PARA Weekly Update For Users May 30, 2018

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 May 30, 2018 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - IV Tubing - Moderate Sedation - G0444 Depression Screening - Updated - Emergency Physician At Clinic Location - ADLT Testing - COAPTITE 1ml Syringe - Bedside Procedures

5

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.

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

CMS RURAL HEALTH STRATEGY PROGRAM CMS "SHADOW" CLAIMS CMS PROPOSES FOUR RULES FOR FY19 RURAL HOSPITAL PROGRAM GRANTS AVAILABLE: - Healthy Eating Research - Vulnerable Rural Hospitals Assistance NEW FEATURE! MLNCONNECTS

PARA COMPANY NEWS

SERVICES

ABOUT PARA

CONTACT US

FAST LINKS

-

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 1-31 HIM /Coding Staff: Pages 1-31 Providers: Pages: 2,4,8,12,22,24 Surgical Services: Page 2 Critical Access Hospital: Page 5 Laboratory Services: Page 5 Emergency Services: Pages 4,7

3

- Finance Departments: Pages 12,17-18,23-25,29 - Rural Healthcare: Pages 8,19 - Behavioral Health: Pages 3,17 - DM E: Page 26 - Hospice Care: Page 18,20 - Anesthesia: 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 Update: May 30, 2018

IV TUBING

The Operating Room personnel is asking if they can charge for IV tubing. They have several different types and are charging for some of them. What are the guidelines for charging for IV tubing?

Answer: We do not recommend billing for IV tubing. We follow the principles set forth in the Medicare Provider Reimbursement Manual, as well as guidance published by a fiscal intermediary that specifically mentions IV tubing ? the full paper is attached, here is an excerpt:

We have found that third-party claims auditors will always deny supply charges for IV tubing.

MODERATE SEDATION In the past there were multiple procedures that included the Moderate (Conscious) Sedation. It was listed in the CPT® book under Appendix G. It gave a list of the procedures and if the CPT® included the conscious sedation. I can't locate this in the 2018 CPT® book. Can you please review the list and let me know if this is still accurate or has it become where you can bill (unbundle this)?

Answer: Appendix G has been deleted from the CPT®, this appendix had nothing which relates to hospital billing. If conscious or moderate sedation is provided, we recommend charge for the process. The AMA deleted Appendix G in 2017. Moderate Sedation is reported on professional fee claims for all CPT®s; in fact, it must be reported for professional fee providers to receive appropriate reimbursement.

Reimbursement was reduced for the CPT® codes which previously incorporated the work of moderate sedation into the CPT®.

PARA recommends that hospitals bill facility fee charges for anesthesia services without a HCPCS under revenue code 0370.

2

PARA Weekly Update: May 30, 2018

G0444 DEPRESSION SCREENING--UPDATED

With the proper documentation when a depression screening was performed with an E&M code, please advise on the appropriate CPTÂŽ and modifier coding based on this information.

Answer: Patient 1: The correct coding for this encounter would be 99395. The documentation shows that a PHQ9 was completed however the documentation does not include the time spent discussing the depression screening with the patient.

G0444 is a time based code for up to 15 minutes. For all timed codes, such as the G-codes you are evaluating, the documentation must report the time spent by the provider to support billing that code. More than half of the time (e.g., 8 minutes on a 15-minute code) must be documented in order to report the code. The time can be documented by a statement, e.g., ?I spent 9 minutes discussing the patient?s responses to the Depression Screening Questionnaire? ? it need not record an actual start and stop time.

Patient 2: The correct coding for this encounter would be G0438 (provided the patient has not had an annual wellness visit within the last 12 months). G0444 cannot be reported for this encounter since the documentation does not include the time spent discussing the PHQ9 with the patient.

The assessment and plan documents a neoplasm identified on the patient?s chest wall, however the documentation does not support billing a problem visit in addition to the G0438 since there is no physical exam documented nor is there any information in the HPI in regards to the neoplasm.

If the documentation supports billing G0444 and an Evaluation and Management Service on the same date of service, modifier 25 would need to be appended to the E&M. 3

PARA Weekly Update: May 30, 2018

EMERGENCY PHYSICIAN AT CLINIC LOCATION

Does it matter if a physician is an emergency physician and is not enrolled in Medicare in order to see patients in an Urgent Care or office?

Answer: If a physician sees patients in a clinic setting, whether billed POS 20 (Urgent Care) or POS 11 (Office), that physician must be enrolled with Medicare, Medicaid, and most other payers in order to be reimbursed for services paid by a health plan. It does not matter that the physician is an emergency physician, there is no exception under Medicare/Medicaid that allows emergency physicians to forego enrollment.

Some commercial insurance plans may be more permissive with coverage for an urgent care visit if the patient has no access to another physician in the insurer?s network. However, if POS 20 is reported together with the exact same organizational NPI and service location as the regular clinic, I would not expect commercial insurers to waive physician enrollment requirements.

Emergency physicians share the same ?specialty group? as family practice, pediatrics, and internal medicine physicians under Medicare?s taxonomy crosswalk at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/ Downloads/TaxonomyCrosswalk.pdf .

Therefore, if the patient is established with another clinic family practice, internal medicine, or pediatrics physician, the emergency physician will be required to report the ?established? office visit codes 99211-99215; the ?new patient? codes 99201-99215 would likely be denied. The emergency department visit codes 99281-99285 are not appropriate unless the services are rendered in a licensed emergency department setting.

It is always best to enroll physicians with Medicare, Medicaid, and the most common commercial insurance plans if the physician will be practicing under the clinic NPI at any location.

Please be careful not to abuse the locum tenens rule, which permits up to 30 days of practice by a substitute physician only.

4

PARA Weekly Update: May 30, 2018

ADLT TESTING

We are a Critical Access Hospital, and we read about the change in Medicare?s DOS policy for Advanced Diagnostic Laboratory Tests (ADLTs) effective 1/1/18 at the website below; does this mean that our hospital may no longer include ADLTs on our hospital claim? https://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/ClinicalLabFeeSched/Clinical-LabDOS-Policy.html Answer: Your understanding is correct -- for testing which meets the following criteria, only the ADLT reference laboratory may bill Medicare, the hospital should no longer include the ADLT test on its outpatient claim.

Hospitals may not bill Medicare for ADLTs performed by reference laboratories on specimens collected during an outpatient encounter which meet the following criteria: 1. The test is performed following a hospital outpatient?s discharge from the hospital outpatient department 2. The specimen was collected from a hospital outpatient during an encounter (as both are defined 42 CFR 410.2) 3. It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter 4. The results of the test do not guide treatment provided during the hospital outpatient encounter; and 5. The test was reasonable and medically necessary for the treatment of an illness Medicare made no exception for Critical Access Hospitals in the policy change, in part because the change was only partly driven by OPPS packaging rules. In fact, ADLT tests were not ?packaged? under OPPS payment methodology in most cases, but the previous DOS policy prohibited reference laboratories from billing when the test was performed within fourteen days of the outpatient encounter at which the specimen was collected.

Note that the criteria above do not apply to specimens collected during an inpatient encounter. The hospital must continue to include the cost of testing performed on specimens collected during an inpatient stay on the hospital?s inpatient claim. Medicare may consider changes to inpatient billing rules at a later date; for now, hospitals should continue as before in regard to ADLT tests performed on specimens collected during an inpatient stay.

Medicare made a change in policy for these outpatient tests for a variety of reasons. Under the previous DOS policy, the reference laboratory was prohibited from billing Medicare directly for ADLTs performed within fourteen days of the date a specimen collected during an outpatient hospital encounter. That DOS rule applied whether the hospital was an OPPS hospital or whether it was a CAH.

5

PARA Weekly Update: May 30, 2018

ADLT TESTING

Medicare determined that the administrative complexity of its previous laboratory DOS policy frequently led hospitals to delay ordering of ADLTs. Some of the problems Medicare has encountered regarding the old policy include: - Because ADLTs are performed by only a single laboratory and molecular pathology tests are often performed by only a few laboratories, and most hospitals do not have the technical ability to perform these complex tests, the hospital may be reluctant to bill Medicare for a test it would not typically (or never) perform. As a result, the hospital might delay ordering the test until at least fourteen days after the patient is discharged from the hospital outpatient department or even cancel the order to avoid the DOS policy, which may restrict a patient?s timely access to these tests. Note that this concern does not apply to Critical Access Hospitals.

- The previous laboratory DOS policy may have disproportionately limited access for Medicare beneficiaries under original Medicare fee-for-service (that is, Medicare Part A and Part B) because Medicare Advantage plans under Medicare Part C and other private payers allowed laboratories to bill directly for tests they perform.

In the 2018 OPPS Final Rule, there is a comment which speaks directly to whether hospitals have the option to continue to bill for ADLTs when the 5 criteria above are met: https://www.gpo.gov/fdsys/pkg/FR-2017-12-14/pdf/R1-2017-23932.pdf

A complete list of the ADLT HCPCS is available at the following link: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads /CLFS-Test-Codes-DOS-Exception.zip

COAPTITE 1 ML SYRINGE When I look up the manufacturer billing code for Coaptite 1 ml syringe coaptite injectable implant - Boston Scientific they give L8606. When I check PARA for the revenue code for L8606 you have 0274. Would I add this charge to the Hospital Chargemaster as 0274 or is it an implant 0278?

Answer: Thank you for bringing this typographical error in our crosswalk to our attention. We verified that revenue code 0278 is correct per the UB Manual.

We are working to have it corrected as soon as possible, and double-checking our rev code assignments for any other corrections.

6

PARA Weekly Update: May 30, 2018

BEDSIDE PROCEDURES

On page 16 of the Emergency Department Charge Process Paper, there are examples of separately billable and not separately billable nursing procedures.

1) Is there a similar list available for bedside procedures, and, 2) would that list be the same if the patient is Observation vs. Inpatient? Since we are CAH, we want to make sure we are capturing all charges for separately billable nursing procedures.

Answer: In the emergency department, the facility fee usually mirrors procedures performed by the emergency department physician, plus nursing procedures such as IV therapy.

However, nursing procedures which are separately billable in the outpatient emergency department setting are not necessarily separately billable bedside procedures for inpatients. The room rate for an inpatient reimburses the hospital for the services of all regularly-assigned unit nursing personnel, as described in PARA's paper entitled ?Bedside Procedures? is attached.

We recommend additional charges for bedside procedures on inpatients only if performed with resources which are drawn from other ?traveling? departments which are not accounted for in the room rate, such as surgery staff, respiratory therapists, or a PICC line team.

7

PARA Weekly Update: May 30, 2018

CMS RURAL HEALTH STRATEGY PROGRAM

n May 2018, The Centers For Medicare and Medicaid Services (CMS) launched a new program, the agency?s first Rural Health Strategy Program. The program is aimed at helping to improve access to high quality, affordable healthcare in rural communities across the United States.

The program ?puts patients first.?

Program summary: 1. Apply a rural lens to CMS program and policies 2. Improve access to care through provider engagement and support 3. Advance telehealth and telemedicine 4. Empower patients in rural communities to make decisions about their health care 5. Leverage partnerships to achieve the goals of the CMS Rural Health Strategy Program The strategy supports CMS?s overall effort to reduce provider burdens, and aligns with other CMS priorities, such as improving quality of care and focus on the opioid epidemic. Utilizing the implementation of the program strategy, CMS is aiming to promote policies that will help make health care in rural America accessible, affordable and accountable. https://www.cms.gov/Newsroom/ MediaReleaseDatabase/ Press-releases/2018-Pressreleases-items/ 2018-05-08.html The CMS Rural Health Council (RH Council) is composed of selected experts from across the Agency. Since its inception, the RH Council in CY 2016, the focus has been targeted to three (3) strategic areas: 1. Ensuring access to high-quality health care to all Americans in rural settings. Under this focus, the program will assist in maintaining security of health insurance coverage and accessibility of health insurance options provided under CMS?program. In this focus, CMS is giving people the tools they need to seek the best care for themselves and their families.

2. Addressing the unique economics of providing health care in rural America. By monitoring health care market impacts in rural areas, advising CMS on payments related to health care services rendered in rural areas, whenever possible, reduce regulations and requirements in rural areas, and encourage stakeholders to participate in the rule-making process.

3. Bringing the rural health care focus to CMS?health care delivery and payment reform initiative. The purpose to engage stakeholders and rural health care providers on delivery system reforms and innovation opportunities.

8

PARA Weekly Update: May 30, 2018

CMS RURAL HEALTH STRATEGY PROGRAM

Objectives: CMS Rural Health Strategy identified five specific objectives for the Agency to achieve in rural health. In addition to identifying these five specific objectives, CMS has developed supporting activities that are key to the objectives.

1. Apply a Rural Lens to CMS Programs and Policies: By understanding that CMS?s policies and programs may uniquely impact rural and other populations, at the same time CMS recognizes the need to consider policymaking, program design and strategic planning CMS Rural Health Strategy identified five specific through a ?rural lens?. objectives for the Agency to achieve in rural health.

CMS has already begun by taking steps to integrate consistent consideration of the rural health impact of policies under review and scrutiny. This process will allow CMS to identify areas where it can improve the needs of vulnerable populations and avoid unintended negative results of policy and programs.

Key Supporting Activities: - Participants are encouraged to utilize the ?Optimizing CMS Policies and Programs for Health Equity Checklist? to review policies, procedures and initiative for possible impacts on rural health insurance plans, providers and communities - Identify and encourage diffusion of evidence-based practices to improve access to services and providers located in rural areas and communities. Integration of rural health into quality improvement and innovation activities.

2. Improve Access to Care Through Provider Engagement and Support: The second of these five objectives, urges improvement to access of care with provider engagement and support. The focus is on the provider's scope of practice; providing technical assistance to providers; and identifying ways to eliminate patient barriers for obtaining medical care.

Key Supporting Activities: - Scope of Practice: This would allow options to increase the number of trained and licensed health care professionals to provide services in rural communities. These options could include evaluations for eligibility for certain designated provider types to practice up to the limit of their licensure to expand ranges of providers in rural areas eligible for payment.

Examples of these options that are being considered are: Chronic Care Management with Nurse Practitioners, Physician Assistants and Certified Registered Nurse Anesthetists - Meaningful Measures: It is being proposed in this program to implement a new approach to quality measurement that will focus on value rather than volume. In implementing this approach, it is intended to reduce reporting burdens for providers, specific to rural providers.

Recommendations are to review and revise the current quality measures across all CMS programs as to ensure measure sets currently in place are streamlined, outcomes-based, and meaningful to rural health providers and patients.

9

PARA Weekly Update: May 30, 2018

CMS RURAL HEALTH STRATEGY PROGRAM

- Technical Assistance: Provide technical assistance to providers to help them comply with policies and implement CMS policies and initiatives to develop or transform their practice.

Examples of this assistance would be Transforming Clinical Practice Initiative, Quality Payment Program, clarifying measure reporting to rural providers in support of quality improvement - Transportation: Review opportunities within existing CMS waivers that could expand coverage for certain transportation services; add and develop flexibilities for transportation; and telehealth services into the CMS Innovation Models 3. Advance Telehealth and Telemedicine: Telehealth has been shown to be a valuable benefit meeting the needs of the rural health care community. Under this program, CMS will try to promote the use of telehealth by reducing some of the barriers that have been identified in questions and answer sessions.

Some of the barriers identified: - Reimbursement - Cross-state licensure issues - Administrative and financial costs to implement Telehealth/Telemedicine Key Supporting Activities: - ¡Review options that will modernize and expand telehealth/telemedicine services utilizing the CMS Innovation model programs. For example: Next Generation Accountable Care Organization, Frontier Community Health Integration Project Demonstration or Bundled Payments Care Initiative advanced models.

4. Empower Patients in Rural Communities to Make Decisions About Their Health Care: One of the biggest barriers is patients not understanding of their health insurance coverage and navigating the health care system to get the care they need. In rural communities, this is particularly difficult due to the lack of specialty care access. CMS will leverage existing rural communication networks to provide patients and families with both the information and tools so they can actively engage in their health care and support.

Key Supporting Activities: - To assist rural patients to navigate the health care system, CMS will collaborate with rural communication networks to develop and easy-to-understand educational materials.

5. Leverage Partnerships to Achieve the Goals of the CMS Rural Health Strategy: The last of the five objectives being presented by CMS with this program was a result of the health care challenges in rural communities. This objective will focus on the importance of collaboration of partnerships on both federal, state, regional and local levels.

10

PARA Weekly Update: May 30, 2018

CMS RURAL HEALTH STRATEGY PROGRAM

Key Supporting Activities: - Consider expanding on opportunities with the Office of the National Coordinator for Health Information Technology as well as other federal partners to promote increased utilization of electronic health records for quality improvements in rural communities.

- With a coordinated effort with the Centers for Disease Control and Prevention, CMS hopes to increase the focus on maternal health, behavioral health, substance abuse and the integration of behavioral health and primary care services.

Rural Health Providers are being encouraged to become a participate with CMS in this program expansion and development. https://www.ruralhealthweb.org/

11

PARA Weekly Update: May 30, 2018

CMS "SHADOW" CLAIMS

eneficiaries who are enrolled in Medicare Advantage Plans (MA) are considered Medicare Part C recipients. MA plans are managed by private insurance companies, which cover medically-necessary services and charge different co-payments, co-insurance and deductibles than original Medicare. MA plans can be identified as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).

MA plans fall into two categories: - Restricted - identified on the Medicare Common Working File (CWF) as Option C - Unrestricted ? identified on the Medicare Common Working File (CWF) as Option 1 Each plan has its own requirements and policies for coverage. The major difference is the ability of the Medicare beneficiary to go ?outside? of the network for services, if policy requirements are met.

Providers are able to confirm the Medicare beneficiary eligibility to determine the type of plan they are enrolled in based on the option code:

Restricted plans (Option C), claims must be submitted by providers to the MA plan, with a few exceptions.

These exceptions are processed by original Medicare when the Medicare beneficiary is enrolled in an MA plan: - Services rendered while a Medicare beneficiary is enrolled in a Hospice election period - Routine costs of qualifying clinical trials (this will be detailed further in this article) 12

PARA Weekly Update: May 30, 2018

CMS "SHADOW" CLAIMS

Unrestricted plans (Option 1), claims are processed by original Medicare when submitted for reimbursement.

Responsibility for billing and reimbursement: If the facility is an inpatient acute-care hospital, inpatient rehabilitation facility, or a long-term care hospital, the payer at the time of the Medicare beneficiary's admission is responsible for the entire stay.

Example: If the beneficiary was not actively enrolled at the time of the admission but enrollment becomes effective while the beneficiary is an inpatient, Providers billing for an Investigational Device original Medicare is responsible for payment, Exemption (IDE) studies or Clinical Studies Approved not the MA plan.

Under Coverage with Evidence Development (CED), If the facility is exempt the MA is responsible and an informational only claim from the Prospective Payment System (PPS), should be submitted to Medicare. such as a children?s hospital, cancer hospital, psychiatric hospital / units or a Maryland waiver hospital then the facility will split the claim and bill each payer.

Hospitals and Skilled Nursing Facilities are required to submit a claim to Medicare for all Medicare beneficiaries, even if the stay is covered by an MA plan. Medicare will NOT make payment on these claims; the claim is informational only to link the spell of illness within the Medicare system.

Claims for the MA billing process: 1. The claim should be billed as a covered claim, including all routine data required on a Medicare covered stay 2. Type of bill (TOB) - Acceptable values in the third position of the TOB are 1, 2, 3, or 4 - TOB should NOT reflect a zero as the third digit 3. All days should be shown as covered 4. Claims should report condition code 04 (patient is a member of MA plan ? informational only) 5. All charges should be billed as covered unless the charges are for items routinely billed as non-covered (i.e.; patient convenience items) 6. Deductible and co-insurance information should be reported in the appropriate claim fields, if applicable 7. Payer information (field 50) (Line A on DDE) should be reported as Medicare 8. Payer code (Z in DDE) and report Medicare as primary payer 9. Insured information (field 58) (Line A on DDE) report the Medicare Beneficiary ID number and NOT the MA member number 10.Remarks are required: Medicare Advantage Paid Claim

13

PARA Weekly Update: May 30, 2018

CMS "SHADOW" CLAIMS

When Medicare receives the claim, the claims are edited against the CWF. If the CWF has the MA established, the claim will process with no Medicare reimbursement and the MA message will appear on the Medicare Remittance Advice.

It is important providers ensure Condition Code 04 is reported on the claim, otherwise, the claim will reject on adjudication.

As mentioned previously in this article, original Medicare will pay for covered clinical trial services furnished to beneficiaries enrolled in MA plans. The clinical trial coding and claim requirements for MA enrollees are the same as those for regular Medicare fee-for-service claims. Beneficiaries are not responsible for Part A and Part B deductibles.

Beneficiaries are responsible for remaining original Medicare co-insurance amounts applicable to services paid under Medicare fee for service rules. Providers must NOT bill for outpatient clinical trial services and non-clinical services on the same claim. If covered outpatient services are un-related to the clinical trials are rendered during the same day/stay, the provider must split as follows: - Clinical trial services are billed as fee-for-service - Outpatient services unrelated to the clinical trial are billed to the MA plan Providers billing for Investigational Device Exemption (IDE) studies or Clinical Studies Approved Under Coverage with Evidence Development (CED), the MA is responsible and an informational only claim should be submitted to Medicare.

Indirect Medical Education (IME) and Direct Graduate Medical Education (DGME) Billing for MA enrollees.

When a beneficiary is enrolled in an MA plan and is an inpatient at an approved teaching hospital, the facility receives a percentage add-on payment for each case paid under the PPS. This payment is an add-on payment to reflect the higher patient care costs of teaching hospitals.

When the beneficiary is enrolled in an MA, the facility submits the claim to original Medicare to receive payment for the IME or DGME payment since the MA is responsible for the regular services on the claim.

Indirect medical education billing (IME): Acute inpatient hospitals bill for the IME as follows: - Type of bill (TOB) 0111 - Condition code 04 (Patient is a member of an MA plan ? Informational only) and - Condition code 69 (Teaching hospital) - Payer code ?Z? (DDE) and list Medicare as the primary payer - Remarks (Box 80) are required ?Billing for IME payment?

14

PARA Weekly Update: May 30, 2018

CMS "SHADOW" CLAIMS

Direct Graduate Medical Education (DGME) Acute inpatient hospitals for Nursing and Allied Health Education, rehabilitation units and hospitals, psychiatric units and hospitals, long-term care hospitals, children?s hospitals and cancer hospitals, bill for DGME as follows: - Type of bill (TOB) 0110 - Condition code 04 (Patient is a member of an MA plan ?

Informational only) and - Condition code 69 (Teaching hospital) - Payer code ?Z? (DDE) and list Medicare as the primary payer - Remarks (Box 80) are required ?Billing for DGME payment?

- Payments for these bill types will be settled at the time of the cost report filing

15

PARA Weekly Update: May 30, 2018

CMS "SHADOW" CLAIMS

Reference: https://www.cms.gov/ Regulations-andGuidance/Guidance/ Manuals/Downloads/ mc86c04.pdf

16

PARA Weekly Update: May 30, 2018

CMS PROPOSES FOUR RULES AFFECTING FY19 PAYMENTS

The Centers For Medicare And Medicaid Services has proposed four new rules that will affect Fiscal Year 2019 Medicare payment policies and rates for a variety of programs. PARA brings you important links and information about each of these proposed rules.

Inpatient Psychiatric Facility: FY 2019 Payment & Quality Reporting Updates Comments accepted until June 26, 2018 CMS Fact Sheet (Click Here)

Skilled Nursing Facility: FY 2019 Payment & Quality Reporting Updates Comments accepted until June 26, 2018 CMS Fact Sheet (Click Here)

17

PARA Weekly Update: May 30, 2018

CMS PROPOSES FOUR RULES AFFECTING FY19 PAYMENTS

Inpatient Rehabilitation Facility: FY 2019 Payment & Quality Reporting Updates Comments accepted until June 26, 2018 CMS Fact Sheet (Click Here)

Hospice: Proposed Updates To The Wage Index And Payment Rates for FY 2019 Comments accepted until June 26, 2018 CMS Fact Sheet (Click Here)

18

PARA Weekly Update: May 30, 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.

Healthy Eating Research: Building Evidence To Promote Health And Well-Being Among Children - Provides approximately 8 small scale grants of up to $200,000 and 2 large scale grants of up to $500,000 to fund research on policy, systems and environmental strategies to promote the health and well-being of children.

- Letter of Intent, July 18, 2018; Application Deadline: September 26, 2018

Here's the link:

Vulnerable Rural Hospitals Assistance Program - The Vulnerable Rural Hospitals

Assistance Program will provide funding of up to $800,000 per year for a single entity to provide targeted in-depth assistance to vulnerable rural hospitals within communities that are struggling to maintain healthcare services.

- Application Deadline: June 16, 2018

Here's the link 19

PARA Weekly Update: May 30, 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!

Th u r sday, M ay 24, 2018 News & Announcements - MIPS Promoting Interoperability Performance Category - Provider Documentation Manual on Home Use of Oxygen: Submit Comments on Draft by May 31 - Proposals for New Measures for Promoting Interoperability Program: Deadline June 29 - Targeted Probe and Educate Video - Hospice Compare Quarterly Refresh - CQM Annual Update - Break Free from Osteoporosis Provider Compliance - Medicare Hospital Claims: Avoid Coding Errors ? Reminder Claims, Pricers & Codes - FY 2019 ICD-10-PCS Procedure Codes Upcoming Events - Hospice Quality Reporting Program Data Submission and Reporting Webinar ? May 30 - DMEPOS Dietary Related Items, Templates and CDEs Special Open Door Forum ? May 31 - Qualified Medicare Beneficiary Program Billing Requirements Call ? June 6 - MIPS Promoting Interoperability Performance Category Webinar ? June 12 Medicare Learning NetworkÂŽ Publications & Multimedia - RARC, CARC, MREP, and PC Print Update MLN Matters Article ? New - Implement Operating Rules - Phase III ERA EFT: CORE 360 Uniform Use of CARC, RARC and CAGC Rule - Update from CAQH CORE MLN Matters Article ? New - Removal of KH Modifier from Capped Rental Items MLN Matters Article ? Revised - Changes to the ESRD Claim to Accommodate Dialysis Furnished to Beneficiaries with AKI MLN Matters Article ? Revised - World of Medicare Web-Based Training Course ? Revised - Your Office in the World of Medicare Web-Based Training Course ? Revised - Your Institution in the World of Medicare Web-Based Training Course ? Revised View this edition as a PDF [PDF, 298KB] 20

PARA Weekly Update: May 30, 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.

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

21

PARA Weekly Update: May 30, 2018

The link to this Med Learn: MM10474

22

PARA Weekly Update: May 30, 2018

The link to this Med Learn: MM10667

23

PARA Weekly Update: May 30, 2018

The link to this Med Learn: MM10644

24

PARA Weekly Update: May 30, 2018

The link to this Med Learn: SE18006

25

PARA Weekly Update: May 30, 2018

The link to this Med Learn: MM10556

26

PARA Weekly Update: May 30, 2018

There were THREE 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

27

PARA Weekly Update: May 30, 2018

The link to this Transmittal R4062CP

28

PARA Weekly Update: May 30, 2018

The link to this Transmittal R2090OTN

29

PARA Weekly Update: May 30, 2018

The link to this Transmittal R4061CP

30

PARA Weekly Update: May 30, 2018

31