CorroHealth eJournal, October, 2023

ej o u r n a l October, 2023

Important UPdatesAcross theHealthcareIndustry

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PARA eJournal: October, 2023

ej o u r n a l Ple as e t ake n o t e .

O u r r e c u r r in g c o n t e n t w ill b e availab le t o c lie n t s w it hin t h e PAR A D at a Ed it o r p lat f o r m s t ar t in g in 2 0 24 .

Th e Novem ber an d Decem ber edit ion of t h e eJou r n al w ill ser ve as t h e f in al pu blicat ion s of t h e r ecu r r in g n ew slet t er .

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W O N Y L P AP 2

PARA eJournal: October, 2023

E/M CODING FOR ED AND HOSPITALIST VISITS

E/ M Coding for ED and Hospit alist Visit s

Qu est ion : Our facility is receiving edits and/or denials from Medicare when we attempt to submit professional fee Evaluation and Management (E/M) charges for both the Emergency Department (ED) physician and the hospitalist during the same encounter. How should we accurately report the services for both the physician and the hospitalist during the visit?

An sw er :

Chapter 12 of the Medicare Claims Processing Manual states that if more than one E/M service is provided for the same beneficiary on the same day by physicians who are in the same specialty and same medical group/same billing entity, only one service may be reported unless the E/M services are for unrelated problems. CMS recommends the physicians select a level of service that represents the combined visits and submit the appropriate level code for those services. This also applies when billing professional fees for E/M services rendered in the CAH setting and billed on an 851 TOB. If the physicians are in different specialties (but within the same group), they may bill and be paid separately for their services.

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PARA eJournal: October, 2023

E/M CODING FOR ED AND HOSPITALIST VISITS

The Medicare Provider and Supplier Taxonomy Crosswalk may assist in determining whether CMS considers the two physicians in question to be part of the same specialty. When a physician or provider applies for a NPI, they must select the taxonomy code that reflects their classification and specialization. If the two providers have taxonomy codes that fall into the same specialty code grouping, Medicare will consider them to be of the same specialty, and therefore will not separately reimburse each provider for their E/M services when performed on the same day.

Furthermore, the CPT® manual guidelines state:

?An initial hospital inpatient or observation care service may be reported when the patient has not received any professional services from the physician or other qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice during the stay.?

When the patient is admitted to the hospital as an inpatient or to observation status in the course of an encounter in other site of service (e.g., hospital emergency department, office, nursing facility), the services in the initial site may be separately reported. Modifier 25 may be added to the other evaluation and management service to indicate a significant, separately identifiable service by the same physician or other qualified healthcare professional was performed on the same date.?

Although the CPT® manual permits, Medicare and most commercial payors will not follow the AMA?s guidance that another E/M can be reported if in a different setting.

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PARA eJournal: October, 2023

E/M CODING FOR ED AND HOSPITALIST VISITS

A review of the NCCI edits for code pair 99223 (initial hospital care) and 99281 ? 99285 (emergency department visit) indicates these codes cannot be billed together on the same date of service by the same provider/group, even with modifier 25:

Additionally, when a CAH claim reports professional fees for more than one provider on the same outpatient claim, the provider information must be entered at the line item level of the charge; in electronic billing speak, that?s loop 2420C of the 837i.

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PARA eJournal: October, 2023

E/M CODING FOR ED AND HOSPITALIST VISITS

If the claim does not specify that charges from more than one provider are on the claim, Medicare?s claim processing system assumes the attending or referring provider listed at the claim level was the rendering provider for all professional fees on the same claim. Since the ?rendering? information was not completed at the line item level, Medicare processed the claim as if both E/Ms were billed by the same provider, even though the revenue codes reporting those professional fees differed.

Here is an excerpt from Noridian?s CAH Billing Guide website that affirms this requirement: https://med.noridianmedicare.com/web/jfa/provider-types/cah/outpatient-cah-billingguide

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PARA eJournal: October, 2023

Hospit als Acr oss Th e Cou n t r y Depen d On Cor r oHealt h To Deliver Resu lt s.

Contact the expert in your state and discover the difference CorroHealth can make on your bottom line.

Ar e You You Con f iden t Wit h You r Over all Com plian ce Wit h Pr ice Tr an spar en cy An d NSA?

Our PRICE TRANSPARENCY & NSA SOLUTIONS - Easy-t o-u se On lin e Pat ien t Pr ice Est im at or - Gen er at e Qu ick An d Com plian t Good Fait h Est im at es (GFEs) - Exper ien ce St r eam lin ed Com m u n icat ion s To Applicable Co-Pr ovider s

If not, we can help.

Ou r Com pr eh en sive Pr ice Tr an spar en cy An d No Su r pr ises Act Solu t ion s Can M ak e A Dif f er en ce.

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PARA eJournal: October, 2023

MLN CONNECTS

Cor r oHealt h in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e! Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces.

Click each lin k f or t h e PDF!

Th u r sday, Oct ober 5, 2023 New s -

Administration Moves Forward with Medicare Drug Price Negotiations to Lower Prescription Drug Costs for People with Medicare CMS Requests Public Input on Coverage of Over-the-Counter Preventive Services, Including Contraception, Tobacco Cessation, and Breastfeeding Supplies Action Plan for Sickle Cell Disease Month CMS Burden Reduction News & Insights Fall Newsletter New COVID-19 Treatments Add-On Payment Ended September 30 Clinical Laboratory Fee Schedule: Submit Your Comments DMEPOS: New Provider Enrollment Appeals & Rebuttals Contractor Starts October 9 Help Detect Breast Cancer Early

Claim s, Pr icer s, & Codes -

RARCs, CARCs, Medicare Remit Easy Print, & PC Print: October Update

Pu blicat ion s -

Medicare Provider Compliance Newsletter

M u lt im edia - Post-Acute Care Quality Reporting Programs: Brief Interview for Mental Status Video

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PARA eJournal: October, 2023

MLN CONNECTS

Cor r oHealt h in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e! Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces.

Click each lin k f or t h e PDF!

Fr iday, Oct ober 6, 2023 News COVID-19: Updat ed Novavax COVID-19 Vaccin e, Adju van t edf or Pat ien t s 12 & Older

On October 3, the FDA amended the emergency use authorization of the Novavax COVID-19 vaccine, Adjuvanted to include the 2023?2024 formula. This updated, monovalent vaccine: -

Addresses currently circulating variants to provide better protection against serious consequences of COVID-19, including hospitalization and death Includes the spike protein from the SARS-CoV-2 omicron variant lineage XBB.1.5

Updat ed paym en t allow an ceef f ect ive Oct ober 3, 2023: CMS updated the national payment allowance to $148.20 for CPT code 91304 ? Novavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older).

The federal government isn?t purchasing these products. Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy.

Use CPT code 90480 to bill for the administration of the vaccine. Get the most current list of billing codes, including short descriptors, payment allowances, and effective dates.

M edicar e n o lon ger pays f or CPT codes 0041A, 0042A, an d 0044A ef f ect ive Oct ober 3, 2023.

Visit the COVID-19 Vaccine Provider Toolkit for more information. Note: You may need to refresh your browser if you recently visited this webpage.

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PARA eJournal: October, 2023

MLN CONNECTS

Cor r oHealt h in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e! Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces.

Click each lin k f or t h e PDF!

Th u r sday, Oct ober 12, 2023 New s -

CMS Roundup (Oct 6, 2023) Protect Your Patients: Give Them a Flu Shot

Pu blicat ion s -

Direct Data Entry: 10-Digit Screen Expansion Medicare Preventive Services ? Revised Medicare Provider Compliance Tips ? Revised

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PARA eJournal: October, 2023

MLN CONNECTS

Cor r oHealt h in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e! Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces.

Click each lin k f or t h e PDF!

Th u r sday, Oct ober 19, 2023 New s -

2024 Medicare Parts A & B Premiums and Deductibles Help CMS Improve Provider Resources ? Respond by November 9 CMS Health Information Handler Helps You Submit Medical Review Documentation Electronically Health Literacy: Help Your Patients Get Information & Services

Claim s, Pr icer s, & Codes -

Discarded Drugs & Biologicals: When to Use JW & JZ Modifiers

Even t s -

Provider Compliance Focus Group Meeting ? November 2 Expanded Home Health Value-Based Purchasing Model: Preparing for CYs 2024 & 2025 Webinar ? November 9

M LN M at t er s® Ar t icles -

Update for Blood Clotting Factor Add-on Payments

Pu blicat ion s -

Complying with Medical Record Documentation Requirements ? Revised Expanded Home Health Value-Based Purchasing Model Resource Index ? Updated

Fr om Ou r Feder al Par t n er s -

Health Care Preparedness Resources

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PARA eJournal: October, 2023

MLN CONNECTS

Cor r oHealt h in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e! Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces.

Click each lin k f or t h e PDF!

Th u r sday, Oct ober 26, 2023 New s -

Help CMS Improve Provider Resources ? Respond by November 9 CMS Roundup (Oct 20, 2023) Nursing Facility Evaluation and Management Visits: Comparative Billing Report in October

Claim s, Pr icer s, & Codes -

Conditional Payment Claims: Continue to Submit to Your Medicare Administrative Contractor Home Health Consolidated Billing Enforcement: CY 2024 HCPCS Code HCPCS Application Summaries & Coding Decisions: Drugs & Biologicals

Even t s -

Inpatient Rehabilitation Facility Prospective Payment System: Coverage Requirements Webinar ? November 29

M LN M at t er s® Ar t icles -

Medicare Deductible, Coinsurance, & Premium Rates: CY 2024 Update Processing Claims Affected by Retroactive Entitlement

Pu blicat ion s -

Medicare Secondary Payer: Don?t Deny Services & Bill Correctly ? Revised

In f or m at ion f or Pat ien t s -

2024 Medicare & You Handbook 12

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FOR YOUR INFORMATION

The preceding materials are for instructional purposes only. The information is presented "as-is" and to the best of CorroHealth's knowledge is accurate at the time of distribution. However, due to the ever-changing legal/regulatory landscape, this information is subject to modification as statutes, laws, regulations, and/or other updates become available. Nothing herein constitutes, is intended to constitute, or should be relied on as legal advice. CorroHealth expressly disclaims any responsibility for any direct or consequential damages related in any way to anything contained in the materials, which are provided on an "as-is" basis and should be independently verified before being applied. You expressly accept and agree to this absolute and unqualified disclaimer of liability. The information in this document is confidential and proprietary to CorroHealth and is intended only for the named recipient. No part of this document may be reproduced or distributed without express permission. Permission to reproduce or transmit in any form or by any means electronic or mechanical, including presenting, photocopying, recording, and broadcasting, or by any information storage and retrieval system must be obtained in writing from CorroHealth. Request for permission should be directed to Info@Corrohealth.com.

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