PARA Weekly Update For Users December 22 2017

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 December 22, 2017 NEWS FOR HEALTHCARE DECISION MAKERS IN THIS ISSUE QUESTIONS & ANSWERS - Provider-Based Billing For Commercial Payers - Telehealth Or Telemedicine?

- Billing For Supplies: Thermofltr Tubing - Handling New Modifiers -96 and -97 2018 CODING UPDATE: NEW MODIFIER FOR COMPUTED RADIOGRAPHY CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA

6

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.

-------------------------------------------------------

PURCHASE ITEM MASTER REVIEW

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.

2018 CODING UPDATE DOCUMENTS

13

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

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

Administration: Pages 1-45 HIM/Coding Staff: Pages 2,4-9,14,17 Providers: Pages 2,4,10,26 Telehealth: Pages 3,26,37 Rehabilitation Services: Pages 5,34

-

Imaging Services: Page 7 Materials Management: Page 10 Finance Depts: Pages 25,27,33,38 Laboratory Services: Pages 17,35 PDE Users: Pages 15,17

© 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 22, 2017

PROVIDER-BASED BILLING FOR COMMERCIAL PAYERS

Question: We?re having trouble getting our facility fees paid by a large commercial insurers when our Method II Critical Access Hospital bills both the professional fee and the facility fee on the same claim form. How can we get full reimbursement for our clinic services?

Answer: It is PARA?s opinion, a provider-based clinic (in other words, a clinic operated as a department of the hospital and meeting the requirements of 42 CFR 413.65 for Medicare) may opt to bill non-Medicare/ Medicaid payers the entire combined professional and facility visit fee sum (i.e. 99213) on a single line of a CMS 1500/ 837p claim form, and separately report ancillaries such as lab and x-rays on a UB04/ 837i facility fee claim.

There are a number of commercial payers which will deny the facility portion of E/ M visit fees, they will honor only the professional fee claim for this type of service. Since professional fee reimbursement is paid at a reduced rate when split-billed with POS 22 (outpatient hospital) on the 1500, the hospital cannot obtain full reimbursement for the visit fee under the payor?s professional fee fee schedule unless they combine both the facility charge and the professional fee on the CMS1500 and bill with POS 11, office. A detailed explanation is available on the Advisor tab of the PARA Data Editor.

For example, Anthem Blue Cross has published an Evaluation and Management policy that sets its expectation clear: https://www.anthem.com/provider/noapplication/f1/s0/t0/pw_e238964.pdf?refer=ahpprovider ?Anthem shall not separately reimburse a clinic fee or any other facility fee associated with space used to provide E&M services in the event they are billed on a UB-04 claim form.?

In order to ensure that the facility complies with Medicare guidance that all patients should be charged on the same basis, we recommend that the total amount of the charges for the same service are equivalent whether billed on a single CMS1500/ 837p claim form or split into separate professional and facility component claims.

2

PARA Weekly Update: December 22, 2017

TELEHEALTH OR TELEMEDICINE?

Question: Is there a difference between Telehealth and Telemedicine Answer: There are no coding changes in the two services. Essentially, the terms are interchangeable. However, as noted in the our article entitled "What Is It: Telehealth Or Telemedicine?" available on the PARA Data Editor.

Here are excerpts and a link to the American Telemedicine Association that provides more detail: Generally speaking, telemedicine is considered to be a clinical application of technology, while telehealth is a broader, consumer-facing approach. Accordingly, to the federal network of telehealth resource centers it is defined as ?a collection of means or methods, not a specific clinical service, to enhance care delivery and education.?

While the term telemedicine has be referenced more commonly in the past, telehealth is becoming the more universal term for the current broad array of applications in this expanding field. Its use crosses most health service disciplines, which includes dentistry, counseling, physical therapy, home health and many other domains. It is worthy to note in this article, that while a connection does exist between health information technology (HIT), health information exchange (HIE) and telehealth, neither HIT or HIE are considered to be telehealth.

Between the two (2) phases, telemedicine is the older of the two however telehealth is rapidly gaining acceptance, largely due to the expanding healthcare arena. With the rise of consumer-directed healthcare, the reimbursement shift from fee-based to quality and outcomes-based care has put more emphasis on health, wellness and care management. In this evolving arena, telehealth fits the mold.

Even to the point that the American Telemedicine Association considers the terms telemedicine and telehealth to be interchangeable.

Telemedicine is not a separate medical specialty. The products and services that are related to telemedicine delivery are most likely to be a part of a larger investment by participating healthcare institution by either providing information technology or clinical care.

Patient consultations via video conferencing, transmission of still images, e-health portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, as well as other applications are all considered to be components of telemedicine and telehealth.

With this being said, along came the Health Information and Management Systems Society (HIMSS) and offered more detail for coders.

3

PARA Weekly Update: December 22, 2017

BILLING FOR SUPPLIES: THERMOFLTR TUBING

Question: We are getting frequent audits from Anthem on certain surgical supply charges. Can you give some feedback on if you see other facilities charging separately for these type of items or if they do not charge separately because the charge is part of the surgical level charge (360 w/ surgical CPTÂŽ billed).

Answer: In our experience, the supply items on the list are typical of line items billed by many hospitals. However, that is not the same as saying that all of these line items meet the test of a separately billable supply, nor is it the same as saying it should or will pass a third party auditor?s review.

Some years ago, the Medicare Fiscal Intermediary for Kansas, Wheatlands, surveyed hospitals to determine what supply items are commonly billed and should be charged separately, versus those that are less commonly billed and should be considered a component of some other charge on the claim.

That survey is attached for your reference, but it does not address many of the surgical items on your examples.

PARA recommends billing supplies that meet the four-question test in our ?Billing for Supplies? paper, available on the PARA Data Editor PDE) ? here?s the pertinent excerpt: 1. Is the item medically necessary and furnished at the discretion of a physician? (not a personal convenience item such as slippers, powder, lotion, etc.)

2. Is the item used specifically for or on the patient? (not gowns, gloves, masks, used by staff or oxyen available but not specifically used by the patient) 3. Is the item not ordinarily used for or on most patients, or was the volume or quantity used for on patient significantly greater than normaly used for or on most patients in the billed setting? (not blood pressure cuffs, thermometers, patient gowns, soap, etc.)

4. Is the item not basically stock (bulk) supply in the billed setting and the amount or volume used is typically measured or traceable to the individual patient for billing purposes? (not pads, drapes cotton balls, urinals, bedpans, wipes, irrigation solutions, ice bags, IV tubing, pillows, towels, bed linen, diapers, soap, tourniquet, gause, prep kits, oxygen masks and oxygen supplies, syringes)

We asked our CDM Desk Review Manager, Kim Francisco, to look over the list of supplies to determine whether they met the 4-question test. Using this 4-question method, Kim found that the charge for ?THERMOFLTR TUBING & FLTR -NCE? may not pass the test ? tubing is usually not separately billable.

However, a number of the supply lines contain red-flag key words that third party auditors target for denial, as displayed in the attached excel file. This word is one we would expect a third-party auditor to flag and possibly attempt to deny these supplies. For example, third party auditors frequently deny line items that say ?system? because it implies an equipment charge rather than a disposable supply.

The supply may or may not meet the 4-question test, and other hospitals may or may not bill for the same item, but the wording of the description makes the item a target for an aggressive auditor.

We have seen a definite uptick in the number of third-party supply audits in the past year to two years.

One defense strategy is to review commonly used surgical procedure supplies, and fold the cost of them into the time-based or procedure-based charge. If an item is always used during the course of a procedure, then consider packaging the cost into the price of the procedure rather than billing it on a separate line item. The end result is that the same amount of money will be on the claim, but the supply detail will not provide an opportunity for supply auditors to deny line items.

4

PARA Weekly Update: December 22, 2017

HANDLING NEW MODIFIERS -96 AND -97

Question: Have you heard anything specific on how Medicare and Medi-Cal are handling the new modifiers -96 and -97? Per ASHA website, these are effective 1/ 1/ 2018.

Modifier 96: HABILITATIVE SVCS - When a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. Modifier 96 will not replace the existing SZ modifier for habilitative services.

Modifier 97: REHABILITATIVE SVCS - When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service.

According to the National Association of Insurance Commissioners, habilitation services are defined as ?Health care services that help a person keep, learn or improve skills and functioning for daily living. Examples include therapy for a child who isn?t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/ or outpatient settings?.

Answer: The Patient Protection and Affordable Care Act (known as PPACA, ACA, or Obamacare) stipulates that ?essential health benefits? which must be offered by any health plan include rehabilitative and habilitative services and devices. Health plans must therefore include benefits related to rehabilitative and habilitative services to comply with the law. If the health plan has specific limits that apply to either category, it will need to distinguish between the two types of therapy in order to track the beneficiary?s use of benefits over time.

This provision in turn caused the AMA to create two new modifiers to distinguish therapy services as habilitative or rehabilitative, as follows (appearing in the 2018 CPTÂŽ Book).

At this time, payors may or may not have distinctions in their benefit design for rehabilitative or habilitative services which cause require the use of these two modifiers. I am not aware of any payors that have benefit limits that apply to one category or the other ? typically, there is no distinction. However, the AMA has provided a means of tracking in the event that a payor needs this information.

Under fee-for-service Medicare, there is no distinction between habilitative and rehabilitative benefits ? there is an annual cap, but it is not divided between the two categories. Therefore, CMS has not issued an instruction which requires these modifiers on Medicare claims. Medi-Cal benefits do not distinguish between habilitative and rehabilitative therapy. Therefore, at this time, the modifiers are not required for Medicare or Medi-Cal billing purposes.

Please watch any bulletins published by commercial payors to announce whether the new modifiers will be required. We expect that as payers begin to accept and/ or require these modifiers, they will apply primarily to services which support the patient?s capacity to perform activities of daily living.

5

PARA Weekly Update: December 22, 2017

Google Chrome and the PDE! Coming Soon!

6

PARA Weekly Update: December 22, 2017

2018 CODING UPDATE: NEW MODIFIER FY FOR COMPUTED RADIOGRAPHY Hospitals which use ?computed radiography? X-ray technology -- cassette-based imaging which utilizes an imaging plate to create the image involved ? must append modifier FY to HCPCS when billing Medicare for such services beginning on January 1, 2018. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals /2017Downloads/R3820CP.pdf The FY modifier will result in a payment reduction of 7 percent of reimbursement on the technical component/ facility reimbursement for Computed Radiography services furnished during CY 2018, 2019, 2020, 2021, or 2022, that would otherwise be made under the Medicare Physician Fee Schedule or the hospital Outpatient Prospective Payment System (OPPS.)Similarly, if such X-ray services are furnished during CY 2023 or a subsequent year, the reduction in reimbursement will increase to 10 percent of the payment under the MPFS or the hospital OPPS. Radiologists reporting the professional component only (-26 modifier appended) need not report the FY modifier; the FY modifier is used to identify only the technical component of a radiography service to be discounted, thereby encouraging providers to upgrade to more modern equipment.

In the 2018 OPPS Final Rule, Medicare clearly outlines that the rules apply to hospitals which are paid under OPPS.Critical Access Hospitals are exempt from OPPS, and therefore the FY modifier will not be required for CAH claims. https://www.gpo.gov/fdsys/pkg/FR-2017-12-14/pdf/R1-2017-23932.pdf Federal Register / Vol. 82, No. 239 / Thursday, December 14, 2017 / Rules and Regulations, 59225 ?? We set forth the services that are excluded from payment under the OPPS in regulations at 42 CFR 419.22.Under ยง 419.20(b) of the regulations, we specify the types of hospitals that are excluded from payment under the OPPS. These excluded hospitals include: - Critical access hospitals (CAHs) 7

PARA Weekly Update: December 22, 2017

CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA In the Medicare Physician Fee Schedule Final Rule for 2018, CMS has delayed the requirement that physicians report their use of Appropriate Use Criteria when ordering advanced diagnostic imaging tests for an additional year, until January 1, 2020, and CMS has also backed away from the notion of using G-codes with modifiers to convey the information.

Following is a link and excerpts from the 2018 Medicare Physician Fee Schedule Final Rule: https:/ / www.gpo.gov/ fdsys/ pkg/ FR-2017-11-15/ html/ 2017-23953.htm In response to public comments we are further delaying the effective date for the AUC consultation and reporting requirements for this program from January 1, 2019 as proposed to January 1, 2020. We are also finalizing a voluntary period during which early can begin reporting limited consultation information on Medicare claims from July 2018 through December 2019. During the voluntary period there is no requirement for ordering profadoptersessionals to consult AUC or furnishing professionals to report information related to the consultation. On January 1, 2020, the program will begin with an educational and operations testing period and during this time we will continue to pay claims whether or not they correctly include such information. Ordering professionals must consult specified applicable AUC through qualified CDSMs for applicable imaging services furnished in an applicable setting, paid for under an applicable payment system and ordered on or after January 1, 2020, and furnishing professionals must report the AUC consultation information on the Medicare claim for these services ordered on or after January 1, 2020. ?

In response to the public comments, we are not moving forward with requiring reporting of AUC consultation information on Medicare claims using a combination of G-codes and modifiers. Rather, we will evaluate a simplified method of reporting during the voluntary reporting period using a single modifier while we work with stakeholders to explore using a standardized unique AUC consultation identifier.

Download the entire paper.

Click the document

8

PARA Weekly Update: December 22, 2017

CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA Elsewhere in the rule, Medicare clarified that the AUC reporting requirements would not apply to testing performed in a Critical Access Hospital: Any advanced imaging service furnished within a CAH wouldnot be furnished in an applicable setting. Applicable settingscurrently include physician offices, hospital outpatient departments and ambulatory surgical centers. CAH patients who are furnished an advanced diagnostic imaging service in an applicable setting but the claim for that imaging service is not paid under one of the applicable payment systems would not require consultation and reporting of the AUC consultation.

This may apply in situations when a CAH has elected Method II billing.

Earlier this year, CMS had proposed that hospitals (without an exception for Critical Access Hospitals) and interpreting radiologists to report new G-codes on certain claims for advanced diagnostic imaging services ordered after 1/ 1/ 2019.That reporting requirement would have conveyed the ordering physicians?consultation of Clinical Decision Support Mechanisms (CDSM) for advanced diagnostic imaging services within eight high-priority clinical areas.Claims for applicable services without the AUC data were to be rejected.

As new reporting mechanisms are announced, PARA will continue to keep clients and readers of the PARA Weekly Update apprised.

9

PARA Weekly Update: December 22, 2017

PURCHASE ITEM MASTER REVIEW BACKGROUND: Many health care organizations experience difficulties capturing and billing supply charges due to inconsistencies between the purchase item master and the billing system.Many times these systems are not linked; and therefore become unsynchronized resulting in lost revenue and other compliance concerns.

There are seven types of supplies used in hospitals, some of which should not be charged to the patient.The various types of supplies and the billing status for each are as follows: 1.Routine items- Low cost, bulk stock items (i.e. Band-Aids, syringes, wipes, gowns, gloves, drapes, and packs) are not to be charged.The cost is to be billed using the OR time charge.

2.Sterile- Higher cost items are itemized on the charge form; multiple units are allowed.These items are to be billed with a HCPCS code (if possible) and 0272 revenue code.

3.DME exempt- These are DME items which can be billed to the Medicare program, they include orthotics (splints, braces, collars, and belts).These items are billed using a HCPCS code and a 0274 revenue code.

4.DME non-exempt- Non-billable DME items (i.e. crutches, canes, and walkers) are not to be billed to the Medicare program on a bill type UB04.

5.Implants- Hard items which remain in the patient post-procedure, these items may have a HCPCS code and are billed using a 0278 revenue code.

6.IOLLenses- Billed using a HCPCS code (if possible) and a 0276 revenue code.High cost lenses can be billed to the patient (lens cost less the $150 Medicare allowance).

7.Pacemakers- Requires a HCPCS code and a 0275 or 0278 revenue code.

10

PARA Weekly Update: December 22, 2017

PURCHASE ITEM MASTER REVIEW THE PARA SOLUTION: Determining which supply items are billable and maintaining consistency between the Purchase Item Master (PIM) and the Charge Description Master (CDM) can become a daunting task for revenue cycle and materials management personnel.

PARA?s Purchase Item Master review brings together the coding and financial analytics components of our services to create a link and a process to appropriately maintain the systems simultaneously.

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

PURPOSE: The goal of the PIM review is to identify all billable items contained within the PIM and reconcile the PIM by line item to the CDM.The review also analyzes the HCPCS and revenue codes for the PIM/ CDM items, to ensure compliant and appropriate supply billing practices.ties captus.

11

PARA Weekly Update: December 22, 2017

PURCHASE ITEM MASTER REVIEW DATA REQUIREMENTS: The analysis compares the PIM to the CDM and identifies the link between the two systems.Therefore the following data pieces are required for the review: ·Purchase Item Master File ·Charge Description Master File The data requirements for the tables required can be found at the following link: PARA Data Requirements

12

PARA Weekly Update: December 22, 2017

PURCHASE ITEM MASTER REVIEW METHOD: - The analysis compares the PIM to the CDM and identifies the link between the two systems.

- The review will determine which items are included in the PIM but not in the CDM files and which are in the CDM but not in the PIM. - Any PIM items which are not currently contained in the CDM will be created and activated in the CDM. - The PARA Coding Staff will review each line item in the PIM to determine its Medicare billable status.

- All revenue and HCPCS codes for supply items will be reviewed and updated for correct coding.

TIMELINE:

DELIVERABLES: The deliverables to the client include an Excel spreadsheet of the following: - List of additions and deletions for the CDM - List of updates for the PIM - List of revenue and HCPCS updates for the CDM - Remote Access Update option to script all recommended changes into the client system

13

PARA Weekly Update: December 22, 2017

2018 CODING UPDATE DOCUMENTS 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.

14

PARA Weekly Update: December 22, 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.

15

PARA Weekly Update: December 22, 2017

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.

16

PARA Weekly Update: December 22, 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:

17

PARA Weekly Update: December 22, 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.

18

PARA Weekly Update: December 22, 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.

19

PARA Weekly Update: December 22, 2017

JANUARY 1, 2018 CMS UPDATES

The COMPLETE List!

Updated!

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

20

PARA Weekly Update: December 22, 2017

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

21

PARA Weekly Update: December 22, 2017

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

22

PARA Weekly Update: December 22, 2017

There were SEVEN 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.

23

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM10385

24

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM10417

25

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM10393

26

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM10238

27

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM10151

28

PARA Weekly Update: December 22, 2017

The link to this Med Learn: MM17037

29

PARA Weekly Update: December 22, 2017

There were THIRTEEN 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

30

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3936CP

31

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3940CP

32

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3941CP

33

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R175SOMA

34

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3942CP

35

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3937CP

36

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3938CP

37

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3939CP

38

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3943CP

39

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R1990OTN

40

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R1988OTN

41

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R3935CP

42

PARA Weekly Update: December 22, 2017

The link to this Transmittal #R1989OTN

43

PARA Weekly Update: December 22, 2017

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

44

PARA Weekly Update: December 22, 2017

45