PARA HealthCare Analytics Weekly eJournal October 2, 2019 Grayscale Version

PARA

O ctober 2, 2019 an HFRI Company

HealthCare Analytics

Weekly

eJOURNAL

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Anesthesia Modifiers - Transesophageal Echocardiogram (TEE) - SnapVac - J0885 Inquiry

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Year-End HCPCS Process

2020 CODING UPDATE DOCUMENTS AHA COMMENTS ON OPPS AND ASC PROPOSED CHANGES

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UPDATED: PARA YEAR-END HCPCS UPDATE PROCESS APPEALING MEDICARE ADVANTAGE DENIALS

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

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The number of new or revised Transmittals released this week.

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BOOSTING CYBERSECURITY CONVERSATION STARTERS FOR PROVIDERS INTEROPERABILITY: 2020 CMS UPDATES

What every revenue cycle professional should know.

PARA COMPANY NEWS

SERVICES

ABOUT PARA

CONTACT US

FAST LINKS

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Speci al Pu l l ou t Sect i on

Administration: Pages 1-35 HIM /Coding Staff: Pages 1-35 Providers: Pages 2,3,9,16 Wound Care: Page 2 Finance: Pages 5,8,9,20 M edicare Enrollees: Page 11 Information Tech: Page 14

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Compliance: Pages 14,21 Inpatient Services: Page 21 Skilled Nursing: Pages 22 Clinical Labs: Pages 22,24 Pharmacy: Page 25 Psychiatric Care: Pages 28,30 Inpatient Services: Page 20

© PARA Healt h Car e An alyt ics an HFRI Company 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: October 2, 2019

ANESTHESIA MODIFIERS

Last year we had education on anesthesia charging. There were multiple discussions on this revolving around General, vs MAC and Conscious Sedation. During this discussion we also found that our facility could charge a technical fee for the anesthesia and we are capturing this and billing.

Now I have a question about the modifiers used for the pro-fees anesthesiologist and CRNA. The modifiers in question AA, AD, G8, G9 and GC. If someone has a MAC should the modifier G8 be added, for example P1, G8 QY. I do not recall a conversation regarding not using the G8 modifier, but if you could review the meeting highlights for us, it would be most appreciated.

Answer: The attached publication from the American Society of Anesthesiologists offers information regarding modifier use, including modifier G8. You will find that modifier G8 is an informational modifier, it simply provides information to the payer regarding how the service was rendered. It will not impact reimbursement.

If the anesthesia procedure is performed by MAC, it is appropriate to append the G8 modifier.

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PARA Weekly eJournal: October 2, 2019

TRANSESOPHAGEAL ECHOCARDIOGRAM (TEE) CHARGES

We had the question arise regarding transesophageal echocardiogram (TEE) charges.

We currently have TEE placement and TEE charges in our chargemaster. The revenue/credit for doing the test/procedure is currently going to the Cardiology department.

However, the Endoscopy and ICU departments are typically the ones doing these tests.

The majority of the resources being utilized (staff, supplies, etc.) are coming from the Endoscopy and ICU department. The cardiology department handles the acquisition and interpretation piece. Since the CPTÂŽ codes for these TEE (93312 and 93314) include all aspects, which departments should be getting the "credit"/revenue for doing these?

When we build charges in our chargemaster we have to choose the revenue department and as a rule this is the department utilizing the most resources to perform the test/procedure. What would PARA's recommendation be?

Answer: There is no easy way to share gross revenue for services which are reported under one CPTÂŽ code on an outpatient claim, but involve resources from two or more departments.

We agree with your internal policy that the department which contributes the greater portion of the resources should be credited for the revenue. If the full revenue for the procedure goes to the Endoscopy department, consider charging the cardiology department staff time to the endoscopy department through the hospital?s employee timekeeping system. That would facilitate a closer match of all costs to the revenue recorded exclusively in the endoscopy department.

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PARA Weekly eJournal: October 2, 2019

SNAPVAC

Our nurse practitioner in our wound care dept is seeing a 16 y/o male whom she transitioned from a regular wound vac (CPTÂŽ 97605) to a "snap vac" which is basically a smaller, more discrete wound vac that is not connected to power (97607).

He has Medicaid and Medicaid reimbursement for wound vacs is not very good. She is wondering if she could legally bill for an office visit based on time versus for the actual snap vac 97607. Please advise how this should be charged. At this time she entered an office visit of 99215 only.

Answer: Providers are required to report the code(s) that most accurately reflect the service provided. It is not appropriate to substitute a code in order to obtain better reimbursement when there is a code that more accurately describes the exact service rendered.

A claim which reports an E/M level which was not supported by the medical documentation, which documentation instead supports another lower-paying procedure code, would be considered a ?false claim?, in that the service billed does not match the documentation of the service provided. Needless to say, it is illegal to submit a false claim, which can trigger both civil and criminal penalties.

In our opinion, the documentation does not support a professional fee coded by 99215, as a considerable portion of the time spent in the application of the NPWT dressing. The total visit time, according to the documentation, was 45 minutes; since measuring the wound is considered part of the NPWT service, and the provider documented that it was a difficult wound to measure, we estimate the portion of time both in measuring and in applying the NPWT dressing consumed most of the 45 minutes. Therefore, the service is most accurately reported by 97607.

In fact, we are not entirely sure that a separate E/M should be reported at all. The documentation is unclear whether this visit was the first visit to this provider/clinic for wound care. If it was the initial visit to the hospital wound care clinic for this wound/problem, it would be appropriate to report a separate E/M visit (along with the 97607), as the patient is presenting with a new diagnosis. That being said, the documentation of the EM portion of care does not rise to the level of a 99215 ? we would more comfortable with 99213. Modifier 25 would be appended to the E/M code to indicate that it is separate and distinct from the procedure.

On the other hand, if the patient is returning to this clinic/provider as scheduled for a change of dressing, we find the documentation of the E/M to be solely in service to the application of the NPWT dressing, and should not be separately reported. Finally, we were unable to verify whether the documentation was signed, electronically or otherwise, by the provider. Unsigned documentation does not support either the 97607 or an E/M. Please verify that your system is recording the documenting provider?s signature.

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PARA Weekly eJournal: October 2, 2019

J0885 INQUIRY

We were wondering if there was any documentation out there regarding J0885. The J code be billed for a certain amount of time and without improvement by the patient then Medicare will stop paying.

Answer: HCPCS Code J0885 is for Epoetin Alfa, not related to ESRD use.

To access NCD and LCD articles in the PDE, you can simply search for the CPTÂŽ Code in question or use a Keyword and choose the Coverage Determination report. Any NCDs and LCDs associated with what you are searching for will be returned in your search results.

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PARA Weekly eJournal: October 2, 2019

J0885 INQUIRY

There is an NCD available specific to HCPCS code J0885 as well as multiple LCDs from different Medicare contractors, however, there are none currently active specific to J0885 for Noridian. Per the Noridian website, the active LCD for this HCPCS code was retired in January, 2018 at which time they deferred to the comprehensive NCD for coverage guidelines. The NCD is 110.21 titled Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions.

https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId =322&ncdver=1&NCAId=203&bc=AAAAAAAAQAAA&

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PARA Weekly eJournal: October 2, 2019

J0885 INQUIRY

As referenced above in the NCD, there are a number of coverage indications, dependent upon the patient's hemoglobin levels and response to the ESA treatment so there are limitations to how often the treatment can be billed if the patient is not responding to the initial dosing of the ESA. If you have received denials for the submission of J0885 on your claims, we would be happy to review if you would like us to take a look at them.

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PARA Weekly eJournal: October 2, 2019

2020 CODING UPDATE DOCUMENTS

In preparation for the year-end CPTÂŽ/HCPCS update, PARA has prepared a number of short, one to twopage ?2020 Coding Update? documents listing deleted codes and added codes within a particular clinical area or procedure group. More papers have been added during the month of October.

The coding topics addressed do not encompass all CPT updates, only those which are most likely to be ?hard-coded? to a line item in a facility chargemaster. Topics are divided into immediately related areas, and more than one paper may contain information useful to a service line manager.

Due to CPTÂŽ licensing restrictions, these documents cannot be published within the PARA Weekly eJournal. PARA Data Editor users may access the information on the Advisor tab; search ?Coding Update? in the type field, and/or 2020 in the subject field, as illustrated below:

It is important to note that we do not have Medicare coverage information on the new codes at this time.

Following the release of the OPPS Final Rule in November, coding update papers may be revised to indicate whether Medicare will accept/cover new HCPCS. PARA Data Editor users can identify updated papers by the word ?Revised? in the title and the date issued will be updated.

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PARA Weekly eJournal: October 2, 2019

AHA COMMENTS ON OPPS & ASC PROPOSED CHANGES

The American Hospital Association (AHA), representing over 5,000 member hospitals, health systems and other health care organizations, and clinician partners ? including more than 270,000 affiliated physicians, 2 million nurses and other caregivers ? and the 43,000 health care leaders who belong to our professional membership groups responds to proposed payment changes from the Centers For Medicare and Medicaid Services (CMS).

Read the full text of this important letter by clicking on the screen shot below:

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PARA Weekly eJournal: October 2, 2019

PARA YEAR-END HCPCS UPDATE PROCESS -- NEW UPDATES

As usual, PARA clients will be fully supported with information and assistance on the annual CPT速 HCPCS coding updates.

The PARA Data Editor (PDE) contains a copy of each client chargemaster; we use the powerful features of the PDE to identify any line item in the chargemaster which has a HCPCS code assigned that will be deleted as of January 1, 2020. For this reason, it is important that clients check to ensure that a recent copy of the chargemaster has been supplied to PARA for use in the year-end update.

PARA will produce excel spreadsheets of each CDM line item, as well as our recommendation for alternate codes, in three waves as information is released from the following sources: 1. The American Medical Association?s publication of new, changed, and deleted CPT速 codes; this information is released in September of each year. PARA will produce the first spreadsheet of CPT速 updates for client review in October, 2019.

2. Medicare?s 2019 OPPS Final Rule, typically published the first week of November; PARA will perform analysis and produce the second spreadsheet to include both the CPT速 information previously supplied, as well as alpha-numeric HCPCS updates (J-codes, G-codes, C-codes, etc.) from the Final Rule. Clients may expect this spreadsheet to be available in November, 2019.

3. Medicare?s 2018 Clinical Lab Fee Schedule (CLFS) ? typically published in late November, the CLFS will reveal whether Medicare will accept new CPT?s generated by the AMA, or whether Medicare will require another reporting method. The final spreadsheet will be available in December, 2019.

Clients will be notified by email as spreadsheets are produced and recorded on the PARA Data Editor ?Admin? tab, under the ?Docs? subtab. The spreadsheet will appear.

In addition, PARA consultants will publish concise papers on coding update topics in order to ensure that topical information is available in a manner that is organized and easy to understand. PARA clients may rest assured that they will have full support for year-end HCPCS coding updates to the chargemaster.

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PARA Weekly eJournal: October 2, 2019

APPEALING MEDICARE ADVANTAGE DENIALS

D

espite a high probability for success, just one percent of Medicare Advantage (MA) reimbursement and pre-authorization denials were appealed by providers and beneficiaries between 2014 and 2016, a recent federal report stated.

During that same time period, 75 percent of the denials that were appealed were overturned by payers themselves, according to a report produced by the U.S. Department of Health and Human Services?

Office of Inspector General (OIG) and released in September 2018. ?The high number of overturned denials raises concerns that some Medicare Advantage beneficiaries and providers were initially denied services and payments that should have been provided,? the report states.

To ensure providers receive every dollar they?re entitled to, hospitals and other organizations may wish to partner with a qualified accounts receivable (AR) recovery and resolution firm for assistance in pursuing the four-level MA appeal process.

Rapid gr ow t h of M A plan s MA plans have surged in popularity in recent years by offering relatively low-cost coverage that includes hospitalization and prescription drug benefits, as well as coverage options not provided with original Medicare, such as dental, fitness and vision.

About 34 percent of all Medicare beneficiaries, or about 20 million people, currently are enrolled in MA plans, nearly double the number enrolled 10 years ago, according to the Kaiser Family Foundation.[1] The Congressional Budget Office (CBO) projects that MA enrollment will exceed 40 percent of all Medicare beneficiaries by 2028.[2] At the state level, MA penetration currently is as high as 56 percent in Minnesota and 40 percent or more in five other states: California, Florida, Michigan, Pennsylvania and Oregon.[3] According to the OIG report, ?a central concern about the capitated payment model used in Medicare Advantage (also known as Medicare Part C) is the potential incentive for insurers to inappropriately deny access to services and payment in an attempt to increase their profits.?

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PARA Weekly eJournal: October 2, 2019

APPEALING MEDICARE ADVANTAGE DENIALS

Appeals con f u sion The OIG examined 448 million requests to payers made in 2016: 24 million pre-authorization requests and 424 million payment requests for service already provided. Of these, about one million pre-authorization requests and 36 million payment requests were denied, equating to denial rates of four percent and eight percent, respectively. ?Because Medicare Advantage covers so many beneficiaries (more than 20 million in 2018), even low rates of inappropriately denied services or payments can create significant problems for many Because Medicare Medicare beneficiaries and their providers,? the report Advantage covers so states. many beneficiaries, The report noted that while beneficiaries receive notice with denials that they have a right to appeal and request that the even low rates of denial be overturned, confusion often surrounds the process. inappropriately denied ?Although there are resources available to help beneficiaries navigate the appeals process, advocacy groups report that services or payments can the process is often confusing and overwhelming for beneficiaries, particularly those struggling with critical create significant medical issues,? the report states. problems.

Nor is it just beneficiaries that are evidently confused about appeals, given the low appeal rate by providers. The MA appeals procedure includes initial review by the managed care organization, then subsequent administrative reviews by independent review entities, administrative law judges and ultimately, the Medicare Appeals Council. ?When beneficiaries and providers chose not to appeal denials, the beneficiary may have gone without the requested service, the beneficiary may have paid for the service out of pocket, or the provider may not have been paid for the service,? the report notes.

Au dit s r aise r ed f lags Of the 75 percent of denials overturned on appeal between 2014-16, 82 percent were for services already delivered and 18 percent were for pre-authorizations, the report states. ?Although overturned denials do not necessarily mean that [Medicare Advantage organizations] inappropriately denied the initial request, each overturned denial represents a case in which beneficiaries or providers had to file an appeal to receive services or payment that are covered by Medicare,? the report states. ?This extra step creates friction in the program and may create an administrative burden for beneficiaries, providers and [Medicare Advantage organizations].?

The findings of the OIG report dovetail with results from the Center for Medicare and Medicaid Services?

(CMS) annual program audits of Medicare Advantage plans. In 2015, CMS cited 56 percent of 140 audited Medicare Advantage organizations for two types of violations related to inappropriate denials of preauthorizations and/or payments.

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PARA Weekly eJournal: October 2, 2019

APPEALING MEDICARE ADVANTAGE DENIALS

These included making the wrong clinical decision based on available information and/or not conducting appropriate outreach before making clinical decisions. Additionally, nearly half of audited Medicare Advantage contracts were cited for sending incorrect or incomplete denial letters, which may inhibit the ability of beneficiaries and providers to appeal.

The OIG report recommended increased oversight of Medicare Advantage contracts, particularly those with high overturn rates and/or low appeal rates. They also suggested that CMS address persistent problems related to inappropriate denials and insufficient denial letters. Finally, the OIG recommended providing beneficiaries with clear, easily accessible information about serious violations by Medicare Advantage organizations.

HFRI can h elp you appeal M A den ials Although MA policies are structured and marketed differently than original Medicare, they must still follow Medicare rules and guidelines when it comes to minimum benefits, medical necessity, denials and appeals. Monitoring payer performance and making sure these rules are followed is essential to ensure providers are fully and properly reimbursed for the services they provide.

Partnering with a firm that that understands the MA payment, denial and appeals process can be enormously beneficial, not only to help address denials when they occur but equally important, to analyze the entire coding, claims and billing cycle to prevent denials in the first place.

HFRI has determined that most MA denials stem from coding and billing-related problems, such as crosswalks that haven?t been set up correctly to bill the appropriate codes. Other factors that trigger denials include incorrectly loaded contract details and failure to pre-certify patients across the care continuum. Incorrectly classifying patients as original Medicare beneficiaries and not MA enrollees also is a common source of denials.

Because MA accounts frequently represent a significant portion of a hospital?s Medicare volume, it is important to partner with a vendor that not only understands MA denials but also can process high numbers of claims quickly and consistently. Healthcare Financial Resources (HFRI) can help you in these areas by providing denial management assistance as well assistance with all your AR recovery and resolution needs.

Contact HFRI today to learn more about how we can help you defeat denials.

[1] Gretchen Jacobson, et al, ?A Dozen Facts About Medicare Advantage,? Kaiser Family Foundation, Nov. 12, 2018 [2] Ibid.

[3] Ibid.

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PARA Weekly eJournal: October 2, 2019

BOOSTING CYBERSECURITY IN THE FACE OF A HACKING TIDAL WAVE

Despite widespread industry determination to bolster healthcare information security, the number of health data cyberbreaches continues to explode nationwide, causing chaos for providers and payers and putting millions of patients at risk for identity theft.

More than 25 million patient records have already been breached in 2019, up 66 percent from the 15 million records stolen through all of 2018, and up 400 percent from the 5 million records exposed in 2017.[1] The onslaught highlights the systemic vulnerability of the healthcare sector and reflects the value hackers place on patient information, which typically offers a trove of rich personal data for identity thieves.

Fighting on two fronts Experts say thwarting cyberattacks requires hospitals and physician groups to fight on two fronts: Internal systems and networks must be secured, and breaches initiated through connected third parties must be prevented. The latter threats can be extensive, due to providers?increased reliance on third parties for a wide range of support services.

Defending against third-party hazards also is problematic, since provider knowledge about the security of third- and even fourth- or fifth-party platforms is necessarily limited. Moreover, the ability to impose fixes typically is out of reach.

The good news is that momentum is building behind an industry-led effort aimed at creating the same level of security for information sharing in healthcare that has long existed across the payment processing industry.

Known as HITRUSTÂŽ, the initiative provides a risk management framework, standards and guidance for systematically securing information and sharing it in compliance with HIPAA and other applicable guidelines. In essence, HITRUST offers a detailed roadmap for achieving and maintaining compliance with over 40 authoritative sources, including HIPAA.

Weak links The avalanche of breach events so far in 2019 underscores just how vulnerable providers are to cyberattacks originating outside their walls. Three of the five largest healthcare breaches this year, in fact, involved third parties:[2] - A billing vendor, American Medical Collection Agency, was hacked for eight months straight between August 2018 and March 2019. Patient data from at least six covered entities was affected. So far, it is believed a least 25 million patient files were exposed, including approximately 12 million from lab giant Quest Diagnostics and 7.7 million from competitor LabCorp.

- Insurer Dominion National experienced ongoing hacking for nine years before the breach was spotted and sealed in April of this year. Data on an estimated 2.9 million patients was potentially exposed. A ransomware attack on Wolverine Solutions Group, a company providing multiple outsourced business services to healthcare companies, is believed to have compromised information on more than 600,000 patients. Many providers and payers in Michigan were especially hard hit.

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PARA Weekly eJournal: October 2, 2019

BOOSTING CYBERSECURITY IN THE FACE OF A HACKING TIDAL WAVE

HITRUST certification To limit third-party breaches, the HITRUST process focuses on the HITRUST CSF, which synthesizes multiple compliance standards and guidelines, including HIPAA, PCI, ISO/27001 and ISO/27002, and NIST SP 800-53.[3][4] In addition to strengthening vendor security, certification creates what is, in effect, a Good-Housekeeping-like seal of approval for vendors that allows them to quantify their security competencies to existing or potential customers.

The CSF addresses 19 different domains?from third party security and network protection to mobile device security?and requires readiness assessments against 135 specific controls.[5] HITRUST offers three progressive levels or degrees of assurance, from a HITRUST-issued CSF Self-Assessment Report to CSF-Validated and finally CSF-Certified. The latter may take up to three months to complete.[6] For vendors and providers, ensuring HITRUST certification represents a significant improvement over traditional, ?take your word for it? business agreements between vendors and covered entities that relied primarily on self-attesting compliance with HIPAA.[7]

An active defense Beyond requiring HITRUST certification from vendors as a condition for doing business, providers can also boost third-party security through efforts in four key areas, according to the Healthcare Information and Management Systems Society (HIMSS).

These include:[8] - Conducting thorough vendor due diligence - Classifying the level of risk associated with each vendor function and relationship - Ensuring ongoing communications with vendors about emerging security concerns - Exploring cyber-liability insurance to mitigate the cost of potential breaches

Practicing what you preach A leader in accounts receivable recovery and resolution, several of Healthcare Financial Resources (HFRI) key systems are HITRUST CSFÂŽ certified to help ensure the highest level of security for protected health information.

[1] Jessica Davis, ?The 10 Biggest Healthcare Data Breaches of 2019, So Far,? Health IT Security, July 23, 2019.

[2] Ibid.

[3] Travis Good, ?What is HITRUST?,? Datica.com, May 10, 2018.

[4] ?Comparing the CSF, ISO/IEC 27001 and NIST SP 800-53,? HITRUST. June 2014.

[5] Ibid.

[6] Ibid [7] Rob Pierce, ?What is HITRUST? A Practical Guide to Certification,? Linford & Company LLP, September 26, 2018.

[8] Ronald Hirsch, MD, ?Vendor Security Risk Management for Healthcare Organizations,? HIMSS Privacy and Security Committee Brief, 2015

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PARA Weekly eJournal: October 2, 2019

CONVERSATION STARTERS: ACUTE PAIN

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PARA Weekly eJournal: October 2, 2019

CONVERSATION STARTERS: CHRONIC PAIN

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PARA Weekly eJournal: October 2, 2019

CONVERSATION STARTERS: PRESCRIPTION OPIOIDS

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PARA Weekly eJournal: October 2, 2019

CONVERSATION STARTERS: REDUCING RISK

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PARA Weekly eJournal: October 2, 2019

IT'S HERE! GET YOURS TODAY

It's here. Thi s i s the defi ni ti ve gui de coveri ng the new and proposed rules and payment rates and schedules from CM S. In thi s speci al edi ti on of the PARA week ly eJournal, we bri ng together i nformati on every revenue cycle professi onal, healthcare provi der and fi nance executi ve needs to k now, all i n one place.

Click Her e For Th is Special Sect ion

If you haven't signed up to receive PARA HealthCare Analytics's free weekly eJournal, now's the time.

Click here https:/ / para-hcfs.com/ newsletter 20

PARA Weekly eJournal: October 2, 2019

2020 CMS UPDATES PROMOTE INTEROPERABILITY PROGRAM

Interoperability

The Final Rule for Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long-Term Care Hospitals was published by CMS on August 2, 2019. Within this rule, CMS continues advancement of its Promoting Interoperability Program (formerly known as Medicare and Medicaid EHR Incentive Programs). The intent of this program is to demonstrate meaningful use of certified EHR technology (CEHRT).

A link to the 2020 IPPS Final Rule is available on the Advisor tab of the PARA Data Editor. It can be found by entering 2020 in the Summary field.

CMS made the following program changes: - Finalized EHR reporting period to a minimum 90 consecutive days for new and returning participants - Changed the Query of Prescription Drug Monitoring Program (PDMP) from required to optional and available for five bonus points. This measure also changes from a numerator/denominator to a yes/no attestation for calendar year 2019 - Lines up the electronic Clinical Quality Measures (CQM) requirements with the Hospital Inpatient Quality Reporting Program (IQR) beginning calendar year 2021. This includes adding a new opioid-related quality measure Safe Use of Opioids Concurrent Prescribing CQM - Removes the Verify Opioid Treatment Agreement from the measures beginning calendar year 2020 - Continues the requirement that all eligible hospitals and CAHs use 2015 edition of certified electronic health record technology (CEHRT) - Requires certification of EHR technology for electronic clinical quality measures (eCQMs) reported in the calendar year 2020 reporting period - Requires hospitals submit one, self-selected calendar quarter of discharge data for four self-selected eQMs in the Hospital IQR Program measure set beginning calendar year 2020 21

PARA Weekly eJournal: October 2, 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, September 26, 2019 New s

· New Medicare Card: More Questions about Using the MBI? · Quality Payment Program: Submit Comments on 2020 Proposed Rule by September 27 · SNF PPS Patient Driven Payment Model: Get Ready for Implementation on October 1 · 2019 QRDA I Implementation Guide and Sample File for Hospital Quality Reporting: Updated · Post-Acute Care and Hospice Utilization and Payment Public Use Files · Clinical Diagnostic Laboratories: Resources about the Private Payor Rate-Based CLFS · Medicare Diabetes Prevention Program: Become a Medicare Enrolled Supplier · Hospice Quality Reporting Program Quarterly Updates · National Cholesterol Education Month and World Heart Day Com plian ce

· DME Proof of Delivery Documentation Requirements Claim s, Pr icer s & Codes

· Medicare Diabetes Prevention Program: Valid Claims Even t s

· IRF/LTCH: Reporting Health Care Personnel Influenza Vaccination Data Webinars ? October 1, 3, or 9 M LN M at t er s® Ar t icles

· Quarterly Update for the Temporary Gap Period of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2020

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PARA Weekly eJournal: October 2, 2019

There were THREE new or revised Med Learn (MLN Matters) article released this week.

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

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

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PARA Weekly eJournal: October 2, 2019

The link to this Med Learn MM11485

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PARA Weekly eJournal: October 2, 2019

The link to this Med Learn MM11495

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PARA Weekly eJournal: October 2, 2019

The link to this Med Learn MM10978

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PARA Weekly eJournal: October 2, 2019

There were SEVEN 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 eJournal: October 2, 2019

The link to this Transmittal R4406CP

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R905PI

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R4400CP

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R902PI

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R4404CP

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R904PI

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PARA Weekly eJournal: October 2, 2019

The link to this Transmittal R479PR1

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PARA Weekly eJournal: October 2, 2019

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

In t r odu cin g, ou r n ew par t n er .

Nikki Graves

Sonya Sestili

Deann M ay

Senior Revenue Cycle Consultant

Chargemaster Client Manager

h f r Review i.n et Claim 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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