September 22 2017 PARA Weekly Update Grayscale Version

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PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 September 22, 2017 NEWS FOR HEALTHCARE DECISION MAKERS IN THIS ISSUE PDE UPDATES -

2017 ASC Reimbursement CPT Appendix B

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OPPS UPDATE -

October 2017 OPPS Update

Q & A: CODING -

Percutaneous Coronary Intervention Conversion of Previous Hip Surgery

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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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PARA PAPER -

Managed Care Remit Process

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.

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 1-30 HIM/Coding Staff: Pages 2,4,6,17,19 Patient Financial Services: 1-30 All Providers: Pages 8,17,20,22

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Hospital Finance Depts:Pages 10,18,21,25-28, PDE Users: Pages 2,4,15 Laboratory Svcs: Page 14

© 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: September 22, 2017

PDE CALCULATOR UPDATE 2018 CPT® APPENDIX B

The Appendix B from the 2018 CPT® Code Set is now available in the PDE Calculator. Select the ?Changes? link on the report line:

The Appendix B lists the changes taking place in 2018, with indicator symbols for the various types:

The appendix also displays codes that will be deleted, with the code and its description appearing with strikethrough:

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PARA Weekly Update: September 22, 2017

PDE CALCULATOR UPDATE 2018 CPT® APPENDIX B In July 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 DRG Table 5. This table lists the MS-DRGs, Relative Weight Factors and Geometric and Arithmetic Mean Lengths of Stay for 2018.

PARA has performed a comparison between the 2017 DRGs and the 2018 DRGs and found the following: For 2018, there were no DRGs added to the DRG Table 5.

However, three DRGs were removed from the DRG Table 5 for 2018: MS-DRG 984 985 986

MS-DRG Description PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC The DRG Table 5 comparison is accessible on the Calculator tab of the PARA Data Editor:

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PARA Weekly Update: September 22, 2017

UPDATE TO PDE CALCULATOR - 2017 ASC REIMBURSEMENT We have updated the ASC Reimbursement Query within the PARA PDE Calculator to geographically adjust ASC Reimbursement Prices.

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PARA Weekly Update: September 22, 2017

UPDATE TO PDE CALCULATOR - 2017 ASC REIMBURSEMENT For the selected Zip Code or Hospital on the Report Selection page, there is an associated Core-based Statistical Area (CBSA) that has an assigned ASC Wage Index.

This Wage Index is used to calculate the ASC Reimbursement by including the effects of regional wage variations in the Base Payment Rate.

The ASC Reimbursement Query will return ASC Reimbursements, adjusting the Base Payment, taking into account whether the queried codes are to be adjusted for geographic wage differences.

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PARA Weekly Update: September 22, 2017

OCTOBER 2017 OPPS UPDATE The quarterly CMS update of the OPPS system implements only one coding update effective October 1, 2017. New modifier ZC has been added to identify an additional manufacturer of biosimilar infliximab, Q5102.

CMS requires providers to identify the manufacturer by a modifier if a biosimilar drug is administered. There are three modifiers available, one manufacturer of biosimilar Filgrastim and two manufacturers of biosimilar infliximab:

A link and an excerpt from the transmittal is provided below: Link To Transmittal Here:

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PARA Weekly Update: September 22, 2017

PERCUTANEOUS CORONARY INTERVENTION Question: Would it be appropriate to report a Diagnostic angiography performed at the time of a coronary interventional procedure following an initial unsuccessful procedure?

Procedure: A patient presents in the urgent care for a left heart catheterization and was stented. One lesion was not able to be crossed. The patient is sent home expecting that medical management would relieve his angina, however, it was unsuccessful. Upon the patients return, the provider was able to cross the lesion that was not successfully crossed at the first encounter.

Answer: As per the CPTÂŽ code book instructions, "Diagnostic angiography performed at the time of a coronary interventional procedure may be separately reportable if: 1. No prior catheter-based coronary angiography study is available, and a full diagnostic study is performed, and a decision to intervene is based on the diagnostic angiography, or; 2. A prior study is available, but as documented in the medical record: a. The patient's condition with respect to the clinical indication has changed since the prior study, or b. There is inadequate visualization of the anatomy and/ or pathology, or c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention.

In the scenario provided, there are no indications that the patient's condition has changed and there is inadequate visualization of the anatomy in the operative report. Therefore, in this case the left heart catheterization would not be reported for the second visit.

However, it would be appropriate to report a code for the percutaneous intervention performed at the circumflex artery during the second visit.

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PARA Weekly Update: September 22, 2017

CONVERSION OF PREVIOUS HIP SURGERY

Question: What is the appropriate code for Conversion of previous hip surgery to total hip arthroplasty, without autograft or allograft?

Answer: Report CPT速 code 27132, Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft. CPT速 Assistant May 2017 states Conversion Hip Arthroplasty, as described by code 27132, applies to any previous hip surgery (except total hip arthroplasty) in the patient's surgical history in which a skin incision was made.

If a previous hip surgery (i.e. fracture fixation, hip pinning for a slipped capital femoral epiphysis, or osteotomy) was performed, the operation to convert the former surgery to a total hip arthroplasty is reported with code 27132. Removal of the old hardware would not be reported separately as this is considered an integral component of CPT速 code 27132. Please refer to the PARA Data Editor code description and the AMA CPT速 Assistant May 2017 and December 2008 reference which can be found in the PARA Data Editor Calculator.

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PARA Weekly Update: September 22, 2017

CONVERSION OF PREVIOUS HIP SURGERY

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PARA Weekly Update: September 22, 2017

MANAGED CARE REMIT ASSESSMENT The goal of the Managed Care Remit Assessment is to provide (at no cost or obligation) a review of select managed care remits to ensure claims have been paid appropriately according to payor contracted terms.

The Managed Care Remit Assessment is a 3-phase process: 1. Process managed care 835 remits and payer contract settlement terms using the PARA Data Editor (PDE) 2. Create actual versus expected reimbursement using PDE Claim/RA/835 Remit - Settlement tab 3. Presentation and review of Assessment findings The PARA Data Editor (PDE) is utilized in each phase of the assessment.

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PARA Weekly Update: September 22, 2017

MANAGED CARE REMIT ASSESSMENT Phase 1 - Process managed care 835 remits and payer contract settlement terms PARA will process the managed care 835 remittance data and payer contract settlement terms using the PDE Claim/RA/835 Remit - Settlement tab.

Hospital to upload two managed care contract plans (HMO, PPO, Medicare Advantage, Medicaid Managed Care) and the following: 1. Five current electronic 835 remittance data files per managed care contract plan 2. Pages from the agreement detailing the payment process 3. Fee schedules in Excel (if applicable) The above data tables are submitted using the secured PARA File Transfer.

To read the instructions, click HERE.

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PARA Weekly Update: September 22, 2017

MANAGED CARE REMIT ASSESSMENT Phase 2 - Create actual versus expected reimbursement The process utilized for the review is driven by the Claim/RA/835 Remit ? Settlement tab within the PDE. PARA will analyze select 835 remits, coupled with managed care contract settlement terms to identify opportunities to improve cash flow and maximize managed care reimbursement.

The Claim/RA/835 Remit ? Settlement tab of the PDE allows users to filter and review claims by payer to identify trends that can be addressed to maximize reimbursement or improve the billing process.

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PARA Weekly Update: September 22, 2017

MANAGED CARE REMIT ASSESSMENT Phase 3 - Presentation and review of Assessment findings PARA summarizes the finding into a worksheet for presentation and discussion with hospital staff.

As a result of this initial assessment, the organization can identify, at the payor contract level, where there are shortfalls and where reimbursement can be improved.

The comprehensive report package outlines charges, adjustments, allowed amounts, payment amounts, and projected payment amounts.

This information is used by hospital managed care and billing staff to rebill (if necessary) and improve billing processes or charge master pricing.

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PARA Weekly Update: September 22, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018 As the final months of 2017 unfold, PARA is watching carefully for Medicare?s publication of the 2018 Clinical Laboratory Fee Schedule. In 2018, reimbursement methodology will change significantly; Medicare payment for the most commonly ordered lab tests is expected to be cut sharply.

The new clinical lab fee schedule payment rates will be based on rates paid by private payors, as reported by laboratories nationwide. The mandatory data collection period ended in May, 2017; the ClinLab ?Final Rule? was published in July, 2017, but the actual rates that will be paid per HCPCS code effective January 1, 2018 have not yet been released.

To read the Medicare publication explaining the payment methodology, click HERE. ?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.

An applicable laboratory must receive greater than 50 percent of its total Medicare revenues from the CLFS and/ or the Medicare Physician Fee Schedule and at least $12,500 in revenues from only the CLFS during a 6-month data collection period.

The reporting entity with a tax identification number (TIN-level) will report private payor rate information to CMS for all of its components that are applicable laboratories. The weighted median private payor rate will be the new CLFS payment rate for most clinical laboratory services furnished on and after January 1, 2018.

When no information for a given test is reported, crosswalking or gapfilling will be used to establish a payment amount for the test. ?However, under the new CLFS, there will be no geographic adjustments to the payment amount.

For more information about the new payor rates, refer to Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018 and Medicare Clinical Diagnostic Laboratory Tests Payment System Final Rule.?

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PARA Weekly Update: September 22, 2017

OCTOBER 2017 MEDICARE UPDATES IN THE PDE The following queries have been updated in the PDE with the October 2017 Medicare releases.

For the quarter specific queries, Q4 is selectable but Q3 will remain the default option until October 1st.

The changes and reports are available in the CALCULATOR tab of the PDE.

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PARA Weekly Update: September 22, 2017

There were SIX 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):

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17019

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17018

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17023

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17026

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17028

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PARA Weekly Update: September 22, 2017

The link to this Med Learn: SE17027

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PARA Weekly Update: September 22, 2017

There were SEVEN 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:

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PARA Weekly Update: September 22, 2017

The link to this Transmittal #R1921OTN

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PARA Weekly Update: September 22, 2017

The link to this Transmittal #R13SS

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PARA Weekly Update: September 22, 2017

The link to this Transmittal #R39COM

The link to this Transmittal #R475PR1

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PARA Weekly Update: September 22, 2017

The link to this Transmittal #R1922OTN

The link to this Transmittal #R1923OTN

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PARA Weekly Update: September 22, 2017

The link to this Transmittal #R3865CP

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PARA Weekly Update: September 22, 2017

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

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PARA Weekly Update: September 22, 2017

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