PARA Weekly Update For Users December 15 2017

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 December 15, 2017 NEWS FOR HEALTHCARE DECISION MAKERS IN THIS ISSUE QUESTIONS & ANSWERS - Motor Neuron Disease - Laboratory Billing For Critical Access Hospitals - Amniotic Fluid Index and Non Stress Test - Bladder Scan CMS CLICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018 2018 CODING UPDATE DOCUMENTS YEAR-END HCPCS UPDATE PROCESS

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The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

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Speci al Arti cle

The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

PHARMACY PRICING PROCESS

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

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FAST LINKS: Click on the link for special areas of interest: Page

Administration: Pages 1-33 HIM/Coding Staff: Pages 2,5,7,17,19 Providers: Pages 2,4,5,7,19 Critical Access Hospitals: Page 3 Obstetrics: Page 4

- Laboratory Services: Pages 3,19,28,30 - Inpatient Rehabilitation: Page 27 - Durable Medical Equipment: Page 31 - PDE Users: Pages 7,17,19

© PARA Healt h Car e Fin an cial Ser vices CPT® is a r egist er ed t r adem ar k of t h e Am er ican M edical Associat ion

PARA Weekly Update: December 15, 2017

MOTOR NEURON DISEASE

Question: What is the appropriate ICD-10 CM code(s) to report Familial motor neuron disease?

Answer: Report ICD-10 CM G12.24, Familial motor neuron disease. Familial Motor neuron disease(MND)is a progressive degenerative disorder of motor neurons in the spinal cord and brain. Loss of these cells results in weakness and wasting of the muscles due to gene mutation.

Effective October 1, 2017, ICD-10 code series G21.2, Motor neuron disease has been expanded to provide greater specificity in code selection. The expansion includes Primary lateral sclerosis (G12.23), Familial motor neuron disease (G12.24), and Progressive spinal muscle atrophy (G12.25).This advice is supported by Coding Clinic for ICD-10 CM 4th Qtr 2017 provided below.

The new codes are identified in the 2018 ICD-10 CM Code book with a solid red circle in front of the code. Please refer to the PARA Data Editor code descriptions and Coding Clinic for ICD-10 CM 4th Qtr, 2017 provided below.

ICD-10-CM New/Revised Codes: Motor Neuron Disease Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 9 Codes G12.23, Primary lateral sclerosis,G12.24, Familial motor neuron disease, andG12.25, Progressive spinal muscle atrophy, have been created to identify these specific types of motor neuron diseases. Primary lateral sclerosis (PLS) is a disorder of the upper motor neurons that affects the face, arms and legs. When the nerve cells of the brain that control voluntary movement start to degenerate, the muscles stiffen and slow movement.Familial motor neuron disease is a degenerative neuromuscular disease that is caused by a genetic mutation that is inherited. Familial motor neuron disease is not clinically different from sporadic forms of motor neuron disease.Progressive spinal muscle atrophy or progressive muscular atrophy (PMA) is an adult-onset non-hereditary disorder of the lower motor neurons in the spinal cord and the brainstem. Gradually, muscles lose their mass and start to atrophy.

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PARA Weekly Update: December 15, 2017

LABORATORY BILLING FOR CRITICAL ACCESS HOSPITALS

Question: What issues should Critical Access Hospitals (CAH's) be aware of regarding laboratory billing?

Answer: Critical Access Hospitals should be careful to use the correct bill type when billing for reference lab services.When a sample is received by the laboratory, but no direct patient contact is provided, the bill type should be 141, Non-patient services.

Cost based reimbursement provides significant financial advantage to CAHs by allowing them to get paid at 101% of costs on all of their hospital Medicare business ? but reference laboratory claims are an important exception to this methodology.Reference lab non-patient services are reimbursed under the cost-reimbursement methodology; Medicare reimburses reference lab services under its Clinical Lab Fee Schedule.There is no cost-based interim payment nor settlement for non-patient services.

The means by which Medicare identifies reference-lab services from other in-person outpatient lab service is the type of bill: - 851 - Services rendered in the CAH outpatient setting or by a CAH employee - 141 ? Laboratory tests rendered by a reference lab or outside of the CAH outpatient setting.

The billing requirements for CAH?s are found in the following excerpt from the Medicare Claims Processing Manual,Chapter 16 - Laboratory Services: https:/ / www.cms.gov/ Regulations-and-Guidance/ Guidance/ Manuals/ Downloads/ clm104c16.pdf As discussed in section 30.3 (?Place of Service Variation, Critical Access Hospitals?) of this chapter, when the CAH bills a 14X bill type as a non-patient laboratory specimen, it is paid on the clinical laboratory fee schedule. For CAHs, payment for clinical diagnostic laboratory tests is made at 101 percent of reasonable cost only if the beneficiary is an outpatient of the CAH (85X TOB), as defined in 42 CFR 410.2, and is physically present in the CAH at the time the specimen is collected, for dates of service prior to July 1, 2009. However, for dates of service on or after July 1, 2009, the beneficiary does not have to be physically present in the CAH at the time the specimen is collected as long as certain criteria are met, per Section 148 of the MIPPA (i.e. other outpatient services are received by the beneficiary in the CAH on the same day the specimen is collected, or the specimen is collected by an employee of the CAH or of a facility provider-based to the CAH) (see Section 30.3 above, Critical Access Hospital).

Clinical diagnostic laboratory tests performed for a beneficiary who is not physically present at the CAH when the specimen is collected, by a non-CAH employee or who are not receiving other outpatient services in the CAH on the same day the specimen is collected, are paid are paid for under the clinical lab fee schedule. Similarly, for Maryland waiver hospitals, the waiver is limited to services to inpatients and registered outpatients as defined in 42 CFR 410.2. Therefore payment for non-patients (specimen only, TOB 14X) who are not registered outpatients at the time of specimen collection will be made on the clinical diagnostic laboratory fee schedule.

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PARA Weekly Update: December 15, 2017

AMNIOTIC FLUID INDEX & NON STRESS TEST

Question: Can we bill an NST (fetal non-stress test) when the physician also ordered an AFI (amniotic fluid index) and should we have two charges set up? For example: Should we set up two different charges as follows: - Amniotic Fluid Index (AFI) without Non-Stress Test (NST) ? reporting HCPCS 76815 (Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heartbeat, placental location, fetal position and/ or qualitative amniotic fluid volume), 1 or more fetuses), and, - AFI with NST ? using CPT code 76818 (Fetal, biophysical profile, with non-stress testing). The parenthetical notes in the CPT book state for amniotic fluid index without non-stress test, use 76815.

Answer: Yes, that charge setup is appropriate to allow for both possibilities. An NST (59025) may be billed with 76815, but it is a component of 76818 and therefore should not be billed unless there is justification for a modifier such as XE, XP, XU, or 59.

If you perform the NST with AFI, report 76818 only. The hospital should report the single comprehensive service rather than separately report the components.

Here?s a link and an excerpt from the 2017 Medicare NCCI Edit Manual, Chapter 1, General Coding Principles ? we can substitute the word ?hospital? for physician: https://apps.para-hcfs.com/para/documents/CHAP1-gencorrectcodingpolicies_ %20FINAL111516.pdf Procedures should be reported with the most comprehensive CPT code that describes the services performed. Physicians must not unbundle the services described by a HCPCS/CPT code.

By reporting the services separately, the hospital would be paid at the higher NST rate of $215.79 (2017 Medicare allowable) ? this would constitute an overpayment unless the services were separate and distinct ? as in separated by time such that one service cannot be construed to reasonably represent a component of the more comprehensive code.

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PARA Weekly Update: December 15, 2017

BLADDER SCANS

Question: Can we charge for on an inpatient bladder scan services ? looking on how it ties to inpatient versus outpatient. The charge is built to charge IP today and I?m thinking we can?t do that? Please advise.

Answer: Bladder scans are typically performed by unit nurses; for inpatients, PARA does not recommend adding charges for services performed by regularly assigned unit nursing personnel.

Please see our paper on bedside procedures, attached.

If the scan is performed by ?traveling? staff from another department, e.g. radiology, then an additional charge on an inpatient would be acceptable

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PARA Weekly Update: December 15, 2017

Google Chrome and the PDE!

Coming Soon!

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Background: According to a study conducted for the Medicare Payment Advisory Commission (MPAC), departments such as pharmacy traditionally develop separate pricing policies when compared to the rest of the organization (Lewin Group, 2005, p. 22-25).

These pricing policies involve the development of distinct formulas. Generally, facilities assign higher level markup formulas to items with lower cost and assign lower markup formulas for higher priced items. Health care organizations create markups based on various factors including: -

Payer mix Utilization Market Rates Service Offerings

Hospitals are moving towards standardizing pharmacy pricing across all departments and services, thus improving compliance issues associated with inconsistent charging practices.Although no standard methodology exists, it is PARA?s opinion that when creating pharmacy pricing methodologies, the following must be considered: - Self-Administered Drugs (SAD) should have lower markups to comply with Medicare billing standards - Pricing should be developed using a nationally recognized cost basis or actual acquisition cost - Fixed Add-On and Minimum Charges should be utilized to compensate for any use of additional departmental resources for handling or compounding the medication.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Charge Category Options: The PARA Pharmacy Pricing Process is also customized to meet the needs of the pharmacy through the use of charge category values either provided by the First Data Bank National Drug Data File or other categories as provided by the client.The following charge category options are available for this review: - First DataBank (FDB) Categories - The following categories are those assigned by FDB according to the National Drug Code (NDC) assigned to the drug.These can be used as new categories for pharmacy markups to assist in lowering markups for self-administered drugs.

- Client Categories ? If clients are unable to adjust the charge categories available, PARA will create a markup using the client?s available categories and may also suggest the addition or removal of some categories during the project.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Cost-Basis Options: The PARA Pharmacy Pricing Process is customized to meet the needs of the pharmacy through the use of a variety of cost-basis options. PARA has partnered with First Data Bank to provide the best available drug cost information available. The PARA Pharmacy Pricing Process can use cost-basis values either provided by the First Data Bank National Drug Data File or other costs as provided by the client. The following cost-basis options are available for this review: - First Data Bank (FDB) Wholesale Acquisition Cost (WAC) ? This cost-basis represents the manufacturer?s published list price for a drug to wholesalers as reported to FDB by the manufacturer. WAC does not represent actual transaction prices and does not include discounts or rebates.

- First Data Bank (FDB) Suggested Wholesale Price (SWP) ? This cost-basis is the manufacturer?s suggested price for the drug from wholesalers to customers (i.e. retailers, hospitals, physicians, and other buyers) as reported to FDB by the manufacturer.This cost basis does not represent actual transaction prices.

- Client Acquisition Cost (ACQ) - This cost-basis value is reported in the client?s pharmacy information system as acquisition cost. Depending on the internal process of the facility, this cost may include any purchasing contract discounts and may not be updated frequently.

- Client Average Wholesale Price (AWP) ? Although AWP was a national standard, many issues have surfaced over the years which discredited the value as a valid source of cost information.Therefore, AWP is no longer considered a nationally recognized cost basis. http:/ / www.fdbhealth.com/ policies/ drug-pricing-policy/

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Some facilities are still receiving AWP as a cost in their pharmacy information system feeds.Depending on the service provider, the ?AWP? provided may include a hybrid of SWP, WAC, and other cost basis options.Some pharmacy systems are publishing an ?AWP? that is actually a markup of WAC. Please verify with the pharmacy information system provider for details and options on what costs are provided in monthly feeds. http:/ / www.medispan.com/ pricing-policy-update/

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Fixed Add-On and Minimum Charges: Pharmacies generally have a need to account for extra compounding resources or other special handling of pharmaceuticals. Minimum charges or fixed add-ons could serve the purpose of accounting for these resources.However, the patient price will reflect differently depending on which is used.

Let?s now consider the following pharmacy markup comparisons with fixed add-on versus minimum charges.In order to ensure an accurate comparison, the markup with minimum charges uses a higher multiplier than the markup using fixed add-ons, but result in the same revenue goal.

Both markups show a consistent increase in the patient price as the cost of the item increases.However, the markup with the minimum charges (because of its higher multiplier) pushes the higher priced items more than when using a fixed add-on fee.

One of the benefits of using a fixed add-on versus a minimum is that it helps to keep the higher cost items lower.

The chart below demonstrates the effect of the different markup structures on chemotherapy medications.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Establishing Fixed Add-On Charges: When establishing a value for a fixed add-on, it is beneficial to map out the time associated with preparing and handling various categories of medications.This information can be used in conjunction with staffing costs to determine a defensible fixed add-on value to use for pharmacy pricing.

Below is a list of some considerations that should be made when determining a fixed add-on charge: -

Route Skill Level Pharmacy Prep Time Average Pharmacy Staff Hourly Rate Additional Outsourcing or Handling Costs

Gross and Net Revenue Projections: PARA?s Pharmacy Pricing Process uses historical transaction data and the top ten payer contract terms to project the gross and net revenue realized by changes to the pharmacy markup. The PARA Data Editor has the ability to copy and compare different markup schedules to ?test? various scenarios using different cost-basis and charge category options.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Implementation Options: PARA has the capability to assist with full implementation of proposed pharmacy markups. The PARA Data Maintenance Services establish a secure connection to the hospital system to update markups, costs, and NDC information.

Please see the link below regarding details of PARA?s Data Maintenance Services. https:/ / apps.para-hcfs.com/ pde/ documents/ PARA%20Data%20Maintenance %20Service%20-%20Final%20March%202013.pdf

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Post-Implementation Analysis: The PARA Pharmacy Pricing Process includes post-implementation impact studies. These are performed after one month of implementation and then on a quarterly basis during the length of the engagement.

The pharmacy impact analysis compares pharmacy transaction data from the base period, the period prior to implementation, and the period of implementation to diagnose the performance of the markup.

The analysis isolates the various aspects of performance including rate and volumes.

The results of these impact studies help to determine if adjustments need to be made to the markup in order to reach the established revenue goals.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS The PARA Solution: Although there is no right or wrong way to structure a markup formula for pharmacy, these concepts help to see the various factors and how they affect the overall result. The PARA Pharmacy Pricing Process assists facilities in creating a rational, cost-based pharmacy markup that remains sensitive to self-administered drugs and uses a nationally recognized cost basis.

Details of this project including purpose, data requirements, method, timeline, and deliverables are as follows. If you would like more information, please contact your Account Executive.

Purpose: The purpose of the PARA Pharmacy Pricing Process is to create a rational, cost-based pharmacy markup using the cost-basis and charge categories as determined by the client according to the information presented above.The project focuses on reducing self-administered drugs while increasing injectable items to meet the revenue goals of the organization.

Data Requirements: The required data tables and fields for the PARA Pharmacy Pricing Process are as follows: - Pharmacy Clinical Data- National Drug Codes (NDC), drug type/ charge category/ route of administration and charge code - Pharmacy Markup- Charge category, multipliers, minimums, and additional fees - Charge Master- Charge code, current charge/ price, HCPCS Code - Cost Basis- NDC and AWP/ ACQ/ ASP as found in the pharmacy system - Transaction Data- Detailed patient level claims data - Payer Contract Matrix- Managed care contract settlement terms Method: PARA Data Staff will tie these tables together and load into the PARA Data Editor. The client will complete a Pharmacy Markup/ Pricing Goals questionnaire to outline preferences in charge category, cost basis, revenue goals, and other important aspects of the analysis.

The PARA analytic staff will create a markup to meet the goals of the project and calculate the gross and net revenue opportunity of the proposed markup. The client will review the proposed markup and identify any areas where changes would like to be made.

After the final markup has been approved, the client will either implement or engage PARA to implement the markup as outlined above.

After implementation, PARA will perform an impact analysis after one month of implementation and every quarter through the length of the engagement.

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PARA Weekly Update: December 15, 2017

PHARMACY PRICING PROCESS Timeline:

Deliverables: The PARA Pharmacy Pricing Process deliverables to the client include a proposed markup, gross and net revenue projections, an item-specific detailed spreadsheet proposed changes, and a full write-up of techniques and findings.

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PARA Weekly Update: December 15, 2017

2018 CODING UPDATE DOCUMENTS

Reprinted!

In preparation for the year-end CPTÂŽ / HCPCS update, PARA is preparing a number of short, one to two- page ?coding update? documents listing deleted codes and added codes within a particular clinical area or procedure group.The coding topics addressed are those which are most likely to be ?hard-coded? to a line item in a facility chargemaster.Users are advised that topics are divided into immediately related areas, and more than one paper may contain information useful to a service line manager.

Due to CPTÂŽ licensing restrictions, these documents cannot be published within the PARA Weekly Update, however, PARA Data Editor users may access the information on the Advisor tab; search ?Coding Update? in the type field, and 2018 in the subject field, as illustrated below:

Following the release of the OPPS Final Rule in November, coding update papers may be revised to indicate whether Medicare will accept/ cover new HCPCS.PARA Data Editor Users can identify updated papers by the word ?Revised? in the title and the date issued will be updated.

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PARA Weekly Update: December 15, 2017

For PD E Users PARA YEAR-END HCPCS UPDATE PROCESS In keeping our commitment to outstanding customer service, PARA clients will be fully supported with information and assistance on the annual CPTÂŽ HCPCS coding updates.

The PARA Data Editor (PDE) contains a copy of each client chargemaster; we use the powerful features of the PDE to identify any line item in the chargemaster which has a HCPCS code assigned that will be deleted as of January 1, 2018.

For this reason, it is important that clients check to ensure that a recent copy of the chargemaster has been supplied to PARA for use in the year-end update.

PARA will produce excel spreadsheets of each CDM line item, as well as our recommendation for alternate codes, in three waves as information is released from the following sources: 1. The American Medical Association?s publication of new, changed, and deleted CPTÂŽ codes; this information is released in September of each year.PARA will produce the first spreadsheet of CPT updates for client review in October, 2017.

2. Medicare?s 2018 OPPS Final Rule, typically published the first week of November; PARA will perform analysis and produce the second spreadsheet to include both the CPT information previously supplied, as well as alpha-numeric HCPCS updates (J-codes, G-codes, C-codes, etc.) from the Final Rule.

3. Medicare?s 2018 Clinical Lab Fee Schedule (CLFS) ? typically published in late November, the CLFS will reveal whether Medicare will accept new CPT?s generated by the AMA, or whether Medicare will require another reporting method (i.e. G0480 ?

G0483 for definitive drug testing in 2016 and 2017.)

Clients will be notified by email as spreadsheets are produced and recorded on the PARA Data Editor ?Admin? tab, under the ?Docs? subtab.

In addition, PARA consultants will publish concise papers on coding update topics in order to ensure that topical information is available in a manner that is organized and easy to understand. PARA clients may rest assured that they will have full support for year-end HCPCS coding updates to the chargemaster.

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PARA Weekly Update: December 15, 2017

Reprinted

JANUARY 1, 2018 CMS UPDATES

The following Transmittals have been published for the January 1 update.

This list will continue to expand in the coming weeks, and links to all documents can be found in the PDE Advisor tab.

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018

January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing

Files and Revisions to Prior Quarterly Pricing Files

Quarterly Influenza Virus Vaccine Code Update - January 2018

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: December 15, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018

In 2018, Medicare reimbursement rates will change significantly under the Clinical Laboratory Fee Schedule; Medicare payment for the most commonly ordered lab tests will be reduced by up to 10% per HCPCS (amounts vary by HCPCS.)The new clinical lab fee schedule payment rates will be based on rates paid by private payors, as reported by laboratories nationwide.Here is a link and an excerpt from a Medicare publication explaining the payment methodology:

https:/ / www.cms.gov/ Outreach-and-Education/ Medicare-Learning-Network-MLN/ MLNProducts/ Downloads/ Clinical-Laboratory-Fee-Schedule-Fact-Sheet-ICN006818.pdf Payment Amounts for Services Furnished on and After January 1, 2018 Based on private payor rates from ?applicable laboratories? reported to the Centers for Medicare & Medicaid Services (CMS) by ?reporting entities,? the payment amount for a test on the new CLFS will be equal to the weighted median private payor rate for each test. ? under the new CLFS, there will be no geographic adjustments to the payment amount. ?

As an example, the following excerpt from Medicare?s final payment rate national file displays the reduction in payment for several very common lab tests:

PARA is developing an analysis of the impact to lab reimbursement for each of its clients; we expect the analysis to be provided in late December 2017. PARA will base its analysis on claims data drawn from the OPPS data set purchased from CMS and loaded into the PARA Data Editor RAC tab.An example of a single code analysis using the Medicare claims data as displayed on the PARA Data Editor RAC tab is provided below:

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PARA Weekly Update: December 15, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018

The spreadsheet report can estimate the impact of reduced reimbursement on a single code as follows:

Use the HCPCS filter to limit the display on HCPCS 80053 only:

Sum the payments column, and approximate reduced reimbursement for 80053 by 10%; this represents the approximate quarterly impact to Medicare reimbursement for this one code.

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PARA Weekly Update: December 15, 2017

JANUARY 1,2018 CMS UPDATES

Instructions for Downloading the Medicare ZIP Code File for January 2018

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018

Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 January 2018 Updates

Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) Front End Updates for January 2018 This link leads to a ZIP file containing several files with several documents.

To go to the full Transmittal document simply click on the screen shot.

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PARA Weekly Update: December 15, 2017

Updated!

JANUARY 1, 2018 CMS UPDATES

The COMPLETE List!

Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3872CP.pdf January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3878CP.pdf Quarterly Influenza Virus Vaccine Code Update - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3827CP.pdf Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3869CP.pdf Instructions for Downloading the Medicare ZIP Code File for January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3860CP.pdf Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3861CP.pdf Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3885CP.pdf Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified, or Unlisted Service or Procedure Code Data Collection https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3881CP.pdf Payment for Services Furnished by Qualified Nonphysician Anesthetists https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3883CP.pdf Place of Service Codes https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3873CP.pdf 2018 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3870CP.pdf Accepting Hospice Notices of Election via Electronic Data Interchange https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3866CP.pdf Instructions for Retrieving the 2018 Pricing and HCPCS Data Files through CMS' Mainframe Telecommunications Systems https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3865CP.pdf Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R475PR1.pdf

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PARA Weekly Update: December 15, 2017

Updated!

JANUARY 1,2018 CMS UPDATES

More of The COMPLETE List!

Annual Clotting Factor Furnishing Fee Update 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3862CP.pdf Updated Editing of Always Therapy Services ? MCS https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3863CP.pdf Correcting Payment of Inpatient Prospective Payment System (IPPS) Transfer Claims Assigned to Medicare Severity-Diagnosis Related Group (MS DRG) 385 and Allowing Part A Deductible on Medicare Secondary Payer (MSP) Same Day Transfer Inpatient Claims Https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1918OTN.pdf 2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3857CP.pdf Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3849CP.pdf Healthcare Provider Taxonomy Codes (HPTCs) October 2017 Code Set Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3842CP.pdf Influenza Vaccine Payment Allowances - Annual Update for 2017-2018 Season https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3837CP.pdf Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3828CP.pdf Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year (FY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3826CP.pdf Implementation of the Transitional Drug Add-On Payment Adjustment https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1889OTN.pdf ICD-10 Coding Revisions to National Coverage Determinations (NCDs) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1875OTN.pdf Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as valid Provider Number https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1877OTN.pdf New Specialty Code for Pharmacy https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R290FM.pdf Screening for Hepatitis B Virus (HBV) Infection https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R198NCD.pdf Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3796CP.pdf

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PARA Weekly Update: December 15, 2017

Updated!

JANUARY 1,2018 CMS UPDATES

More of The COMPLETE List!

2017-2018 Influenza (Flu) Resources for Health Care Professionals https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE17026.pdf New Waived Tests https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3902CP.pdf Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R237BP.pdf Annual Medicare Physician Fee Schedule (MPFS) Files Delivery and Implementation and Medicare Physician Fee Schedule Database (MPFSDB) 2018 File Layout Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3903CP.pdf Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3909CP.pdf Off-Cycle Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2018 Pricer https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3912CP.pdf Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3919CP.pdf Therapy Cap Values for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3918CP.pdf Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as valid Provider Number https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1976OTN.pdf Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2018 - Recurring File Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3922CP.pdf 2018 Annual Update to the Therapy Code List https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3924CP.pdf Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf

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PARA Weekly Update: December 15, 2017

There were TWO new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type ?Med Learn? in the Advisor tab of the PARA Data Editor (see example below.) To go to the full Med Learn document simply click on the screen shot or the link.

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PARA Weekly Update: December 15, 2017

The link to this Med Learn: SE17036

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PARA Weekly Update: December 15, 2017

The link to this Med Learn: MM10409

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PARA Weekly Update: December 15, 2017

There were TWO new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type Transmittals in the Advisor tab of the PARA Data Editor. To go to the full Transmittal document simply click on the screen shot or the link.

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PARA Weekly Update: December 15, 2017

The link to this Transmittal #R3934CP

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PARA Weekly Update: December 15, 2017

The link to this Transmittal #R1987OTN

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PARA Weekly Update: December 15, 2017

The PDE Editor Bulletin Board Tablet lists all articles added to the Bulletin Board

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PARA Weekly Update: December 15, 2017

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