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Jurisdiction B & C Orthotics & Prosthetics (O&P) POE Advisory Group Meeting Minutes – June 6, 2024

Meeting Date and Time: June 06, 2024, 1:00 p.m. ET

Facilitator: Judie Roan, JC POE Senior Analyst

Advisory Group Members: Curt Bertram, Kimberly Hanson, Aaron Sorensen, Stephanie Greene, Joyce Ardrey and Danielle Sparks

Agenda

  • Roll Call & Purpose
  • Updates and Changes
  • Suggestions – Last Meeting
  • Educational Feedback
  • Online Tools & Spotlight
  • Upcoming Events & 2024 Educational Planning
  • Feedback & Suggestions
  • Open Discussion

Roll Call & Purpose

Judie welcomed the group, then reviewed the purpose of the advisory group:

  • The primary function of the O&P POE AG is to help CGS in the creation, implementation, and review of provider education strategies and efforts.
  • The POE AG gives input and feedback on training topics, educational materials, and dates and locations of provider education workshops and events.
  • The group also identifies relevant provider educational issues and gives recommendations of how to effectively distribute the information to suppliers and their staff.

Judie reminded the group of the importance of completing the surveys.

Updates and Changes

Judie reviewed information about the addition and removal of codes from the required prior authorization, written order prior to delivery (WOPD) and face-to-face encounter lists, retroactive Medicare coverage for prior authorization, myCGS updates, CERT reducing the sample size, and the new CGS Operation: Reduce the Error Rate.

Suggestions from the last meeting:

  • Suggestion: Billing reminder for miscellaneous (99) codes due to issues with custom fitted items that don’t have corresponding OTS codes. Response: This information is in Chapter 10 of the Supplier Manual (JB Supplier Manual Chapter Ten – PricingPDF & JC Supplier Manual Chapter TenPDF – Pricing )
  • Suggestion: Add custom fabricated items to CGS Connect (specifically AFO/KAFO). Response: Judie shared this suggestion with medical review.
  • Suggestion: Add a slide to presentations that highlight the changes implemented due to survey responses. Response: CGS POE has added the slide and Judie shared a copy with the members.

Educational Feedback & Online Tools

Judie asked if anyone attended webinars, workshops, association meetings, councils, or viewed online education.

A member said they have all their new hires attend CGS webinars and it is good education. Another member said they were revamping their onboarding process and are including CGS education in their process, they also had all existing staff attend webinars and view online education and the information is helpful.

Online Tool Spotlight

Judie reviewed the Prior Authorization Lookup Tool 

Upcoming Events & Educational Planning

Judie presented the list of upcoming webinar topics and workshop location. She then asked for suggestions and feedback for the educational plan for 2024.

Feedback & Suggestions

Open Discussion

The L1951 as a custom fitted code and having to use the miscellaneous code when billing for the off-the-shelf (OTS) version.  There was more discussion about going to the PDAC to have an OTS HCPCS created.

There was also a brief discussion about skilled nursing facility overpayments. Judie asked for claim examples and will research.

The meeting adjourned.

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