Grayscale Version PARA Weekly Update For Users March 14 2018

Date

PARA WEEKLY CODING FOR HPV SCREENING

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 March 14, 2018 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - ICD-10 CM Non-Palpable Testicles - ICD-10 CM Undescended Intra-Abdominal Testis - Botox Injections - NDC HCPCS Numbers - OB Labor Check Claims - "All Provider" Number PDE CALCULATOR UPDATES: Interventional Radiology Charge Mapping, CPT® Assistant, HCPCS/CPT Crosswalk, Quick Claim Evaluation, National Provider ID, UB-04 Data Specifications

VOLUNTARY APPROPRIATE USE CRITERIA REPORTING NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

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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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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.

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

Administration: Pages 1-45 HIM/Coding Staff: Pages 1-45 Providers: Pages 2-5,10-11,16,18-19 PDE Users: Pages 12, 32 Imaging Services: Page 16

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Finance: Pages 6,19,37 Pharmacy: Pages 4,6,38-40,43-44 Obstetrics: Page 10 Durable Medical Equipment: Page 41 Outpatient Services: Pages 35,42

© 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: March 14, 2018

ICD-10 CM NON-PALPAPLE TESTICLES

Question: What is the appropriate ICD-10 CM to report Bilateral non-palpable testicles?

Answer: Report ICD-10 CM code R39.84, Bilateral non-palpable testicles. Effective October 1, 2017, ICD-10 code series R39.8- (Other symptoms and signs involving the genitourinary system) has been expanded to include two new codes that provide greater specificity in code selection. The expansion identifies unilateral versus bilateral non-palpable testicles.

The distinction is identified in the fifth character of ICD-10 CM code series R39.8-. The fifth character of ?3? identifies unilateral non-palpable and the fifth character ?4? identifies bilateral non-palpable.

This advice is supported by Coding Clinic for ICD-10 CM 4thQtr 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 4thQtr, 2017 provided below.

ICD-10-CM New/Revised Codes: Pediatric Cryptorchidism (Undescended and Nonpalpable Testicle)Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 22 A child may be referred for evaluation of a non-palpable testicle, which would require further evaluation to determine the location and presence or absence of that testicle. Two new codes have been created to identify this condition: - R39.83, Unilateral non-palpable testicle - R39.84, Bilateral non-palpable testicles

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PARA Weekly Update: March 14, 2018

ICD-10 CM UNDESCENDED INTRA-ABDOMINAL TESTIS

Question: What is the appropriate ICD-10 CM to report left undescended intra-abdominal testis?

Answer: Report ICD-10 CM code Q53.111, Unilateral intra-abdominal testis. Effective October 1, 2017, ICD-10 code series Q53.11- (Abdominal Testis Unilateral) has been expanded to include two new codes that provide greater specificity in the location.

The expansion identifies Intra-abdominal versus inguinal. The distinction is identified in the sixth character of ICD-10 CM code series Q53.11-.

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 4thQtr, 2017 provided below.

ICD-10-CM New/Revised Codes: Pediatric Cryptorchidism (Undescended and Nonpalpable Testicle)Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 22 New codes have been created at category Q53, Undescended and ectopic testicle, to provide additional information regarding the specific location of the undescended testicle, as this information may have important implications for follow up and treatment.

The new codes specify whether the condition is unilateral or bilateral, as well as the location such as intra-abdominal (Q53.111, Q53.211), or inguinal (Q53.112, Q53.212).

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PARA Weekly Update: March 14, 2018

BOTOX INJECTIONS

Question: We have 2 Medicare patients who have received Botox injections. As a hospital, we bill the drugs as a technical charge on our UB04. However, the administration for these injections (one patient was 64612 an the other was 64616) both dropped as professional charges on a 1500. That leaves our non-payable drug J0585 as the only charge on the UB, it's un-billable since there's no payable procedure (the injection).

We found documentation from Botox to confirm that the administration can be billed on a UB04, but we need assistance in trying to make sure the charge & tiering is setup correctly in our charge master.

Since these encounters were both in a hospital based clinic, is it appropriate for the administration (64612/ 64616) to be billed as a technical charge with Rev Code 519?

We understand these codes are professional services, and are currently setup in the CDM with either 969 or 975 Rev Codes, which is causing the charge to drop on the 1500. Medicare does not allow those Rev Codes on a UB04, so we believe not only does the tiering need to change to a technical charge but also the Rev Code needs to be corrected to reflect the location of the service. Can anyone confirm the above or provide guidance on the Botox administration billing specifically for Medicare in a OPPS setting?

Answer: The hospital may report the facility component of 64612 and 64616; if the service was performed in an outpatient clinic on your main campus, the professional fee should report those services with place of service 22, outpatient hospital. Here are those two codes from the PARA Data Editor Calculator HCPCS search ? as you can see, the physician fee schedule pays slightly less for the ?Physician ? Facility? rate ? that is POS 22, for example. The reason the professional fee is reimbursed at a lower rate is that the payer expects a separate claim from the facility, which would report the same HCPCS as well as the Botox.

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PARA Weekly Update: March 14, 2018

BOTOX INJECTIONS

There are a number of revenue codes that may be reported with these HCPCS ? Medicare will accept revenue code 0510, but many commercial payers will balk at that code, as they require clinic-setting services to be billed in entirety on a CMS1500/ 837p claim.

The Revenue Codes are available in the Calculator HCPCS report by clicking the blue hyperlinked HCPCS code on the HCPCS report.

Here?s a screenshot, though not all of the rev codes are visible ? and by the way, 0519 is one of the accepted rev codes:

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PARA Weekly Update: March 14, 2018

NDC HCPCS NUMBERS

Question #1: Our Biller tells us that if the same NDC or HCPCS is present for the same date of service on a claim, payers require these to be rolled up to one line and units combined. Meditech automatically rolls these together, except for when the NDC/ HCPCS differs. In these instances, the billers are manually rolling the lines together. We are unsure if this is appropriate, but Meditech is programmed around CMS guidelines. Meditech states that the system would not be programmed that way if NDC number wasn?t a factor. That raises the question of if the billers should be manually rolling the two lines together at all.

Answer: For Medicare, commercial, and non-Medicaid payors, it is not necessary to report the NDC number, and units of the same drug with different NDC numbers may be combined for reporting on a single line on the UB04/ 837i claim or they may be billed separately on more than one line for the same DOS. Medicaid payers require reporting to be broken out by NDC number.

Question #2: Some payers, Anthem commercial specifically, want all rev code 250 charges rolled together on one line, no matter the NDC HCPCS. According to our biller, the payer doesn?t even want the NDC number or HCPCS at all. I think that for one reason or another, if they roll all this together, blank out HCPCS/ NDC, combine units and charges, the payer will pay the charges. This is probably not compliant, but for some reason doesn?t raise any red flags in their system, so it has worked in the past for them and they think this is the answer to their issues.

Answer: The hospital should report drugs which are eligible for HCPCS reporting in revenue code 0636 with the HCPCS. Here?s a link and an excerpt from Anthem?s Indiana Provider Manual (July 2017): https://www11.anthem.com/provider/in/f1/s0/t0/pw_g309330.pdf?refer=ahpprovider&state=in

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PARA Weekly Update: March 14, 2018

NDC HCPCS NUMBERS

Commercial payers typically do not require NDC numbers on claims, it is not a factor in their reimbursement ? but the HCPCS and revenue code could impact reimbursement. Therefore, we recommend reporting HCPCS codes on drugs which are assigned HCPCS codes. Please note that in the excerpt from Anthem?s manual, Anthem could not possibly reimburse the hospital for ?the Anthem Rate for the drug? if the drug is not identified by HCPCS. According to the UB manual, Revenue Code 0636 (Drugs requiring detailed coding) should be used to report charges for drugs and biologicals (except radio-pharmaceuticals, which may be reported under RC 0343 or 0344) requiring specific identification by the payer. PARA has never encountered a commercial payer which required hospitals to delete HCPCS codes and convert the charge to revenue code 0250, general pharmacy.

Billers need not roll drugs which have a HCPCS into revenue code 0250 unless there is some unusual contractual requirement to do so (which is unlikely.) The HCPCS provides details of the care provided which may be important for reimbursement ? particularly for expensive drugs like Remicade or chemotherapy. Report the HCPCS and the billed units in revenue code 0636.

It's worth mentioning that Medicare requires self-administered drugs to be reported in revenue code 0637, whether or not the self-administered drug is eligible for a HCPCS. The PARA Data Editor has a helpful NDC/ HCPCS lookup feature ? the use can enter the drug name (generic or trade name, single word), the HCPCS, the NDC, or a partial NDC in the search field, and the report returned will list all drugs which match the search:

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PARA Weekly Update: March 14, 2018

NDC HCPCS NUMBERS

The report returned will provide the HCPCS, the manufacturer, the NDC, and the bill units for single-use vials or packages:

When PARA reviews the hospital chargemaster for its clients, we search the NDC?s to ensure that the correct HCPCS and revenue code are assigned to each line in the pharmacy chargemaster.

Moving on now to the question regarding Medicaid billing and NDC numbers.

The NDC code is a ten digit unique, three-segment number which serves as a product identifier for human drugs. The NDC will be in one of the following configurations: 4-4-2, 5-3-2, or 5-4-1. The first segment of NDC code identifies the establishment (manufacturer, packer, labeler etc...)

The second segment of NDC Labeler code identifies the drug (strength, dosage and formulation). Third segment of NDC Labeler code identifies the package size and package type.

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PARA Weekly Update: March 14, 2018

NDC HCPCS NUMBERS

Most state Medicaid agencies (including both original state Medicaid agencies and managed Medicaid payors) require the NDC number to be itemized on the claim.

The Medicaid Drug Rebate Program (MDRP) is a program that includes Centers for Medicare & Medicaid Services (CMS), state Medicaid agencies, and participating drug manufacturers that helps to offset the Federal and state costs of most outpatient prescription drugs dispensed to Medicaid patients.

Approximately 600 drug manufacturers currently participate in this program. All fifty states and the District of Columbia cover prescription drugs under the MDRP, which is authorized by Section 1927 of the Social Security Act. The MDRP program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for state Medicaid coverage of most of the manufacturer?s drugs. Medicaid agencies claim their rebate by collecting data from claims paid ? in other words, the NDCs that appear on the hospital claims for outpatient services are used to reclaim money for Medicaid.

It is therefore important, when billing a Medicaid program, to accurately report the number of units attributed to the corresponding NDC. If billers roll together all units of the same drug filled from two different NDC numbers, then in turn Medicaid may claim an inaccurate amount of a discount from the a drug manufacturer that is associated with the single NDC reported.

For the record, PARA's previous response is repeated below: - The claim should follow UB04 guidelines.

- There should be a single 0250 line without a HCPCS code.

- There should be a single line for each 0636 line each with its single J code and unique NDC code for Medicaid.

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PARA Weekly Update: March 14, 2018

OB LABOR CHECK CLAIMS

Question: Recently we have been receiving denials on OB Check claims for Medicaid patients. We have been using the 99213 CPTÂŽ to bill the OB level charge. Medicaid is stating these are doctor office visit levels and cannot be billed in the hospital facility. Is there another CPTÂŽ code we could use to bill the service we provide for our patients that aren't going to be admitted in delivery but have an emergent situation?

Answer: Kansas Medicaid prefers to use the Medicare outpatient hospital visit code, G0463. If there is an order for observation care beyond the antepartum evaluation, the hospital should report hours of observation using G0378.

The Kansas Medical Assistance Program Fee-for-Service Provider Manual offers this instruction: https://www.kmap-state-ks.us/Documents/Content/Provider%20Manuals/Hospital_02232018_18044.pdf

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PARA Weekly Update: March 14, 2018

"ALL PROVIDER" NUMBER

Question: Our CEO has asked us to look into the following inquiry. Could you provide any information? In years past, hospitals were allowed to attain an "all provider" number for ER so that professional fees could be billed for multiple providers until they could be enrolled in the various insurance plans. Is this still an option?

Answer: No, that is no longer an option. Medicare has focused intensely on reducing fraud, waste, and abuse, and therefore it requires that all physicians who are to receive reimbursement from Medicare for services to its beneficiaries are fully enrolled.

Here is a link and an excerpt from the Medicare Program Integrity Manual, Chapter 15: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c15.pdf

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

The Calculator is a robust web-based research tool that allows the User unlimited access to search and report against a number of disparate data sources. Users have numeric and alpha query capabilities; the returned information can be exported to PDF, Excel or copied to the desktop clipboard for email applications. Users can save their preferences which are specific to their geographic and provider types; all codes, reimbursement, and claim edits are always the most current available.

Interventional Radiology Charge Mapping The purpose of the query is to provide the User the acceptable codes as defined in CPTÂŽ between the radiology guidance and the surgical codes.If there is a CMS device mapped to the code(s) the HCPCS code for the device and description are displayed.

The query format is code (comma separated), wildcard and text.

The returns are as follows: 1.

2.

3.

4.

Surgical Procedure HCPCS Code and Description Radiology Guidance Procedure Codes and Descriptions CMS Device A Mapped Code and Description CMS Device B Mapped Code and Description

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

CPT® Assistant ? 1990 to Present PARA licenses the CPT® Assistant from the American Medical Association, the tables are updated quarterly.

The query format is comma separated code, wildcard and text.

The query returns a list of articles-the User can then review the article description and click to view the details of the article.

CPT®/HCPCS code or text query:

Selection of specific article:

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

HCPCS/CPT速 to ICD-9 Crosswalk This query is based on the 3M data tables, which provide a cross reference between HCPCS/ CPT速 codes and procedural ICD-9 codes.

The query format is comma separated code, wildcard and text.

The returns are as follows: 1.

2.

3.

4.

CPT速 / HCPCS Code CPT速 / HCPCS Code Description ICD-9 Code ICD-9 Code Description

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

Quick Claim Evaluation The Quick Claim Evaluation report allows the User to view a series of CPTÂŽ codes in a UB04 claim format within the Claim Evaluation module. The User enters a series of codes (comma separated) and the Calculator displays the following:

CCI Edits are performed against the codes, and any items that would require a modifier or those that cannot be billed in the same encounter will have a color-coded indicator.

The return includes: 1. CPTÂŽ code and Description 2. Modifiers 3. APC Status 4. Service Units 5. Revenue Code 6. Service Date 7. CCI Edit result 8. Medicare Reimbursement 9. Medically Unlikely Edits 10. OCE Quantity 11. Reimbursement Comment The results can be exported to a PDF formatted report, or the User can ?create? a claim within the Claim Evaluator Module.

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

National Provider ID The PDE User can search the National Provider ID Database for individual or Organization NPIs in any state. The query can be performed on an NPI ID number or a keyword. The example below was a keyword search on ?Childrens? in California.

The return displays the following data points: 1.

2.

3.

4.

5.

6.

7.

8.

NPI Number Name (of individual or organization) Address City State Zip Code Phone Number Fax Number

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

UB-04 Data Specifications Manual Limited access is available to select users to the searchable UB-04 Data Specification Manual:

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PARA Weekly Update: March 14, 2018

PDE CALCULATOR UPDATES:RADIOLOGY/HCPCS TO ICD-9 CROSSWALK

HCPCS to Anesthesia Code Crosswalk This crosswalk allows Users to enter a surgical CPT® code to determine the appropriate Anesthesia CPT® code. As with other crosswalk files, either code will display the same result:

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

CMS has announced that new modifier QQ (ORDERING PROFESSIONAL CONSULTED A QUALIFIED CLINICAL DECISION SUPPORT MECHANISM FOR THIS SERVICE AND THE RELATED DATA WAS PROVIDED TO THE FURNISHING PROFESSIONAL) will be accepted on claims to Medicare for advanced imaging procedures effective July 1, 2018.

Reporting this modifier is voluntary for now, and the QQ modifier will have no effect on reimbursement at this time.Medicare expects to make reporting this modifier mandatory in a future year (possibly 2020), at which time payment for advanced diagnostic imaging will depend on compliance with the AUC program.

The QQ modifier is to be reported by providers and facilities on a voluntary basis to indicate whether the ordering physician utilized a ?Clinical Decision Support Mechanism? (CDSM) to determine whether the imaging study was appropriate.CDSMs are integrated into the electronic health record to support ordering physicians in determining the utility of an expensive exam prior to ordering.CDSMs are developed by physician-led organizations and integrated into provider EHR systems.Some EHR vendors offer approved CDSMs within the EHR, others may offer to integrate another approved CDMS to the physician order entry process.(See page 12 for a list of qualified CDSM programs.)

A link and an excerpt from the Medlearn announcing voluntary reporting is provided below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning -Network-MLN/MLNMattersArticles/Downloads/MM10481.pdf

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

The Medlearn also provides a list of 247 HCPCS codes on which AUC reporting will be accepted:

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

While reporting is voluntary and limited to the QQ modifier at this time, Medicare plans to make AUC reporting mandatory at some point in the future, possibly 2020. The Medlearn addresses this plan in the following excerpt: ?When this program is more fully implemented (expected January 1, 2020), consultation with a qualified CDSM will be required and detailed information regarding the ordering professional?s consultation must be appended to the furnishing professional?s claim. This includes the ordering practitioner?s National Provider Identifier (NPI) and documenting which CDSM was consulted (there are multiple qualified CDSMs available). The Centers for Medicare and Medical Services (CMS) does not have guidance at this time regarding what the claims-based reporting requirements will be in 2020. In addition, this program will include exceptions to consulting CDSMs that include: 1. The ordering professional having a significant hardship, 2. Situations in which the patient has an emergency medical condition, or, 3. An applicable imaging service ordered for an inpatient, and for which payment is made under Part A. Ultimately, this program will result in identified outlier ordering professionals being subject to prior authorization.?

This new announcement incrementally advances, but does not yet fully implement, the Appropriate Use Criteria plan described in the Medicare Physician Fee Schedule Proposed Rule for 2018. In that rule, CMS proposed to require 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 proposal was indefinitely postponed, but is likely to be implemented eventually because it was mandated by congress in the Protecting Access to Medicare Act. As written in the proposed rule, the G-code reporting will be ?required across claim types (including both the furnishing professional and facility claims) and across all three applicable payment systems (PFS, hospital outpatient prospective payment system and ambulatory surgical center payment system).? This appears to include Critical Access Hospitals, although this is not specifically addressed.

To read the proposed requirement, PARA Data Editor users will find the 2018 MPFS Proposed Rule on the PARA Data Editor Advisor tab; simply enter ?2018? into the summary field to locate the appropriate document.

The discussion of Appropriate Use Criteria begins on page 418:

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

Eventually, CMS will create a unique G-code for each CDSM, and proposes to require providers (such as hospitals) to report informational G-codes with modifiers on claims for certain imaging services ordered for certain ?high priority? clinical areas. Both hospital and interpreting radiologists will be required to report the G-codes as a condition of payment. A separate G-code (with appropriate modifiers) is expected for each advanced diagnostic imaging study, if more than one appears on the same claim. An ?other? G-code will be created to be used for CDSMs which are approved between quarterly HCPCS updates.

The eight high-priority clinical areas are:coronary artery disease (suspected or diagnosed), suspected pulmonary embolism, headache (traumatic and non-traumatic), hip pain, low back pain, shoulder pain (to include suspected rotator cuff injury), cancer of the lung (primary or metastatic, suspected or diagnosed), and cervical or neck pain.

Excerpts from the proposed rule are provided below: - ?? 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, 2019.? [note ? the implementation was indefinitely postponed in the final 2018 MPFS rule.]

- [CDSM reporting will be] ?? required across claim types (including both the furnishing professional and facility claims) and across all three applicable payment systems (PFS, hospital outpatient prospective payment system and ambulatory surgical center payment system). In other words, we would expect this information to be included on the practitioner claim that includes the professional component of the imaging service and on the hospital outpatient claim for the technical component of the imaging service.?

- ?HCPCS level 3? G-codes would describe the specific CDSM that was used by the ordering professional. Ultimately there would be one G-code for every qualified CDSM with the code description including the name of the CDSM.?

- ?G-codes would be a line-item on both practitioner claims and facility claims ? one AUC consultation G-code would be reported for every advanced diagnostic imaging service on the claim.

If there are two codes billed for advanced imaging services on the claim then we would expect two G-codes.?

- Each G-code would be expected, on the same claim line, to contain at least one new HCPCS modifier. Modifiers to provide necessary information as to whether, when a CDSM is used to consult AUC: (1) the imaging service would adhere to the applicable appropriate use criteria; (2) the imaging service would not adhere to such criteria; or (3) such criteria were not applicable to the imaging service ordered

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

The plan to report AUC criteria would apply to all claim types (including both the furnishing professional and facility claims) across all three applicable payment systems (PFS, hospital outpatient prospective payment system and ambulatory surgical center payment system). Since Critical Access Hospital outpatient payment is a prospective payment system, it is PARA?s opinion that CAHs are required to comply, although this is not specifically addressed in the proposed rule.

The rule allows exceptions to these requirements for only those providers which face extreme hardship in conforming with the requirements, such as a lack of internet connectivity, providers practicing for less than two years, extreme and uncontrollable circumstances, lack of control over the availability of CEHRT, or a lack of face-to-face patient interaction.

CMS has also published a list of entities which have developed approved Clinical Decision Support Mechanisms.

A link and an excerpt from the CMS website is provided on the following page. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ Appropriate-Use-Criteria-Program/CDSM.html Critical Access Hospitals are not explicitly excluded from this requirement.The proposed rule does not specifically identify Critical Access Hospitals in its description of the broad applicability of these requirements.

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PARA Weekly Update: March 14, 2018

MEDICARE ALLOWS VOLUNTARY APPROPRIATE USE CRITERIA REPORTING

Critical Access Hospitals are not explicitly excluded from this requirement. The proposed rule does not specifically identify Critical Access Hospitals in its description of the broad applicability of these requirements.

The specific language of the 2018 Proposed Medicare Physician Fee Schedule Rule requires the new G-code reporting is provided below: ?Section 1834(q)(4)(B) requires that payment may only be made if the claim for the service includes the specific information discussed in this proposed rule. This information, to the extent feasible, is required across claim types (including both the furnishing professional and facility claims) and across all three applicable payment systems (PFS, hospital outpatient prospective payment system and ambulatory surgical center payment system). In other words, we would expect this information to be included on the practitioner claim that includes the professional component of the imaging service and on the hospital outpatient claim for the technical component of the imaging service. Claims for services for which payment is not made under the three identified payment systems would not be required to include consultation related information.?

Considering that the applicability language is very broad and does not appear to contemplate any exceptions for Critical Access Hospitals, PARA recommends that CAHs consider the requirements to be applicable until and unless additional clarification is offered from CMS. For additional background on the Appropriate Use Criteria program, read PARA?s paper at the following link: https://apps.para-hcfs.com/para/ Documents/CMS_Developing_ Appropriate_Use_Criteria_Rules_v2_edited.pdf

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PARA Weekly Update: March 14, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

We have been working on making the PARA Data Editor compatible with multiple web browsers so that everyone can have options when it comes to which browser to use, depending on resources or preferences.

As of today, we are making available our PARA Data Editor Multiple Web Browser (Beta) Version to everyone with a proper PARA Data Editor Login.

The Web Browsers that we are rolling out first with this version are Internet Explorer and Google Chrome.

To all users who wish to use the Multiple Web Browser (Beta) Version, please be aware that this is a PRELIMINARY version meant to work out any errors and issues that it might exhibit.

It is in the process of being updated to mirror the current production version of the PARA Data Editor.

With your help, we will be able to narrow in on fixes throughout the PARA Data Editor Multiple Web Browser (Beta) Version to then ensure full functionality and to further expand to more Web Browsers.

The PARA Data Editor Multiple Web Browser (Beta) Version can be accessed via the following link and using the appropriate login when prompted by the browser: https://www.para-hcfs.com/projects/pde_upgrade/pde_MultBrowser

Note new interface with options.

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PARA Weekly Update: March 14, 2018

NEW CHROME VERSION OF PDE AND OTHER BROWSER FORMATS

Once logged in, we would like for you to please be aware of a few key features to help us improve the PDE Multiple Browser (Beta) Version.

First, please be aware of the change in look for the Multiple Browser (Beta) Version. We are attempting to update the look and feel of the PDE to be cleaner and user-friendly.

Second, if you may have any questions, need help, would like to report an error or issue with the PDE Multiple Web Browser (Beta) Version, or anything else you may think of, click on the ?Contact Support? Link in the upper-right hand corner of the PDE:

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PARA Weekly Update: March 14, 2018

There was ONE new or revised Med Learn (MLN Matters) article released this week.

To go to the full Med Learn document simply click on the screen shot or the link.

FIND ALL THESE MED LEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: March 14, 2018

The link to this Med Learn: MM10515

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PARA Weekly Update: March 14, 2018

There were EIGHT new or revised Transmittals released this week.

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

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: March 14, 2018

The link to this Transmittal R3993CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal R3997CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal: R3998CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal: R3995CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal: R3994CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal: R3996CP

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PARA Weekly Update: March 14, 2018

The link to this Transmittal: R2P244

43

PARA Weekly Update: March 14, 2018

The link to this Transmittal: R8P214

44

PARA Weekly Update: March 14, 2018

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