. 

Educational Opportunities for 2025

  • Provided members with a projected list of topics for the beginning of 2025 (list is not all-inclusive)
     
    • Understanding the Redetermination and Clerical Error Reopening Process
    • OIG Projection/Projects for 2025
    • Continue with ADRs and TPE education
    • NCCI Edits
    • Self-ServiceTools
    • eServices (starting with Account Linking)
    • Annual Wellness Visits
    • Social Determinants of Health
    • Chronic Pain Management
    • Ambulance Services
    • Opioid Use Disorder
    • CERT
    • New vs. Established Patients
    • New to Medicare
    • Medical Review Topics

eServices Enhancements/Updates

First Quarter Website Updates and Enhancements

  • Eligibility Options Module — Created to use as a step-by-step guide to assist providers with locating patient eligibility information in the portal
  • eServices Now Displays Claims Messages for Part B Providers
    • Part B added a new feature that allows provider to view Explanation of Benefits (EOB) narrative message descriptions associated with claim lines
    •  The "line messages" field will display high level EOB narratives that have been added to the claim tab so providers can see the high level remarks codes 

Agenda Items Submitted by Members

Advanced Primary Care Management (APCM) — Member Submission/Response

  • Submission: A good topic that I see trending now is Advanced Primary Care Management services. Many of my providers are asking for education regarding what documentation is required to support the new codes. During the call, the member further stated providers would like to know what to look for in the event of an audit.
     
  • Response: Palmetto GBA’s clinical team has received and appreciates the suggestion and will add to their work plan as the schedule permits. The clinician further clarified that as they continue to research they are exploring best practices to share as well. 
     
  • Also shared current CMS resources: Advanced Primary Care Management Services

Open Discussion Questions

None.

Next Meeting Date

May 14, 2025

Adjournment


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