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

Published 02/28/2024

Welcome and Introductions

Palmetto GBA Associates: Yoshiko White Dimes

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

  • Provider Enrollment — Paper Applications
    • Member explained that they work with a large number of providers who don’t prefer to use PECOS to upload electronic applications. Providers would like to see eServices accept paper applications to accommodate provider request.
    • Action Item/Resolution: After meeting, it was determined that there is already a submitted Action Request (A/R) with our eCommerce/eServices team requesting this addition to the portal. There is no ETA at this time for completion.

Special Agenda Topics

  • 2024 Spring Tour
    • We will resume our face-to-face Spring Tour again this year. Our kickoff will be in Columbia, S.C., at the Palmetto GBA GPC building on April 1, 2024.
    • We look forward to receiving our N.C./S.C. providers there. Providers from all states are welcome to attend. We will then continue with our Jurisdiction J states (Alabama, Tennessee, Georgia) the second week of April and round out our tour in Virginia and West Virginia, the following week.
  • IVR Focus Group
    • During our third Quarter 2023 POE-AG we solicited volunteers for an IVR focus group. Focus group participants do not have to members of the POE-AG. Participants can be anyone from your facility who calls into the PCC and uses our IVR. If you are still interested in participating, please send me an email after this meeting letting me know that your facility is willing to participate. My goal is to get at least two volunteers from JJ and two from JM
      • Update: After meeting, was able to secure three volunteers for Part B
         
  • CPT J3300
    • Kenalog Injection
      • We received guidance from our claims department in regards to rejections for CPT J3300 — the Kenalog injection
      • Providers who bill for this code will need to continue to include the invoice when submitting your claims. We will not require medical documentation, only the invoice is needed.
      • Once pricing for this code is finalized, we will be updating files to include this code in the 2023 Invoice Pricing article and updates for 2024
      • This update is only for J3300 (triamcinolone acetonide), which is the preservative free version. All the other versions should be billed as J3301.
      • If you are filing a paper claim, include the invoice with the claim
      • Electronic filers, which will be the majority of these, must submit the invoice via PWK or for JM — narrative fax with the box indicator that a fax is attached
      • Providers will see the following message their remit:
        • Reject message 625
        • 252 — An attachment/other documentation is required to adjudicate this claim/service
        • Remark Code: M23 — Missing Invoice
           
  • Final Rule 2024
    • Educational Needs
      • We know the final rule was full of new guidelines and changes for providers across many Part B specialties. As we are gearing up for travel to various conferences and workshops both provider sponsored and Palmetto GBA sponsored, we wanted to get a pulse on what providers are hearing or need additional education on. We want to take a look at what has been published and topics we may need to develop more
        • Provider Suggestions:
          • Education on CT scans and X-rays — Professional and tech component
          • G2211 — Update: This topic will be a webinar in March 2024
             
  • Social Media, website and self-service tools
    • Members we asked for feedback on how they use social media, and what types of social media posts they look for. Are you coming to our social media channels looking for webinar information, CMS updates, etc? What would you like to see there? What type of information would be helpful to you there?
      • Responses:
        • Provide registration replay links — Advised member we are transitioning to a new webinar platform that will provide the links she is used to seeing with ON24
        • Hot Topic Tuesday — Explore making TEAMS recording available or send to registered participants who could not attend
        • Website — Be sure to always advertise when site is down for maintenance
        • Updates on PECOS 2.0 
           

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)

  • Low Utilization Probe and Educate (LUPE)
    • Five claim review of provider claims, similar to TPE but with a smaller sample. Providers are identified based on their utilization sample size
    • LUPE letters are available for all JM Part A, HHH and Part B providers selected for the review
    • eServices — Letters are available in eServices
      • Advised member is her organization gets letters via US mail due to interal requirements, she will receive any LUPE letters via US Mail. Only active eServices members will get the greenmail letters 
  • Cognitive Care Assessment
    • Cognitive assessment and care planning services is an ongoing CMS initiative to make providers aware of the benefits of the service. Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan .Use CPT code 99483 to bill for this service if all the requirements are met
    • Please visit the CMS website for the guidelines and additional information.
  • Enrollment for New Provider Types
    • CMS updated the enrollment application fee for 2024
      • The 2024 application fee is $709
      • Whether you apply for Medicare enrollment online or use the paper application, you can pay the Medicare application fee online through PECOS. During the application process, PECOS prompts you to pay the application fee or CMS Paper Application. Go to PECOS Application Fee Information to submit the application fee.
    • Merged Form CMS-855R into the CMS-855I paper enrollment application
      • CMS-855I — The Medicare enrollment application physicians and nonphysician practitioners (NPPs) (individual physicians or NPPs) use to enroll, revalidate enrollment, or change enrollment information
      • Physicians and NPPs can also reassign their right to bill the Medicare Program, terminate a current reassignment of Medicare benefits, or make a change in their reassignment of Medicare benefit information using the CMS-855I
    • Added
      • Marriage and family therapists, mental health counselors, and certain dental specialties to the Part B suppliers list 
        • This information was added to the enrollment section of the booklet. Specifically under the section “Who are Part B Providers.”
          • There is a listing of Provider types that fall under the 855I for physicians, NPPs and Suppliers
      • New provider specialty code information for dentists
        • Beginning January 1, 2024, established new provider specialty codes for dentists
        • There are approximately 12 different specialty types that were added

Resources

Provider Enrollment

Licensed Family Marriage Therapist & Mental Health Counselor

Note: We have a lot of new moving parts in the Part B world and it all starts with the enrollment process. For our new provider types and our old, members were reminded that Palmetto GBA offers providers the opportunity to schedule one on one time to assist with questions.

Provider Enrollment Open House is held the first and third Tuesday of every month and allows providers, suppliers, and others the opportunity to speak directly with a Provider Enrollment subject matter expert.

Note: These are individual sessions and are held telephonically. This is not an informational seminar/presentation.

Palmetto GBA Provider Enrollment will hold a virtual open house on Tuesday, February 6, 2024. There are ten 30-minute sessions available from 8:30 a.m. to 4:30 p.m. ET. During each of these sessions, we are available to answer questions, assist with application completion, PECOS enrollment and all things enrollment-related.

eServices Enhancements

  • Low Utilization Probe & Educate (LUPE)
    • Palmetto GBA has two new greenmail letter options through eServices. Providers are now able to receive the Skilled Nursing Probe and Educate, or SPE (Part A only) Low Utilization Probe and Educate, or LUPE (Parts A, B and HHH) letters as greenmail via the eDelivery tab in eServices
    • To start receiving greenmail, you must be signed up for our eServices online provider portal. Once you have signed into eServices, selectthe Admin tab and navigate to the eDelivery Preferences subtab. You can then update your eDelivery preferences by simply clicking the drop down box to choose eDelivery, instead of US Mail, for the letters you would like to receive via greenmail. You can also select the User Pref Email Notification checkbox to start receiving emails when your letters are available in eServices for you.
    • To register for eDelivery instead of the U.S. Mail, the eServices account administrator can select the letters in eDelivery preferences under the Admin tab
    • Letters are accessible to all users on the eServices account. The eServices account administrator will need to grant access permissions for users
    • There are many other Medical Review letters available to receive as eLetters in eServices. The administrator can view the entire list in the eDelivery Preferences subtab.
       
  • Accountable Care Organizations (ACO)
    • On January 2, 2024, eServices made an update to display information on the ACO models for Part A, Part B and HHH providers that are participating in an Accountable Care Organization. A new menu tab, ACO, will display to provider account administrators. Administrators can then add the permission to view the data to other users. 
      • The Accountable Care Organization page will display a listing of providers and organizations participating in the ACO program. The page also features:
        • The ability to sort:
          • Entries per page
          • Status — active vs. inactive
          • Show Model

Agenda Items Submitted by Members

Open Discussion Questions

None.

Announcement of Next Meeting Date

  • May 8, 2024

Adjournment
 


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