PARA Weekly eJournal May 15, 2019

PARAWeekly -

eJOURNAL

PRICING CODING REIM BURSEM ENT COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS M ay 15, 2019

Feat ur ing

IN THIS ISSUE

Hospitals face increased price scrutiny and transparency expectations.

The M ar k et Based Pr icin g program ensures rates are justifiable.

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QUESTIONS & ANSWERS - L-Codes And Acronyms - Observation Billling - 94640 MUE - Billing J3490 For Drugs SCREENING COLONOSCOPY UPDATE FOR COINSURANCE EMERGENCY TREAT, TRIAGE AND TRANSPORT (ET3)

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The number of new or revised Med Learn articles released this week.

M ar ket Based Pr icin g

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The number of new or revised Transmittals released this week.

BILLING MISCELLANEOUS ITEMS ENDING IN 99, J3490, J3590 CALIFORNIA UPDATE: BILLING FOR ANTEPARTUM VISITS RURAL HOSPITAL GRANTS MLN CONNECTS NEWSLETTER

PARA COMPANY NEWS

SERVICES

Billing J3490 For Drugs

ABOUT PARA

CONTACT US

Det ai l ed Pr ocedu r es Page 6

FAST LINKS

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Administration: Pages 1-39 HIM /Coding Staff: Pages 1-39 Critical Access Hospital: Page 2 Providers: Pages 4,6,10,14,27 DM E: Page 2 Laboratory: Pages 3,19,24 Ambulatory Care: Page 10

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Respiratory Care: Page 4 Finance: Pages 14,15,29 California Providers: Page 22 Gastorentorology: Page 10 Imaging: Page 18 Compliance: Page 14 PDE Users: Page 2

© 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 eJournal: May 15, 2019

L-CODES AND ACRONYMS

I would like to ask again what L-codes we are allowed to bill for as CAH hospital?

Currently, we have L-codes for elbow/hand/wrist/finger orthosis that are pre-fabricated and custom used by our Occupational Therapists, and, what does FTS and POC stand for in the billing example below, and what should a CAH facility be following for therapy services?

ANSWER: We have attached a list of the billable HCPCS L-codes for a hospital that is not enrolled as a DME supplier. These codes may be reported to your regular Part A/B MAC on a UB04/837i claim form when dispensed incidental to other medical services, such as PT/OT therapy or an emergency department visit (to name a few.) Usually FTS means Focused Therapy Session, and POC means Plan of Care.

However, we are not sure if that is accurate in the context of the document quoted from the website at SupplementalHealth at https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/Downloads/bp102c15.pdf The document may be referring to different software applications that assist therapists in documenting and coding time-based services. We phoned the SupplementalHealth contact number (866.474.6677). The switchboard operator passed us to a representative who said she is not familiar with this document, and if it was written over 10 years ago, she would not be able to assist me with the acronyms.

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PARA Weekly eJournal: May 15, 2019

OBSERVATION BILLING

If we have an Observation patient can we bill the laboratories separately so that there would be reimbursement?"

Answer: No. Providers must bill for all services performed on the same day for the same patient on a single claim form. Failure to do so impedes the application of all necessary edits and/or adjudication logic when the payer (particularly Medicare) processes the claim. As a result, claims may be under- or over-paid and member liability may be under- or over-stated. It is non-compliant to break different services for the same patient encounter into different claim, and we would expect separate claims would be detected by the Medicare processing system, which looks for other claims billed for the same DOS. Here is the pertinent excerpt from the Medicare Claims Processing Manual, Chapter 4: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf# 290.5.3 - Billing and Payment for Observation Services Furnished Beginning January 1, 2016 (Rev. 3425, Issued: 12-18-15, Effective: 01-01-16, Implementation: 01-04-16) ? ?? Non-repetitive services provided on the same day as either direct referral for observation care or observation services must be reported on the same claim because the OCE claim-by-claim logic cannot function properly unless all services related to the episode of observation care, including hospital clinic visits, emergency department visits, critical care services, and T status procedures, are reported on the same claim. Additional guidance can be found in chapter 1, section 50.2.2 of this manual.?

Medicare (and most other payors) will adjust all individually submitted claims for the same patient, same DOS to deny separate claims for the same encounter. The denial code would typically be CO-18, duplicate claim -- even if the services billed on claim 1 differed from claim 2, the second claim would be denied if it was received by the same provider reporting services to the same patient on the same DOS. The provider would be required to submit a corrected claim including all services for the encounter.

Each UB04/837i claim form displays a "from/through" date span. All the services performed in a single encounter (from the time the patient arrives at the hospital to the time they leave) must be reported on the same claim.

That being said, there are a few exceptions to the general rule. Billers may use condition codes on claims to allow hospitals to bill repeater services (i.e. weekly chemotherapy services) on one claim per month, and other hospital encounters during the same month (such as ED visits) for the same patient on a separate claim. There are also specific billing instructions for reporting services on separate claims if the services span the calendar year-end (i.e. patient seen in the ED on 12/31 and referred to observation, discharged on 1/2 of the following year.) And, finally, there are special billing instructions when an OPPS hospital needs to report two ED visits on the same DOS."

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PARA Weekly eJournal: May 15, 2019

94640 MUE

Can we code and charge for more than one of the 94640 codes per day if multiple treatments are done? If we can, do we append the 76 modifier. will Medicare pay for more than one per day?

Answer: Due to Medicare?s ?Medically Unlikely Edit? quantity of 1, only one unit of 94640 may be charged per outpatient encounter. It is not appropriate, nor would it be successful, to append modifier 76 to additional units of 94640 on a Medicare outpatient claim.

Here is an excerpt from the 2019 National Correct Coding Manual: https://apps.para-hcfs.com/para/documents/CHAP11-CPTcodes90000-99999_final103118.pdf 8. CPT® code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction...) describes either treatment of acute airway obstruction with inhaled medication or the use of an inhalation treatment to induce sputum for diagnostic purposes. CPT® code 94640 shall only be reported once during an episode of care regardless of the number of separate inhalation treatments that are administered. If CPT® code 94640 is used for treatment of acute airway obstruction, spirometry measurements before and/or after the treatment(s) shall not be reported separately. It is a misuse of CPT® code 94060 to report it in addition to CPT® code 94640. The inhaled medication may be reported separately.

An episode of care begins when a patient arrives at a facility for treatment and terminates when the patient leaves the facility. If the episode of care lasts more than one calendar day, only one unit of service of CPT® code 94640 shall be reported for the entire episode of care.

If a patient receives inhalation treatment during an episode of care and returns to the facility for a second episode of care that also includes inhalation treatment on the same date of service, the inhalation treatment during the second episode of care may be reported with modifier 76 appended to CPT® code 94640.

If inhalation drugs are administered in a continuous treatment or a series of ?back-to-back? continuous treatments exceeding one hour, CPT® codes 94644 (continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour) and 94645 (...; each additional hour) may be reported instead of CPT® code 94640.

9. CPT® code 94640 (pressurized or non-pressurized inhalation treatment for acute airway obstruction...) and CPT® code 94664 (demonstration and/or evaluation of patient utilization of an aerosol generator...) generally should not be reported for the same patient encounter. The demonstration and/or evaluation described by CPT® code 94664 is included in CPT® code 94640 if it utilizes the same device (e.g., aerosol generator) that is used in the performance of CPT® code 94640. If performed at separate patient encounters on the same date of service, the two services may be reported separately.

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PARA Weekly eJournal: May 15, 2019

94640 MUE

Hospital billing staff have been struggling since 2016 with Medicare?s reduction in the Medically Unlikely Edit (MUE) value for inhalation treatment: 94640 - PRESSURIZED OR NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION FOR THERAPEUTIC PURPOSES AND/OR FOR DIAGNOSTIC PURPOSES SUCH AS SPUTUM INDUCTION WITH AN AEROSOL GENERATOR, NEBULIZER, METERED DOSE INHALER OR INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) DEVICE.

The 2019 MUE limit for 94640 since 1/1/2017 is only 1 per encounter. In 2016, it was 2; in 2015, it had been 10.

The MUE change follows guidance first published in the 2014 National Correct Coding Edit Manual. The manual states that regardless of the number of treatments in the same outpatient encounter, only one unit of 94640 should be billed. However, if inhalation treatments were performed at two separate encounters on the same date of service, the MUE allows a second unit of 94640.

The NCCI Manual also explains that HCPCS 94664 - DEMONSTRATION AND/OR EVALUATION OF PATIENT UTILIZATION OF AN AEROSOL GENERATOR, NEBULIZER, METERED DOSE INHALER OR IPPB DEVICE is considered ?integral to? 94640, and should not be billed separately on the same date of service unless the demonstration used a different device, or if the demonstration/evaluation was performed at a different encounter on the same day. Incidentally, 94664 has an MUE of only 1.

PARA recommends establishing two charges for outpatient inhalation treatments, particularly in the emergency department, as follows: - The initial treatment charge should be priced at the average total charges per account for outpatient inhalation services billed in 2015. For example, if each 94640 were charged in 2015 at $100, and the average number of units billed on outpatient claims in 2015 was 2.5, the value of the ?initial? treatment charge in 2016 should be $250.00 - The subsequent treatment charge should be a zero-dollar charge for statistical purposes only.

Zero dollar charges will not appear on the claim. We should also point out that a second treatment occurring during a separate encounter on the same day may be billed with modifier XE (Separate Encounter, i.e. 94640-XE.), however this circumstance is not common.

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PARA Weekly eJournal: May 15, 2019

BILLING J3490 FOR DRUGS

We are a Critical Access Hospital. Should we report J3490 instead of S-codes (such as S0028, S0030, S0162, S0164) when billing Medicare for an outpatient encounter that includes these drugs?

Answer: S-codes are ?Temporary national codes? that are not recognized by Medicare.

As you have discovered, S-codes will cause a claim to be rejected

by Medicare. However, the drugs these codes represent are covered under Part B when billed by a hospital if the drug was prescribed by a physician for a medically necessary purpose, so long as it is not a self-administered drug.

It is not necessary to report J3490 (Unclassified Drugs) to Medicare simply because an S-code also exists for a drug. You may report drugs which have no Medicare-accepted HCPCS under revenue code 0250 on an outpatient claim. While it is also permissible to report the drugs under J3490 in revenue code 0636, that code should be reported with specific drug information in the remarks field on the claim, which is often an unrewarding exercise. The use of J3490 and the extra effort to explain what drug it represents may not affect reimbursement.

This would certainly be true of a Critical Access Hospital reporting drugs to Medicare on an outpatient claim.

We have attached a guide from Novitas, the Medicare Administrative Contractor for Texas and several other southwestern/central states, regarding the appropriate use of ?Not Otherwise Classified? (NOC) codes, such as J3490.

It states, in part: ?When the medication administered has not been assigned a HCPCS/CPT code, it is appropriate to use an NOC code based on the descriptor. A description of the drug and/or biological and dosage must be entered in the remarks field of the claim.?

We note that it does not say that hospitals are required to report an NOC code (such as J3490) for every drug that has no HCPCS assigned. Nor does the guidance prohibit hospitals from reporting drugs which are not assigned a HCPCS under revenue code 0250 without a HCPCS ? as is the widely-practiced standard for reporting drugs without assigned HCPCS on hospital outpatient claims.

Unless there is a specific payor requirement to report J3490, PARA does not recommend J3490 for reporting low-cost drugs which are not assigned another Medicare-recognized HCPCS code. Instead, report low-cost drugs without a HCPCS under revenue code 0250.

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PARA Weekly eJournal: May 15, 2019

BILLING J3490 FOR DRUGS

We advise clients to report J3490 if there is good reason to separately report a drug which has not been assigned a Medicare-approved HCPCS. For instance: -

Payer Requirements: Some payers may have a requirement that certain drugs should be reported with J3490. For example, certain state Medicaid authorities specifically instruct providers to report J3490 for various drugs. California, Texas, and North Carolina (to name a few) each require J3490 for numerous drugs which have no specific HCPCS assigned. In addition, most Medicaid programs also require NDC reporting for each drug on the claim, so the provider is already supplying detailed drug information

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Additional Reimbursement: Some payers may reimburse a drug if billed with J3490 and drug details are provided (this is not common unless stipulated in the payer?s provider billing manual)

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Special Cases: For particular drugs on a short-term basis as communicated by payers in provider bulletins or other communications

If/when the hospital reports J3490, the claim remarks must include: - Name of drug - Dosage (mg, mL, etc.)

- Route of administration (IV, IM, SC, PO, etc.)

Of course, a Critical Access Hospital is paid under cost-reimbursement methodology by Medicare for all medications except self-administered drugs, so it is not necessary to report J3490 to receive Medicare reimbursement.

Under Medicare OPPS/APC payment methodology (which does not apply to Critical Access Hospitals), J3490 is APC status N, payment is packaged to payment made on another line of the same claim. Similar to Medicare?s APC methodology, most payers will not volunteer additional reimbursement simply because the hospital reports J3490.

Furthermore, Medicare does not include J3490 in its ?NDC to HCPCS crosswalk? for outpatient hospital claim reporting, which is published each quarter.

Here?s a snip and a link for that file: https://www.cms.gov/apps/ ama/license.asp?file=/Medicare/ Medicare-Fee-for-Service-PartB-Drugs/McrPartBDrugAvgSales Price/Downloads/January-2019ASP-NDC-HCPCS-Crosswalk.zip 7

PARA Weekly eJournal: May 15, 2019

BILLING J3490 FOR DRUGS

We checked the Indiana Medicaid website for the provider code set for injectable medications. It does not include J3490: http://provider.indianamedicaid.com/ihcp/Publications/providerCodes/Injections_Vaccines_and_ Other_Physician-Administered_Drugs_Codes.pdf

Special Case Illustration: A payer may specifically ask for J3490 for an expensive item that it wants providers to report separately, in order to enable reimbursement.

For example, Indiana Medicaid specifically requested that providers report J3490 for the IUD Kyleena for a period of four and a half months prior to Kyleena having been assigned its HCPCS code Q9964 (and later, J7296.) Kyleena is an expensive IUD which is reimbursed at nearly $1,000 under Indiana Medicaid; therefore the Medicaid claims processing system needed a HCPCS to properly adjudicate provider reimbursement on claims. The Kyleena announcement appeared in the February 27, 2018 IHCP ?Banner? publication: http://provider.indianamedicaid.com/ihcp/Banners/BR201809.pdf

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PARA Weekly eJournal: May 15, 2019

BILLING J3490 FOR DRUGS

By the way, one of the S-codes you inquired about ? S0164 for pantoprazole sodium ? should be reported with HCPCS C9113 when reporting to Medicare, which will not accept the alternate S-code:

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PARA Weekly eJournal: May 15, 2019

SCREENING COLONOSCOPY UPDATE FOR COINSURANCE

Law m ak er s h ave r ein t r odu ced legislat ion t h e w ill m ak e ch an ges t o M edicar e ben ef iciar y f in an cial r espon sibilit y f or Scr een in g Colon oscopies.

Under the current Medicare guidelines, co-insurance and deductibles are waived on a screening colonoscopy procedure.

When a polyp is discovered and removed, however, the procedure is reclassified as a therapeutic for Medicare billing purposes. This makes Medicare beneficiaries subject to financial responsibility for coinsurance.

This can place a huge financial liability that many Medicare beneficiaries are unprepared to pay.

H.R. 1070 is intended to remove the financial responsibility from the Medicare beneficiary by removing the coinsurance when a screening colonoscopy becomes a therapeutic procedure. https://www.congress.gov/bill/115th-congress/house-bill/1017/text

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PARA Weekly eJournal: May 15, 2019

SCREENING COLONOSCOPY UPDATE FOR COINSURANCE

https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPSQuickReferenceChart-1.html#COLO_CAN

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PARA Weekly eJournal: May 15, 2019

EMERGENCY TREAT, TRIAGE AND TRANSPORT (ET3)

ET3

The Centers for Medicare and Medicaid (CMS) in conjunction with the U.S. Department of Health and Human Services (HHS) have recently announced the Emergency Treat, Triage and Transport (ET3) Payment Model, which will enable Medicare reimbursement for certain non-transport ambulance services and ambulance transports to alternate destinations.

Below are summary reviews of five key components of this proposed model payment program:

1) ET3 Encourages the use of community paramedicine program ? Under this payment model program it is designed to decrease the burden on emergency departments and connect the patient with the best place for care, which may not necessarily be the hospital.

Agencies that complete the application process to operate under the ET3 payment model will be authorized to transport patients to other destinations, including doctors?offices, as well as encourage the use of community paramedicine programs, when it is applicable to the case scenario. Example of this case scenario would be assisting patients without the need for more complex care.

2) The ET3 payment model provides Medicare transportation and Medicare reimbursement. Currently, agencies only receive payment from Medicare if they transport patients to hospitals, critical assess hospitals, skilled nursing facilities and dialysis centers, regardless of whether the patients?needs could be met at a lower-acuity level.

When using the ET3 payment model, agencies are eligible to be reimbursed for Medicare transportation and receive Medicare reimbursement, based on their determination upon patient triage at the scene. The ET3 payment model could also save patients out-of-pocket costs when utilizing community paramedicine programs and by avoiding costly emergency department visits.

3) The ET3 payment model was designed to improve quality, lower costs, and demand higher efficiency ?

Under the new model the focus is directed to a patient-centered system that provides the correct level of care at the most adequate facility for emergency. Under this proposed provision, it means that agencies can utilize doctors?offices, urgent care facilities and other community paramedicine or mobile integrated healthcare options to meet the needs of the patient in transport.

In providing the level of care that matches the health need, EMS providers will improve the quality of life and circumstances of the patient in the moment, in addition to saving the beneficiary money by potentially avoiding an unnecessary emergency department trip and allow EMS providers to quickly and efficiently move on to more emergent transports.

4) ET3 provides an emphasis on triage ? A component of the new reimbursement plan, 911 call centers that are participating in the ET3 system will screen callers to find those that are eligible to speak with medical triage services prior to an ambulance being dispatched.

The goal of the screening allows for community paramedicine, or other de-escalated methods of care, to be utilized when responding to calls. In addition, the screening will ascertain information that could direct the ambulance to a lower level of care, such as an urgent care facility. In this example, using the ET3 payment system, Medicare would reimbursement for this transport.

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PARA Weekly eJournal: May 15, 2019

EMERGENCY TREAT, TRIAGE AND TRANSPORT (ET3)

5. The ET3 model puts patient care first. By understanding the needs of the patient through triage screening at the 911 operator level, EMS agencies are positioned to provide more in-depth, thoughtful and deliberate care to patients, while being compensated.

Under the proposed ET3 payment model, CMS is envisioning the future for EMS providers will be able to even transport and get reimbursement for -

A chronic inebriate to a sobering center Stay on scene with a fall patient to review medications and identify trip hazards Drop off a patient with a respiratory infection at an urgent care center Educate an asthma patient about triggers and how to prevent attacks

Currently, ET3 is a voluntary five-year performance program that will begin January 2020. CMS will be releasing future updates. https://innovation.cms.gov/initiatives/et3/

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PARA Weekly eJournal: May 15, 2019

PDE SERVICE: MARKET BASED PRICING

Healthcare provider prices are being scrutinized more than ever now with the Affordable Care Act in place. The demand for rational pricing is a major component to transparency, price competitiveness and earned reimbursement.

It is imperative to ensure that your rates are justifiable.

The purpose of PARA Market Based Pricing (MBP) Program is to identify line items in the charge master which have negative patient satisfaction due to high prices, identify gross margin improvement opportunities due to low prices and to establish a rational pricing methodology by setting prices based on fee schedule, APC, cost, or competitive market pricing data.

The PARA Market Based Pricing (MBP) Program deliverables include a review of existing prices, price transparency, market/cost based pricing, market analysis, contract modeling, a series of pricing iterations with recommended prices and quarterly post-implementation progress reports.

Contact Violet Archuleta-Chiu at varchuleta@para-hcfs.com or Sandra LaPlace at slaplace@para-hcfs.com for more information.

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PARA Weekly eJournal: May 15, 2019

BILLING MISCELLANEOUS ITEMS ENDING IN 99, J3490,J3590

All medical billers and AR follow-up teams have experienced billing or claim denials because there is a ?miscellaneous? HCPCS on a claim. The reason is because miscellaneous codes do not provide adequate information for the item being billed.

Unlike established HCPCS for standard procedures and testing, most payers will manually calculate the reimbursement for the claim line reporting the miscellaneous item or testing. To do this, however, the provider is expected to supply the additional information on the claim upon submission.

The type of information required varies on the type of miscellaneous service or item that is being reported on the claim.

For example: - If the service is a surgery, an operative report will be required to be submitted with the claim. This allows the payer to review the procedure and adjudicate the claim correctly - If the service is a diagnostic test, clinical notes should be included. The clinical notes should clearly and precisely describe the patient?s diagnosis, the full name of the test performed and the results of the test - If the item is a DME item, the name of the item, a full description of the item, the name of the manufacturer, the produce code/number and a copy of the invoice should be included with the claim submission - If the miscellaneous item is a drug, the claim should contain the full name of the drug, the manufacturer, strength and dosage, NDC code for the drug and route of administration. This would apply to anesthesia agents - **Special note for 80299: The name of the drug being tested must be indicated in Box 19 of the CMS 1500 claim form (remarks field) or in Box 80 of the UB04 claim In the tables on the follow pages of this article, are examples of various procedures and items for which this article is applicable:

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BILLING FOR ANTEPARTUM VISITS IN THE HOSPITAL SETTING

California Update When a patient arrives at a facility?s Labor and Delivery department for an antepartum labor check, it is important to use the correct billing codes for Medi-Cal beneficiaries. Facilities should report HCPCS Code Z7514 for the use of an OB Triage Room while the patient is being monitored for an antepartum labor check.

It is not appropriate for a facility to separately bill CPTÂŽ Code 59025 (Fetal Non-Stress Test) when the test is performed as part of a standard protocol for an antepartum visit. For the facility to be reimbursed separately for the Fetal Non-Stress Test there needs to be a Physician?s order for Fetal Non-Stress Testing and specific documentation in the Medical Record to substantiate the need for billing CPTÂŽ Code 59025 separately.

Per Medi-Cal guidelines, listed below are examples of appropriate ?High Risk? diagnoses that would allow for separate reimbursement of a Fetal Non-Stress Test. It is important to remember that this is not a comprehensive list of ?High Risk? diagnoses, but a snap shot of those that would potentially qualify for separate reimbursement.

If a patient is monitored for longer than 4 hours in an antepartum visit, it is recommended that the physician be contacted, and an order obtained for observation care. Observation is charged hourly and should not exceed forty-eight hours in total.

https://apps.para-hcfs.com/para/Documents/PARA_LaborDeliveryAndPost-PartumCare.pdf 22

PARA Weekly eJournal: May 15, 2019

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.

340B Drug Pricing Program - The program provides prescription drugs at a reduced cost to eligible entities. Participation in the Program results in significant savings estimated to be 20% to 50% on the cost of pharmaceuticals for safety-net providers.

- Registration periods are open 4 times throughout the year, and are processed in quarterly cycles.

- Funding cycles are as follows: April 1 - April 15 for a July 1 start date; July 1 July 15 for an October 1 start date; October 1 - October 15 for a January 1 start date

Rural Health And Safety Education Competitive Grants Program Provides up to $350,000 to increase individual or family motivation to take responsibility for their own health. Application Deadline:

June 10, 2019

Small Ambulatory Program For Native Americans And Alaska Natives Provides up to $2,000,000 to fund ambulatory healthcare facilities on municipal, private or Tribal land to provide healthcare services to eligible Native Americans. Can be used for modernization or expansion of existing facilities, or new or replacement facilities.

Application Deadline: June 28, 2019

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PARA Weekly eJournal: May 15, 2019

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 for the PDF!

Thursday, May 9 2019 New s & An n ou n cem en t s

· DMEPOS Competitive Bidding: Registration and Bid Window for Round 2021 · Comprehensive Strategy to Foster Innovation for Transformative Medical Technologies · Recovery Audits: Improvements to Protect Taxpayer Dollars and Put Patients over Paperwork · New Part D Opioid Overutilization Policies: Myths and Facts · Open Payments: Review and Dispute Data by May 15 · SNF Provider Preview Reports: Review Your Data by May 30 · Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11 · Promoting Interoperability Programs: Submit Comments on Proposed Changes by June 24 · Part D Prescriber PUF and Opioid Prescribing Mapping Tools Updated with 2017 Data · Quality Payment Program Look Up Tool: Secure Access for APM Entities · National Women?s Health Week Kicks Off on Mother ?s Day Com plian ce

· Laboratory Blood Counts: Provider Compliance Tips Even t s

· DMEPOS Competitive Bidding: Round 2021 Webcast Series · Medicare Documentation Requirement Lookup Service Special Open Door Forum ? May 14 M LN M at t er s® Ar t icles

· AMCC Lab Panel Claims Payment System Logic · E/M Services of Teaching Physicians: Documentation · FISS: Updates for Pricing Drugs Depending on Provider Type · HH Patient-Driven Groupings Model Additional Manual Instructions · IPPS-Excluded Hospitals: System Changes · Medicare Physician Fee Schedule Database File Record Layout · Clinical Laboratory Fee Schedule: Quarterly Update · Medicare Physician Fee Schedule Database: Quarterly Update · Typhoon Yutu and Medicare Disaster Related Commonwealth of the Northern Mariana Islands Claims ? Revised · Implementation of the SNF Patient Driven Payment Model ? Revised

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PARA Weekly eJournal: May 15, 2019

WEEKLY IT UPDATE

PARA HealthCare Analytics has provided a list of enhancements and updates that our Information Technology (IT) team has made to the PARA Data Editor this past week.

The following tables includes which version of the PDE was updated, the location within the PDE, and a description of the enhancement.

Week ly IT Updat e

Prev ious Updates

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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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The link to this Med Learn MM11293

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There were 9 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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The link to this Transmittal R2305OTN

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The link to this Transmittal R2304OTN

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The link to this Transmittal R2302OTN

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The link to this Transmittal R2301OTN

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The link to this Transmittal R2300OTN

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The link to this Transmittal R123GI

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The link to this Transmittal R19PDB

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The link to this Transmittal R2303OTN

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The link to this Transmittal R2306OTN

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Con t act Ou r Team

Peter Ripper

M onica Lelevich

Randi Brantner

President

Director Audit Services

Director Financial Analytics

m lelevich@para-hcfs.com

rbrantner@para-hcfs.com

pripper@para-hcfs.com

Violet Archuleta-Chiu Senior Account Executive

Sandra LaPlace

Steve M aldonado

Account Executive

Director Marketing

slaplace@para-hcfs.com

smaldonado@para-hcfs.com

varchuleta@para-hcfs.com

Nikki Graves

Sonya Sestili

Deann M ay

Senior Revenue Cycle Consultant

Chargemaster Client Manager

Claim Review Specialist

ngraves@para-hcfs.com

ssestili@para-hcfs.com

dmay@para-hcfs.com

M ary M cDonnell

Patti Lew is

Director, PDE Training & Development

Director Business Operations

mmcdonnell@para-hcfs.com

plewis@para-hcfs.com

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PARA Weekly eJournal: May 15, 2019

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