PARA Weekly Update For Users 7-25-2018

Date

PARA WEEKLY

UPDATE For Users

I mproving T he Business of H ealthCare Since 1985 July 25, 2018

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Actemra Coding - 90791 And 90792 Questions - Masters Level Social Worker In ED REPRINT: PROPOSED RULE: CHANGES FOR SNFS CY 2018

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CMS FACT SHEET: PROPOSED PHYSICIAN FEE SCHEDULE CHANGES REPRINT: 2019 MFS RULE EASES APPROPRIATE USE CRITERIA REPORT ANXIETY NEW! RURAL HEALTHCARE GRANTS MLNCONNECTS BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

PARA COMPANY NEWS

SERVICES

ABOUT PARA

CONTACT US

FAST LINKS

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

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.

Administration: Pages 1-40 HIM /Coding Staff: Pages 1-40 Oncology Services: Page 2 Providers: Pages 2,4,8,13,19,29 Pharmacy Services: Page 2 Behavioral Health: Pages 4,8 SNF: Pages 10,27,33

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M edicare: Page 38 Finance: Pages 13,38,39 Practice M gmt: Pages 13,14 Rural HealthCare: Page 17 DM E: Page 19 Business Development: Page 25 Laboratory: Pages 28,30-35,39

© PARA Healt h Car e An alyt ics 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: July 25, 2018

ACTEMRA CODING

What is the correct CPTÂŽ infusion code for Actemra? 96365? Or 96413?

Answer: The HCPCS for Actemra is J3262; the generic name is Tocilizumab. The ?mab? at the end of the generic name identifies this drug as a monoclonal antibody.

Monoclonal antibodies qualify as chemotherapy under the narrative of the Medicare Claims Processing Manual: D. Chemotherapy Administration Chemotherapy administration codes apply to parenteral administration of non-radionuclide anti-neoplastic drugs; and also to anti-neoplastic agents provided for treatment of noncancer diagnoses (e.g., cyclophosphamide for auto-immune conditions) or to substances such as monoclonal antibody agents, and other biologic response modifiers. The following drugs are commonly considered to fall under the category of monoclonal antibodies: infliximab, rituximab, alemt uzumb, gemtuzumab, and trastuzumab. Drugs commonly considered to fall under the category of hormonal antineoplastics include leuprolide acetate and goserelin acetate. The drugs cited are not intended to be a complete list of drugs that may be administered using the chemotherapy administration codes. A/B MACs (B) may provide additional guidance as to which drugs may be considered to be chemotherapy drugs under Medicare.

Here are the indicators from Medicare in the 2018 HCPCS file.

Each drug HCPCS is assigned a Berenson-Eggers Type of Service code. Actemra is TOS O1E, ?Other Drugs.? The identifier for chemotherapy is O1D ? therefore it appears that Medicare has not classified this drug as chemotherapy: 2

PARA Weekly Update: July 25, 2018

ACTEMRA CODING

Checking the drug manufacturer ?s website for guidance ? it offers either 96365 or 96413: https://www.genentech-access.com/hcp/brands/actemra/learn-about-our-services/ reimbursement.html

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PARA Weekly Update: July 25, 2018

ACTEMRA CODING

The Medicare coverage database offers further guidance. Noridian, the MAC for many western states, has published an LCD which indicates that Actemra should not be reported with chemotherapy administration when it is injected subq or IM, but then it goes on to say that they will deny both the drug and the administration of the drug if the provider reports chemotherapy administration codes ? apparently regardless if the drug is infused slowly or injected. https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=52953&ver =86&CoverageSelection=Both&ArticleType=All&PolicyType=Final&s=All&KeyWord=chemotherapy +administration&KeyWordLookUp=Title&KeyWordSearchType=And&LCDId=37205&bc =gAAAACAAAAAA&

Considering that there is not specific guidance on the administration code from the MAC in Wisconsin for the infusion of this drug, we find it safest to report the non-chemo administration code, such as 96365, if Actemra is infused.

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PARA Weekly Update: July 25, 2018

90791 AND 90792 QUESTIONS

Can we bill the 90791 when patients are admitted to our inpatient unit as the psychiatric medication provider will also then bill the 90792- their psychiatric diagnosis evaluation with medical services--when they see the patient for the initial workup?

So, likely we cannot charge both the 90791 and 90792 correct? We know in the outpatient world we have to appeal if both of those services are charged within a two-year time period. We cannot imagine billing both the 90791 and 90792 within a few hours or days of each other will actually get paid.

Could I learn more about the 90839? I have never heard of this CPTÂŽ code. Is the length of time 60 minutes minimum? Would PARA suggest we bill this instead if a patient is admitted? Does it also require a supervising MD if the LCSW/LSW bills this? Thank you!

Answer: We'll provide answers as it pertains to both professional fees and facility fees.

Professional Fees: The same provider cannot report 90791 and 90792 on the same date of service, but there is no CCI edit preventing separate providers from each reporting 90791 or 90792 on the same patient on the same DOS.

However, Medicare?s claim processing manual explains that it will not separately reimburse two evaluation and management services billed by two providers of the same specialty (per their taxonomy crosswalk) billing under the same medical group for the same patient on the same DOS: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf 30.6.5 - Physicians in Group Practice (Rev. 1, 10-01-03) Physicians in the same group practice who are in the same specialty must bill and be paid as though they were a single physician. If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

Physicians in the same group practice but who are in different specialties may bill and be paid without regard to their membership in the same group.

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PARA Weekly Update: July 25, 2018

90791 AND 90792 QUESTIONS

Attached is the latest taxonomy crosswalk for your convenience, it explains which types of providers are considered to be in the same specialty.

Facility Fees: There is no CCI edit which prevents billing 90791 and 90792 on the same DOS for an outpatient.

However, under Medicare OPPS reimbursement, the hospital will earn reimbursement for only one of the 9079X codes when performed on the same DOS, as they are both status Q3 (paid or packaged.) If billed together with an ED visit on the same claim, only one will be paid separately. (Incidentally, both 90791 and 90792 are reimbursed under the same APC, therefore the rate of OPPS reimbursement is the same on either.)

Finally, once the patient is admitted to inpatient status, then the facility will report only the daily room rate, there should be no additional facility fee when a psychiatric diagnostic evaluation is performed on an inpatient, regardless of how often the service is repeated by different providers.

You asked to learn more about 90839; we suggest reading articles in the AMA publication ?CPT® Assistant?, which are available on the PARA Data Editor Calculator page. Simply key in the CPT® in the search field and select the ?CPT® Assistant? report ? a list of articles will be displayed. Click on the article to read more.

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PARA Weekly Update: July 25, 2018

90791 AND 90792 QUESTIONS

The June 2013 edition offers this comment: Psychotherapy for Crisis Code 90839, Psychotherapy for crisis; first 60 minutes, was added for psychotherapy provided for a patient in a crisis state. This code is used to report the first 30 to 74 minutes of psychotherapy for crisis on a given date. Add-on code 90840, Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service), is reported for each additional increment of up to 30 minutes after the first 74 minutes. Psychotherapy for crisis of less than 30 minutes should be reported with code 90832 or code 90833. (See the CPTÂŽ codebook for specific guidelines as to what constitutes a crisis for the use of these codes.)

In the outpatient setting, an LCSW may bill the professional fee for services that are provided within the scope of practice defined by his/her state licensure. In the inpatient setting, LCSW professional fees are not reported, they are considered to be a component of the facility room and board charge.

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PARA Weekly Update: July 25, 2018

MASTERS LEVEL SOCIAL WORKER IN ED

In the Emergency Department, we have Master Level Social Workers who complete behavioral health evaluations on patients. They bill a 90791 as the documentation supports this level of service. The ordering MD is entered as the physician who has ordered the consult. However, is the Performing MD the actual MSW who completes the assessment or the Psychiatrist who is supervising the MSW for this service? We just want to ensure we are billing these services correctly.

Answer: We will address both professional fees and facility fees.

Professional Fees: In the facility setting, professional fees are reported by only the provider who personally performed the service. No professional fee claim should be submitted reporting the rendering provider NPI as that of a physician or psychologist in the facility setting, such as the ED, when that service was performed by a masters level social worker. Incident-to professional fee billing is a common area of confusion. It does not exist in the facility setting. In a free-standing clinic setting (in other words, a clinic that is not part of the hospital), a supervising physician may report services performed by clinic staff provided that all of the requirements of ?incident to? billing are met.

Attached is PARA's paper that explains the requirements of ?incident to? billing.

If the masters level social worker is licensed by the state, then s/he may become enrolled with Medicare (and other payers which recognize that level of provider) and bill a professional fee for services performed in the facility setting under his/her own NPI. I have attached our paper on what services are billable by LCSWs in the facility setting.

Facility Fees: The facility may charge for the ED visit and may also report 90791 if the provider who performs the psychiatric evaluation is licensed by the state to perform that care. If the masters level social worker is not working within the scope of practice s/he is licensed to perform under state law, we do not recommend reporting the 90791 code on the claim. You may want to consider the additional resource required to complete this evaluation as a factor in assigning the ED visit level ? it may warrant charging the next level up. https://apps.para-hcfs.com/ para/Documents/Incident_ to_Billing_in_Clinic_and_ Hospital_Settings_ edited.pdf

https://apps.para-hcfs.com/ pde/documents/Billing_LCSW _Pro_Fees_for_Hospital_ Patients_Rev4_March_ 2014.pdf 8

PARA Weekly Update: July 25, 2018

PROPOSED RULE: CHANGES FOR SNFS CY 2018

On May 15, 2017, The Centers for Medicare and Medicaid (CMS) issued the proposed rule that could lay the groundwork for retiring the existing case-mix classification model, also known as the Resource Utilization Groups, Version 4 (RUG-IV), in the skilled nursing facility prospective payment system (SNF-PPS). Switching to the Resident Classification System, Version 1 (RCS-1), would be a monumental change, ending the use of therapy minutes as the driver for Part A therapy payment, as well as accounting for variation in nursing and non-therapy ancillary (NTA) services.

The proposed rule is currently out for public comments ended June 26, 2017, however CMS is targeting as early as CY2019 for full replacement of SNF PPS RUG-IV payment methodology to convert to the RCS-1 payment methodology as early as VY 2019. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017Fact-Sheet-items/2017-04-27-3.html

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PARA Weekly Update: July 25, 2018

PROPOSED RULE: CHANGES FOR SNFS CY 2018

The current payment model for PPS- SNF has been the standard for about 10 years. This system has raised concerns with the Office of Inspector General (OIG) and the Medicare Payment Advisory Commission (MPAC) because the system encourages providers to deliver therapy to residents based on financial goals and not patient need. Under the proposed RCS-1 case-ix model, any concerns based on the current RUGs would be resolved by removing service-based metrics from the SNF PPS and deriving payment, almost exclusively, from objective resident characteristics.

The most key target points in this proposed rule are: 1. Remove therapy minutes from payment: by no longer using minutes of therapy provided to a resident to classify the resident for payment purposes, and impose a 25% limit on group therapy and a 25% limit on concurrent therapy, this method would ensure residents would receive at least 50% of their therapy minutes on an individual basis.

2. Establish new case-mix components: by classifying each resident into four (4) case-mix adjusted components (PT/OT, SLP, Nursing and non-therapy ancillaries (NTA) that would be based, almost exclusively, on objective resident characteristics, and rely on each component to determine the actual per-diem payment received by the SNF 3. Front-load payments: Used to incorporate variable per-diem payment adjustments for the PT/OT and NTA components. These would reduce the payment amount associated with the PT/OT and NTA components over time consistent with research that suggests a SNF?s costs for PT/OT and NTA decrease during a resident?s stay 4. Significantly revise the assessment schedule: to requirements of only: - 5-day scheduled PPS Assessments - Significant Change in Status Assessments - PPS Discharge Assessments For the remainder of CY2017 and CY2018, CMS will retain the RUG-IV case-mix methodology. CMS is projecting to update the SNF-PPS for FY 2018 would increase overall payments to participating SNFs by $390 million, or 1.0% in comparison to FY 2017 levels. This projected target is being currently controlled by the implementation of the Medicare Access and CHIP Reauthorization Act of CY2015 (MACRA). Under MACRA a special rule for FY2018 requires the market basket percentage, after the application of the productivity adjustment to be 1.0%.

SNF providers are reminded of the implementation of the Improving Medicare Post-Acute Care Transformation Act of CY2014 (IMPACT Act, see link above).

Under this Act implementation, the annual update of 2% for SNFs is reduced for all SNFs that fail to submit required reporting quality data to CMS under the SNF Quality Reporting Program (QRP) scheduled to begin as of FY2018.

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PARA Weekly Update: July 25, 2018

PROPOSED RULE: CHANGES FOR SNFS CY 2018

Additionally, for FY2020, CMS is proposing to replace the current pressure ulcer measure with an updated version of that measure and to adopt four new, outcome- based functional measures that align with the Inpatient Rehabilitation Facility (IRF) QRP. Separately from these proposed changes, CMS is required to begin reporting standardized patient assessment data beginning with FY2019 SNF QRP; CMS will satisfy this requirement using the data submitted on the existing pressure ulcer measure, however, CMS will begin standardized patient data in the following five (5) categories beginning CY 2020: 1.

2.

3.

4.

5.

Functional status Cognitive function Special services, treatments and interventions Medical conditions and co-morbidities Impairments

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/ Post-Acute-Care-Quality-Initiatives/Cross-Setting-Pressure-Ulcer-Measurementand-Quality-Improvement.html

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PARA Weekly Update: July 25, 2018

CMS FACT SHEET: PROPOSED PHYSICIAN FEE SCHEDULE CHANGES

n July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.

The calendar year (CY) 2019 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.

Background on the Physician Fee Schedule Payment is made under the PFS for services furnished by physicians and other practitioners in all sites of service. These services include, but are not limited to, visits, surgical procedures, diagnostic tests, therapy services, and specified preventive services.

In addition to physicians, payment is made under the PFS to a variety of practitioners and entities, including nurse practitioners, physician assistants, and physical therapists, as well as radiation therapy centers and independent diagnostic testing facilities.

Payments are based on the relative resources typically used to furnish the service. Relative Value Units (RVUs) are applied to each service for physician work, practice expense, and malpractice. These RVUs become payment rates through the application of a conversion factor. Payment rates are calculated to include an overall payment update specified by statute.

Click on the link and icon here to read the Fact Sheet in its entirety. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/ 2018-07-12-2.html

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PARA Weekly Update: July 25, 2018

2019 MFS RULE EASES APPROPRIATE USE CRITERIA REPORT ANXIETY

n July 13, 2018, CMS released the 2019 Proposed Rule for the Medicare Physician Fee Schedule. Among the proposals, CMS has clarified the direction it will take on appropriate use reporting.

Specifically, CMS has indicated that until 2021, no claims will be denied simply due to the lack of Appropriate Use information from the referring physician: ?? the AUC program will begin on January 1, 2020 with a year-long educational and operations testing period during which time claims will not be denied for failure to include proper AUC consultation information.?

Additionally, CMS clarified the AUC consultation information is not limited to the furnishing professional; AUC may be consulted by personnel assisting the physician: ? We propose to revise the AUC consultation requirement specified at ยง414.94(j) to specify that the AUC consultation may be performed by auxiliary personnel under the direction of the ordering professional and incident to the ordering professional?s services.?

CMS also reported that while it considered a number of alternative reporting methods, it has settled on the use of G-codes and modifiers unless and until a better idea comes to light: ?? we propose in this rule to use established coding methods, to include G-codes and modifiers, to report the required AUC information on Medicare claims. This will allow the program to be implemented by January 1, 2020.?

AUC information will be required on claims for the professional interpretation and/or technical component for Advanced Diagnostic Testing (imaging, such as CTs and MRIs) billed on OPPS hospital claims, Independent Diagnostic Testing Facility (IDTF) claims, Ambulatory Surgery Center (ASC) claims, and claims for the global or technical portion of such services performed in an independent physician office.

Appropriate Use reporting requirements do not apply to claims for services performed in a Critical Access Hospital, however.

CMS is late in meeting regulatory deadlines established in the 2014 Protecting Access to Medicare Act. (PAMA) required that physicians report their use of Appropriate Use Criteria when ordering advanced diagnostic imaging tests in 2017. In the 2018 MPFS Proposed Rule, CMS communicated its intent to implement the required reporting on January 1, 2019, but the issues and questions brought forward in responses from stakeholders caused them to delay an additional year, until January 1, 2020.

Following is a link and excerpts from the 2019 Medicare Physician Fee Schedule Proposed Rule which will be valid until the rule is published in the Federal Register, on July 27, 2018: https://s3.amazonaws.com/public-inspection.federalregister.gov/ 2018-14985.pdf 5. Summary ?Section 1834(q) of the Act includes rapid timelines for establishing a Medicare AUC program for advanced diagnostic imaging services. The impact of this program is extensive as it will apply to every physician or other practitioner who orders or furnishes advanced diagnostic imaging services (for example, MRI, computed tomography (CT) or positron emission tomography (PET)). This crosses almost every medical specialty and could have a particular impact on primary care physicians since their scope of practice can be quite broad."

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PARA Weekly Update: July 25, 2018

2019 MFS RULE EASES APPROPRIATE USE CRITERIA REPORT ANXIETY

?We continue to believe the best implementation approach is one that is diligent, maximizes the opportunity for public comment and stakeholder engagement, and allows for adequate advance notice to physicians and practitioners, beneficiaries, AUC developers, and CDSM developers. It is for these reasons we propose to continue a stepwise approach, adopted through notice and comment rulemaking.

In summary, we are proposing policies to modify existing requirements and criteria and to provide further clarification on implementation of the AUC program. We include a proposal to add IDTFs to the definition of applicable settings under this program. We also include proposals regarding who beyond the ordering professional may consult AUC through a qualified CDSM to meet the statutory requirements for the AUC program, as well as a proposal to more clearly include all entities required to report AUC consultation information on the claim. Finally, we propose to modify the significant hardship exception criteria and process under ยง414.94(i)(3) to be specific to the AUC program and independent of other Medicare programs. We are also requesting public comment on other circumstances that could be considered significant hardships, posing particular real-time difficulty or challenge to the ordering professional in consulting AUC. We invite the public to submit comments on these proposals, as well as provide comment on potential methods for, and issues related to, mechanisms for claimsbased reporting and identifying outlier ordering professionals.

We will continue to post information on our website for this program, accessible at:

www.cms.gov/Medicare/Quality-Initiatives -Patient-Assessment-Instruments/AppropriateUse-Criteria-Program/index.html PARA?s previous report on Medicare?s Appropriate Use Criteria program is available at the following link:

https://apps.para-hcfs.com/para/Documents/ 2018_MPFS_Proposed_Rule_Requires_ Appropriate_Use_Data_in_2019_v4_edited.pdf

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PARA Weekly Update: July 25, 2018

PARA SERVICES AT A GLANCE

Here is a simple, easy-to-follow presentation PARA experts recently made to the Idaho Hospital Association. We invite you to review the presentation by clicking either of the icons below.

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PARA Weekly Update: July 25, 2018

RURAL HOSPITAL PROGRAM GRANTS AVAILABLE

Rural hospitals and clinics face their own set of unique and burdensome challenges when it comes to program development, cash management and maintaining volume. That's why it's great when they can get some assistance from external funding sources.

At PARA, we've found an excellent source of funding opportunities for rural healthcare facilities.

Here are some examples.

Rural Residency Planning And Development Program Technical Assistance - Provides $800,000 for three years to promote the process of rural residencies-to-rural pipeline by assisting with the development of new rural family medicine, internal medicine, or psychiatry residency programs.

- Application Deadline: August 22,2018

Rural Opioid Response Program - Provide funding for a single entity to provide technical assistance services to HRSA's Rural Communities Opioid Response Program - Award recipient will provide resources and expertise in support of the execution of the following focus areas: 1) Prevention; 2)Treatment; and 3) Recovery - Application Deadline: August 10,2018

Service Area Funding For Health Center Programs - Provides grants to health centers that offer comprehensive primary healthcare services to an underserved area or population.

- Estimated funding is $409,300,000 for 86 awards.

- Project period is up to three years - Application Deadline: August 6, 2018

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PARA Weekly Update: July 25, 2018

MLN CONNECTS

PARA invites you to check out the mlnconnects page available from the Centers For Medicare and Medicaid (CMS). It's chock full of news and information, training opportunities, events and more! Each week PARA will bring you the latest news and links to available resources. Click each link or the PDF!

Thursday, July 19, 2018 News & Announcements · MIPS 2017 Performance Feedback User Guide · MIPS Payment Adjustment Targeted Review: Request by October 1 · PEPPERs for Home Health Agencies, Partial Hospitalization Programs · July Quarterly Provider Update Provider Compliance · Cardiac Device Credits: Medicare Billing Upcoming Events · CY 2018 eCQM Self-Directed Tools and Resources Webinar ? July 24 · IMPACT Act and SPADE Special Open Door Forum ? July 25 · Meeting the Behavioral Health Needs of the Dually Eligible Webinar ? August 2 · ESRD Quality Incentive Program: CY 2019 ESRD PPS Proposed Rule Call ? August 14 · CBR on Independent Diagnostic Testing Facilities Referring Providers Webinar ? August 22 Medicare Learning Network® Publications & Multimedia · New MBI: Get It, Use It MLN Matters® Article ? Revised · Medical Review of E/M Documentation MLN Matters Article ? New · New Physician Specialty Code for Undersea and Hyperbaric Medicine MLN Matters Article ? New · Medicare Part A SNF PPS Pricer Update MLN Matters Article ? New · Automating First Claim Review in Serial Claims for DMEPOS MLN Matters Article ? Revised · Medicare Preventive Services Educational Tool ? Revised · Behavioral Health Integration Services Fact Sheet ? Reminder · Chronic Care Management Services: Changes for 2017 Fact Sheet ? Reminder · Chronic Care Management Services Fact Sheet ? Reminder · Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training ? Reminder View this edition as a PDF [PDF, 296KB] 17

PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

edicare billers are occasionally stymied by the edit ?Claim lacks device code? when the device or implant does not have an assigned HCPCS code, and no other HCPCS is appropriate.

Until 2015, Medicare specified exactly which device HCPCS were required for the various procedure HCPCS. However, Medicare changed its policy to accept any device code to satisfy the ?missing device code? edit when reported on a claim with a device-intensive procedure. In addition, Medicare modified the list of procedures which require device reporting in 2017.

The list may change annually.

To address procedures which require a device HCPCS, but the device has not yet been assigned a unique HCPCS, Medicare created HCPCS code C1889 ?Implantable/insertable device for device intensive procedure, not otherwise classified.? Reporting HCPCS code C1889 with a device-intensive procedure will satisfy the edit requiring a device code to be reported on a claim with a device-intensive procedure.

While Medicare no longer imposes specific procedure-to- device and device-to-procedure edits for any HCPCS, and any of the device codes will satisfy billing requirements, hospitals are still expected to report the most appropriate HCPCS for each procedure. Hospitals should continue reporting the appropriate device codes on claims APCs with a device offset of more than 40 percent as ``device-intensive'' APCs, and report C1889 if no other HCPCS is appropriate. The list of HCPCS which are considered ?device-intensive? is found in the OPPS Final Rule, Addendum P. The list for CY 2018 is provided here and on the following pages:

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PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

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PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

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PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

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PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

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PARA Weekly Update: July 25, 2018

BILLING MEDICARE FOR DEVICE-DEPENDENT PROCEDURES

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PARA Weekly Update: July 25, 2018

PARA INTRODUCES NEW OUTPATIENT OUTMIGRATION REPORTS In their continuing expansion of product lines critical to streamlining hospital data collection and improving decision support tools for Chief Executive Officers, Chief Financial Officers and Business Development executives, PARA Analytics introduces the new Outpatient Migration Report.

Among other items, PARA customers using this vital report will be able determine where patients in their primary and secondary service areas are going for outpatient services, total volumes of selected outpatient services and the value of these services.

The Outpatient Migration Report provides information on Medicare Outpatient Visits and the patient?s county of residence. The source of this information is the Medicare Outpatient Limited Data Set. For the selected hospital, the top ten counties are identified based on the number of outpatient visits from those counties of residence. These counties are listed horizontally across an easy-to-read report.

All facilities that had an outpatient visit from the selected hospital?s home county are listed vertically on the report and it then details how many outpatient visits to each facility originated from each of the ten corresponding counties.

The Outpatient Migration Report includes ten tabs with this same format. The first tab includes statistics on all outpatient visits. The subsequent nine tabs include the visit counts that have been identified as specific visit types.

These include: - Emergency, Mammography - CT - MRI - Therapy - GI - Diagnostic Radiology - Lab, and - Wound Care The final tab provides reference information on how outpatient visits are assigned to the preceding categories. If any of the listed codes appear on the claim, then the visit is assigned the corresponding label.

PARA Analytics is the first national healthcare financial firm to develop such valuable reports in a more timely manner than data typically available from public sources. Using PARA?s proprietary algorithms in the PARA Data Editor, PARA can rapidly produce relevant and functional reports.

For more information and a demonstration of these new reports, please contact PARA Account Executives: Violet Archuleta-Chiu, Senior Account Executive varchuleta@para-hcfs.com (800) 999-3332, ext. 219 Sandra LaPlace, Account Executive slaplace@para-hcfs.com (800) 999-3332, ext. 225 24

PARA Weekly Update: July 25, 2018

There were FIVE 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.

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

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PARA Weekly Update: July 25, 2018

The link to this Med Learn: MM10852

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PARA Weekly Update: July 25, 2018

The link to this Med Learn: MM10873

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PARA Weekly Update: July 25, 2018

The link to this Med Learn: MM10819

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PARA Weekly Update: July 25, 2018

The link to this Med Learn: MM10875

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PARA Weekly Update: July 25, 2018

The link to this Med Learn: MM10809

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PARA Weekly Update: July 25, 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: July 25, 2018

The link to this Transmittal R4093CP

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The link to this Transmittal R4092CP

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The link to this Transmittal R4090CP

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The link to this Transmittal R244BP

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PARA Weekly Update: July 25, 2018

The link to this Transmittal R4094CP

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The link to this Transmittal R2100OTN

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PARA Weekly Update: July 25, 2018

The link to this Transmittal R2099OTN

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PARA Weekly Update: July 25, 2018

The link to this Transmittal R4091CP

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PARA Weekly Update: July 25, 2018

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