PARA HealthCare Analytics Weekly eJournal September 9, 2020

September 9, 2020

PARA

WeeklyeJOURNAL NEWS FOR HEALTHCARE DECISION MAKERS

Therapist Services At Home Page

October 1, 2020 OPPS HCPCS Update

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SPECIAL NOTICE PAGE 46

- Sw in g Bed/ Sk illed St ay Du r in g COVID - 2021 DRG Table 5 Comparison - CM S Pr ovides HCPCS Pr ocedu r e List For M odif ier CS - COVID-19 Coding

FAST LINKS

Self Adm in ist er ed Dr u gs Page 7

Update As Of 9/1/2020 - COVID-19 Un in su r ed Gr ou p Applicat ion Por t al Sof t Lau n ch - CMS Proposes Prompt Coverage For "Breakthrough Devices"

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Administration: Pages 1-47 HIM /Coding Staff: Pages 1-47 Providers: Pages 7,10,12,19,21 Skilled Nursing: Pages 2,16 CAHs: Pages 2,16 Therapy Svcs: Pages 5,21 1 7 Emergency Svcs: Page

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Pharmacy: Pages 7,14,34,38 Compliance Pages 8,27 RHCs: Page 10 Laboratory: Page 13 COVID Coding Update: Page 16 California Providers: Page 17 Wound Care: Page 24

© 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: September 9, 2020

SWING BED/SKILLED STAY DURING COVID

We are currently allowed to bill Swing Bed Medicare without the prior 3-day IP Acute stay, due to COVID and guidelines set forth by our government.

I am inquiring outside of the 3-day stay and not having a prior medical necessity from IP to Swing Bed. What other qualifying factors do we need for medical necessity for our Swing Bed patients?

For instance, we had an 84-year old patient who came into the ER with broken ribs and punctured lung (no obstruction of breathing), she was then admitted into Observation. She did not qualify for an IP stay as her injuries were not severe enough and there was no obstruction of breathing from the punctured lung. Upon discharge, it was requested that she have someone help her at home, as she was not able to take care of herself and was still in pain. The other choice was to stay under Swing Bed. We were not aware of the changes with Medicare and billed private - however, if she qualifies based on the information I have, are we able to bill Medicare?

Answer: No, Medicare would not cover a swing bed stay as described in the example you provided because the care could have been provided in the home setting. One of the requirements for Medicare to cover a skilled-level of care is ?The daily skilled services must be ones that, as a practical matter, can only be provided in a SNF, on an inpatient basis?.

If the patient?s stay in a skilled nursing unit after an observation stay was arranged out of social necessity, not because the patient required skilled nursing care, then Medicare will not cover the service. Even during the COVID-19 crisis, a patient must meet the ?Skilled Nursing Facility Level of Care criteria? to qualify for Medicare coverage.

Here is an excerpt from the CMS publication ?COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers?, updated August 20, 2020: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

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PARA Weekly eJournal: September 9, 2020

SWING BED/SKILLED STAY DURING COVID

Expanded Ability for Hospitals to Offer Long-term Care Services (?Swing-Beds?) for Patients Who do not Require Acute Care but do Meet the Skilled Nursing Facility (SNF) Level of Care Criteria as Set Forth at 42 CFR 409.31.

Under section 1135(b)(1) of the Act, CMS is waiving the requirements at 42 CFR 482.58, ?Special Requirements for hospital providers of long-term care services (?swing-beds?)? subsections (a)(1)-(4) ?Eligibility?, to allow hospitals to establish SNF swing beds payable under the SNF prospective payment system (PPS) to provide additional options for hospitals with patients who no longer require acute care but are unable to find placement in a SNF. In order to qualify for this waiver, hospitals must: - Not use SNF swing beds for acute level care - Comply with all other hospital conditions of participation and those SNF provisions set out at 42 CFR 482.58(b) to the extent not waived - Be consistent with the state?s emergency preparedness or pandemic plan Hospitals must call the CMS Medicare Administrative Contractor (MAC) enrollment hotline to add swing bed services. The hospital must attest to CMS that: - They have made a good faith effort to exhaust all other options - There are no skilled nursing facilities within the hospital?s catchment area that under normal circumstances would have accepted SNF transfers, but are currently not willing to accept or able to take patients because of the COVID-19 public health emergency (PHE) - The hospital meets all waiver eligibility requirements; and, - They have a plan to discharge patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.This waiver applies to all Medicare enrolled hospitals, except psychiatric and long term care hospitals that need to provide post-hospital SNF level swing-bed services for non-acute care patients in hospitals, so long as the waiver is not inconsistent with the state?s emergency preparedness or pandemic plan.

The hospital shall not bill for SNF PPS payment using swing beds when patients require acute level care or continued acute care at any time while this waiver is in effect. This waiver is permissible for swing bed admissions during the COVID-19 PHE with an understanding that the hospital must have a plan to discharge swing bed patients as soon as practicable, when a SNF bed becomes available, or when the PHE ends, whichever is earlier.

The excerpts from the Code of Federal Regulations cited in the waiver (42 CFR 409.31) follow. ยง 409.31 Level of care requirement. (a) Definition. As used in this section, skilled nursing and skilled rehabilitation services means services that: (1) Are ordered by a physician; (2) Require the skills of technical or professional personnel such as registered nurses, licensed practical (vocational) nurses, physical therapists, occupational therapists, and speech pathologists or audiologists; and 3

PARA Weekly eJournal: September 9, 2020

SWING BED/SKILLED STAY DURING COVID

(3) Are furnished directly by, or under the supervision of, such personnel. (b) Specific conditions for meeting level of care requirements.

(1) The beneficiary must require skilled nursing or skilled rehabilitation services, or both, on a daily basis.

(2) Those services must be furnished for a condition (i) For which the beneficiary received inpatient hospital or inpatient CAH services; or (ii) Which arose while the beneficiary was receiving care in a SNF or swing-bed hospital for a condition for which he or she received inpatient hospital or inpatient CAH services; or (iii) For which, for an M + C enrollee described in ยง 409.20(c)(4), a physician has determined that a direct admission to a SNF without an inpatient hospital or inpatient CAH stay would be medically appropriate.

(3)The daily skilled services must be ones that, as a practical matter, can only be provided in a SNF, on an inpatient basis.

You may have heard about the waiver Medicare provided that permits coverage of patients who qualify for a skilled level of care, even if the skilled care does not follow a three-day inpatient stay (which would normally be a prerequisite of coverage.) Here?s and excerpt from the CMS ?Current Emergencies? webpage, document ?COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing? (question appears on pg. 107): https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf 4.Question: Does waiving (pursuant to section 1812(f) of the Act) the requirement for a 3-day prior hospitalization for coverage of a SNF stay apply to swing-bed services furnished by CAHs and rural (non-CAH) swing-bed hospitals?

Answer: Yes, under the section 1812(f) waiver, CAHs and rural (non-CAH) swing-bed hospitals may furnish extended care services to a SNF-level patient even if the patient has not had a 3-day prior hospitalization in that or any other facility.

The Social Security Act permits certain CAHs and rural (non-CAH) swing-bed hospitals to enter into a swing-bed agreement, under which the hospital can use its beds, as needed, to provide either acute or SNF care. Rural (non-CAH) hospitals are paid under the SNF PPS for their SNF-level swingbed services. By contrast, CAH swing-bed services are not subject to the SNF PPS. Instead, Medicare pays CAHs based on 101 percent of reasonable cost for their swing-bed services.

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PARA Weekly eJournal: September 9, 2020

THERAPIST SERVICES IN PATIENT'S HOME

With a patient who has a medical condition causing them to not be able to come to outpatient services, can the hosital based theraist go into the home to provide services until the patient is able to come to outpatient therapy at the hospital? If this can be done, how would it need to be billed? Can it be billed?

Answer: We recommend providing the therapy care over telecommunications technology, as we find Medicare has not addressed whether face-to-face care in the patient?s home is covered by the flexibilities provided by CMS during the COVID-19 National Health Emergency.

On its Current Emergencies website, Medicare has posted a FAQ document regarding the temporary waivers of certain requirements during the COVID-19 National Health Emergency. We find several entries which address whether a hospital can include the patient?s home as ?temporary expansion site? for delivering outpatient hospital services ? but the Q&As are focused on delivering services via telehealth or over telecommunications technology, not face-to-face at the patient?s home.

This makes sense because the flexibilities CMS provides are intended to facilitate rendering care while limiting exposure for either the patient or the provider.

Here is the most pertinent Q&A: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf Page 132: Question: How do hospitals bill for outpatient therapy services furnished by employed or contracted therapists using telecommunications technology on the UB-04 claim form during the COVID-19 PHE? Answer: There are two options available to hospitals and their therapists.1) A hospital could choose to bill for services furnished by employed/contracted PTs, OTs, or SLPs through telehealth, meaning that they would identify furnished services on the telehealth list

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PARA Weekly eJournal: September 9, 2020

THERAPIST SERVICES IN PATIENT'S HOME

https://www.cms.gov/Medicare/Medicare-GeneralInformation/Telehealth/Telehealth-Codes, they would bill these services on a UB-04 with a ?-95? modifier on each line for which the service was delivered via telehealth. No POS code is required (and there is no location for it on the UB-04).

2) A hospital could, instead, use the flexibilities available under the Hospital Without Walls initiative. The hospital would register the patient as a hospital outpatient, where the patient?s home acts as a provider-based department of the hospital. The hospital?s employed/contracted PT, OT, SLP would furnish the therapy care that the hospital believed could be furnished safely and effectively through telecommunications technology.

The hospital is not limited to services included on the telehealth list (since these would not be considered telehealth services), but must ensure the care can be fully furnished remotely using telecommunications technology. The hospital would bill as if the therapy had been furnished in the hospital and the applicable PO/PN modifier would apply for the patient?s home since it would be serving as an off-campus department of the hospital.

The option to bill for telehealth services, along with the -95 modifier, furnished by employed/contracted PTs, OTs, and SLPs using applicable audio-visual telecommunications technology applies to the following types of hospitals and institutions: - Hospital ? 12X or 13X (for hospital outpatient therapy services) - Skilled Nursing Facility (SNF) ? 22X or 23X (SNFs may, in some circumstances, furnish Part B PT/ OT/ SLP services to their own long-term residents) - Critical Access Hospital (CAH)? 85X (CAHs may separately provide and bill for PT, OT, and SLP services on 85X bill type) - Comprehensive Outpatient Rehabilitation Facility (CORF) ? 75X (CORFs provide ambulatory outpatient PT, OT, SLP services) - Outpatient Rehabilitation Facility (ORF) ? 74X (ORFs, also known as rehabilitation agencies, provide ambulatory outpatient PT and SLP, as well as OT services); and- Home Health Agency (HHA) ? 34X (agencies may separately provide and bill for outpatient PT/OT/SLP services to persons in their homes only if such patients are not under a home health plan of care)

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PARA Weekly eJournal: September 9, 2020

SELF-ADMINISTERED DRUG CHARGES

Our Emergency Department clerks have stated thay have never charged for insulin administration (IM, SQ, IVP, or Infusion) as they were told that this is to be treated as a self-administered drug. Can PARA please provide any feedback to whether this is best practice?

Answer: It stands to reason that if the drug itself is statutorily non-covered, charges for the administration of that excluded drug are also non-covered.

While neither the Medicare Benefits Policy Manual nor the Medicare Claims Processing Manual specifically exclude coverage of the administration charges when giving a self-administered drug (such as insulin) in the outpatient setting, we take a conservative approach. PARA recommends reporting the drug administration charges associated with a self-administered injectable/IV drug (i.e. injection or infusion administration charges) as non-covered on the facility claim.

Of course, the self-administered drug(s) should also be reported as non-covered charges.Unlike the self-administered drug itself, which are statutorily non-covered, drug administration charges for IV therapy and injections are usually covered by Medicare.

Consequently, if the hospital expects the Medicare beneficiary to pay for the administration of the SAD, it must first obtain an Advance Beneficiary Notice, which might be an EMTALA violation in an emergency room situation.

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PARA Weekly eJournal: September 9, 2020

2021 DRG TABLE 5 COMPARISON

In Sept em ber 2020, t h e Cen t er s f or M edicar e & M edicaid Ser vices (CM S) r eleased t h e 2021 DRG Table 5. This table lists the MS-DRGs, Relative Weight Factors and Geometric and Arithmetic Mean Lengths of Stay for 2021.

PARA has performed a comparison between the 2020 DRGs and the 2021 DRGs and found the following: For 2021, there were twelve DRGs added to the DRG Table 5.

M S-DRG

M S-DRG Descr ipt ion

018

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY

019

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

140

MAJOR HEAD AND NECK PROCEDURES WITH MCC

141

MAJOR HEAD AND NECK PROCEDURES WITH CC

142

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

143

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

144

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

145

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

521

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

522

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

650

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

651

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Also, six DRGs were removed from the DRG Table 5 for 2021: M S-DRG

M S-DRG Descr ipt ion

129

MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE

130

MAJOR HEAD & NECK PROCEDURES W/O CC/MCC

131

CRANIAL/FACIAL PROCEDURES W CC/MCC

132

CRANIAL/FACIAL PROCEDURES W/O CC/MCC

133

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC

134

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC

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PARA Weekly eJournal: September 9, 2020

2021 DRG TABLE 5 COMPARISON

The DRG Table 5 comparison is accessible on the Calculator tab of the PARA Data Editor.

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PARA Weekly eJournal: September 9, 2020

CMS PROVIDES HCPCS PROCEDURE LIST FOR MODIFIER CS

On August 27, 2020, CMS clarified the correct use of modifier CS by providing a list of HCPCS codes which are appropriate for waiving cost-sharing for physicians, hospitals, and RHCs/FQHCs when providing medically necessary COVID-19 related Medicare Part B services. CMS waives beneficiary coinsurance and deductible amounts for these services when Modifier CS is appended. CMS will return claims containing modifier CS on procedure codes which are not listed.

CMS provides separate lists of CS-eligible HCPCS code for three categories of medical providers: - Physicians/Non-physician Practitioners - Hospital OPPS Outpatient Departments - RHCs and FQHCs The document instructs Critical Access Hospitals to use the lists applicable to their billing method (Method I or Method II.) https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email -archive/2020-08-27-mlnc#_Toc49329805

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PARA Weekly eJournal: September 9, 2020

CMS PROVIDES HCPCS PROCEDURE LIST FOR MODIFIER CS

The CMS spreadsheet is available in the Advisor tab of the PARA Data Editor. Enter ?Cost? in the summary field for quick access:

CMS also revised its MLN on Medicare Fee-For-Service Response to the PHE on Coronavirus.

The update can be found using the link below: https://www.cms.gov/files/document/se20011.pdf

Additionally, CMS continues to update tje ?COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing? document posted on the CMS ?Current Emergencies? website. https://www.cms.gov/files/document/03092020 -covid-19-faqs-508.pdf

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PARA Weekly eJournal: September 9, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

CMS released documents with details of the October, 2020 OPPS Update and the Integrated Outpatient Code Editor update on August 28, 2020. PARA chargemaster clients will be notified by email prior to 10/1/2020 of any required chargemaster updates.

Links are provided on the last page of this paper.

Specifically, the OPPS updates to HCPCS codes include the following actions: - Reaffirms and updates COVID-19 Lab Testing HCPCS ? repeating previously established codes and adding new codes developed since the 7-1-2020 update - U0001 CDC 2019 Novel Coronavirus (2019-nCoV) RealTime RT-PCR Diagnostic Panel; Effective 2/4/2020, OPPS Status A - U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC;Effective 2/4/2020, OPPS Status A - 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique; Effective 3/13/2020, OPPS Status A - 86328 Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); Effective 4/10/2020; OPPS status A - 86408 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen; Effective 8/10/2020, OPPS status A - 86409 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer 08/10/2020 A N/A 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 04/10/2020 A N/A 87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzymelinked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]); Effective 6/25/2020, OPPS status A - U0003 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020- 01-R; Effective 4/14/2020, OPPS status A - U0004 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020- 01-R; Effective 4/14/2020, OPPS status A

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PARA Weekly eJournal: September 9, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

- 0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected 05/20/2020 A N/A 0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected; Effective 6/25/2020, OPPS status A - 0224U Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed; Effective 6/25/2020, OPPS Status A - 0225U Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected; Effective 8/10/2020, OPPS status A - 0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum ; Effective 8/10/2020, OPPS status A - G2023 Specimen collection for severe acute respiratory syndrome coronavirus ?2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source; Effective 3/1/2020, OPPS status B - G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source; Effective3/1/2020, OPPS status B - 0014M Liver disease, analysis of 3 biomarkers (hyaluronic acid [ha], procollagen iii amino terminal peptide [piiinp], tissue inhibitor of metalloproteinase 1 [timp-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years; Effective 4/1/2020, OPPS status Q4 - C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sarscov-2) (coronavirus disease [covid-19]), any specimen source; Effective 03/01/2020, OPPS status Q1 Adds three new surgical HCPCS Codes: - C9761 Describing Vacuum Aspiration of the Kidney, Collecting System and Urethra (OPPS status J1) - C9768 Describing Endoscopic Ultrasound-guided Direct Measurement of Hepatic Portosystemic Pressure Gradient (OPPS status N) - C9769 Describing Cystourethroscopy with Insertion of a Temporary Prostatic Implant or Stent with Anchor and Incisional Struts (OPPS status J1)

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PARA Weekly eJournal: September 9, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

Adds two new CPTÂŽ Administrative Codes for Multianalyte Assays with Algorithmic Analyses (MAAA), and assigns them OPPS status Q4 (payment often packaged) - 0015M Adrenal cortical tumor, biochemical assay of 25 steroid markers, utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other adrenal malignancy - 0016M - Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)

Establishes payment policy for 20 new CPTÂŽ Proprietary Laboratory Analyses (PLA) Codes (0203U through 0221U) Effective October 1, 2020 Adds 18 new HCPCS Codes and Dosage Descriptors for Certain Drugs, Biologicals, Radiopharmaceuticals, and skin substitutes - 8 new codes will be assigned Pass-Through Status (separately payable) - C9060 Fluoroestradiol F18, diagnostic, 1 mCi - C9062 Injection, daratumumab 10 mg and hyaluronidase-fihj - C9064 Mitomycin pyelocalyceal instillation, 1 mg - C9065 Injection, romidepsin, non-lypohilized (e.g. liquid), 1mg - C9066 Injection, sacituzumab govitecan-hziy, 10 mg - C9067 Gallium ga-68, dotatoc, diagnostic, 0.01 mCi - J7351 Injection, bimatoprost, intracameral implant, 1 microgram - J9227 Injection, isatuximab-irfc, 10 mg - 2 new drug HCPCS will be status E2, excluded ? but status may change next quarter - J1437 Injection, ferric derisomaltose, 10 mg - J9304 Injection, pemetrexed (PEMFEXY), 10 mg - 4 new HCPCS will replace drugs with temporary C-codes, all remain pass-thru status G: - J1632 Inj., brexanolone, 1 mg -- replaces C9055 - J1738 Inj. meloxicam 1 mg ? replaces C9059 - J3241 Inj. teprotumumab-trbw 10 mg ? replaces C9061 - J3032 Inj. eptinezumab-jjmr 1 mg ? replaces C9063 - 4 new skin substitute codes will be status N, payment packaged - Q4249 Amniply, for topical use only, per square centimeter - Q4250 AmnioAMP- MP, per square centimeter

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PARA Weekly eJournal: September 9, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

- Q4254 Novafix dl, per square centimeter - Q4255 Reguard, for topical use only, per square centimeter

Updates the status of three existing HCPCS Codes to Pass-Through Status - Q5112 Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg (prior status K) - Q5113 Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg (prior status K) - Q5121 Injection, infliximab-axxq, biosimilar, (avsola), 10 mg (prior status E2) Stops pass through status forQ5121(Infliximab-axxq, biosimilar (avsola) 10 mg., effective September 30, 2020 Revises the long descriptor forJ9305(injection pemetrexed, 10 mg) to ?Injection, pemetrexed, not otherwise specified, 10 mg?

Implements the regular quarterly update to drug payment rates which are based on the Average Sales Price, including some retroactive updates.

Reassigns 3 skin substitute HCPCS to the ?High Cost Skin Substitute Group? as of 10/1/20 ? this means that the corresponding skin substitute application code for these products must be reported using the 15271-15278 codes set for OPPS hospitals (if a low-cost skin substitute is reported, OPPS hospitals must use the C5271-C5278 application code set.)

- Q4205 Membrane graft or wrap sq cm - Q4226 Myown harv prep proc sq cm - Q4234 Xcellerate, per sq cm Full details of the update are available at the link below: https://www.cms.gov/files/document/r10331cp.pdf

Readers interested in additional updates to the Integrated Outpatient Code Editor, which includes ICD10 updates (among many other changes), should visit the following webpage: https://www.cms.gov/files/document/mm11944.pdf

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PARA Weekly eJournal: September 9, 2020

COVID-19 CODING UPDATE AS OF 9/1/2020

Preface PARA continues to update COVID-19 coding and billing information based on frequently changing guidelines regulations from CMS and payers. All coding must be supported by medical documentation.

ICD-10-CM Official Coding and Reporting Guidelines for Coronavirus, effective April 1, 2020 through September 30, 2020, may be downloaded from the link below: https://www.cms.gov/files/document/se20015.pdf

Download The Entire 20-Page Updated Document By Clicking The Icon To The Left.

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PARA Weekly eJournal: September 9, 2020

COVID-19 UNINSURED GROUP APPLICATION PORTAL SOFT LAUNCH

Effective August 28th, 2020 the California Department of Health Care Services (DHCS) launched the Coronavirus (COVID-19) Uninsured Group Application Portal in a soft launch format.This enables certain providers to submit applications for temporary coverage of low-income COVID-19 patients under Medi-Cal?s presumptive eligibility (PE) program.

The COVID-19 Uninsured Group program provides temporary, no-cost diagnostic testing, testing-related services and treatment services, including all medically necessary care. This includes associated office, clinic, or emergency room visits related to COVID-19.

This program is available to uninsured individuals determined eligible by a Qualified Provider (QP) based on preliminary applicant information. https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30339_85.aspx

The portal was created to provide access to the following providers who may not have access to the existing COVID-19 workaround to enter income requirements to submit a Presumptive Eligibility (PE) for COVID-19: - QPs of Presumptive Eligibility for Pregnant Women (PE4PW) - QPs for Breast and Cervical Cancer Treatment Program (BCCTP) - QPs for Hospital Presumptive Eligibility (HPE) program - QPs for Child Health & Disability Prevention Program (CHDP) These QPs (PE4PW, BCCTP, HPE, and CHDP) will have access to the COVID-19 Group Application Portal. The income requirements at this time are stated as $99,999 per month and a household size of 98 people. Participating QPs should use the new COVID-19 Uninsured Group Application Portal in the Transactions area located on the California Medi-Cal Website:

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PARA Weekly eJournal: September 9, 2020

COVID-19 UNINSURED GROUP APPLICATION PORTAL SOFT LAUNCH

If QPs are unable to access the new COVID-19 Uninsured Group Application Portal, providers are being asked to use the existing manual process to submit a presumptive eligibilityfor COVID-19 Application.

For further assistance on how to do this, please review the web link below: https://files.medi-cal.ca.gov/pubsdoco/newsroom/Step_by_Step_Guide_for_Qualified_Providers _30339_52.pdf

Link to updated FAQ for COVID-19 https://files.medi-cal.ca.gov/pubsdoco/COVID19_response/COVID19_UninsuredGroupProgram_FAQs.pdf

Questions can also be submitted via email to: COVID19APPS@dhcs.ca.gov 18

PARA Weekly eJournal: September 9, 2020

CMS PROPOSES PROMPT COVERAGE FOR "BREAKTHROUGH DEVICES"

SEVERAL

months ago, the Office of M anagement and Budget,

which is part of the Office of the President, began considering a policy which would require Medicare and other insurers to provide coverage for the FDA?s ?Breakthrough Medical Devices? for 3 to four years after receiving FDA approval. The experience during that 3 to 4 years would develop the rationale for continued support, or limitation, of coverage thereafter.

On Monday, August 31, 2020, CMS issued a Proposed Rule that would grant Medicare coverage to ?Breakthrough Devices? immediately upon the date of FDA market authorization, rather than waiting for the current National Coverage Determination process, which takes 9 to 12 months.

Under the proposed rule, Medicare coverage would be provided for four years after approval from the FDA, and would be consistent nationwide (rather than vary due to Local Coverage Determinations made by MACs.) Devices which received approval in 2019 and 2020 would be eligible for this special treatment.Public comments on the proposed rule will be accepted until November 2, 2020. Typically, CMS will issue a Final Rule 30 to 45 days following the end of the public comment period.

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PARA Weekly eJournal: September 9, 2020

CMS PROPOSES PROMPT COVERAGE FOR "BREAKTHROUGH DEVICES"

https://s3.amazonaws.com/ public-inspection.federal register.gov/2020-19289.pdf

The FDA?s Breakthrough Medical Devices program is intended to expedite the development and prioritize the review of certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.

The Breakthrough Devices Program is for medical devices and device-led combination products that meet two criteria: 1.The device provides for more effective treatment or diagnosis of life-threatening or irreversibly debilitating human disease or conditions 2.The device must satisfy one of the following elements: it represents a breakthrough technology; no approved or cleared alternatives exist; it offers significant advantages over existing approved or cleared alternatives, including additional considerations outlined in the statute; or device availability is in the best interest of patients At the end of the 4-year MCIT pathway, coverage of the breakthrough device would be subject to one of these possible outcomes: - NCD (affirmative coverage, which may include facility or patient criteria); - NCD (non-coverage); or - MAC discretion (claim-by-claim adjudication or LCD) CMS proposes that reimbursement for MCIT devices would follow the current reimbursement processes for New Technology.

- Under the Inpatient Prospective Payment System, the amount of additional reimbursement, above the DRG varies depending on the hospital?s cost to charge ratio and the DRG reimbursement.At most, the add-on would be one-half the cost of the MCIT device (for full details, see section 160 of Chapter 3 of the Medicare Claims Processing Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf#.)

- Under the Outpatient Prospective Payment System, HCPCS for New Technology items are paid under OPPS as pass-through status G, which utilizes the hospital?s cost-to-charge ratio applied to billed charges in calculating reimbursement.

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PARA Weekly eJournal: September 9, 2020

OTA AND COTA DESIGNATIONS

Wh at ar e t h e dist in ct ion s bet w een an OTA an d a COTA? Definition of an OTA vs a COTA: An OTA or COTA is the assistant to an Occupational Therapist. The C stands for certified and means the OTA has taken the additional steps in education in addition to holding their state license as an OTA. The OTA has become certified by the National Board of Certified Occupational Therapists (NBCOT).

This C distinction is similar to how an Occupational Therapist, or OT, is also recognized by OTR/L, indicating the therapist is Registered (R) and Licensed (L)."

OTAs are educated at an accredited OTA program and then take the necessary steps to obtain their state OTA license. A COTA professional takes one additional education step to obtain the NBCOT certification.

Where an OTA/COTA may work: Generally an OTA/COTA can be found working in: - Hospitals - Nursing care facilities - Patient?s homes - Schools K-12 - OT/PT Clinics - Traveling OTAs/COTAs who service patients all over an assigned territory at various locations The reason OTAs work in these places is that their patients are generally pediatric, geriatric, or someone with a debilitating health condition that requires day to day assistance.

What does an OTA/COTA do? An OTA/COTA works with the young, old, or disabled to assist them through their day to day activities. They perform activities or ?occupations? with their patients to help them maintain, develop, and progress fine motor skills or mental skills that the patient is lacking for any number of medical reasons. These reasons or problems may be physical, mental, developmental, or emotional depending on the work setting and specialization of the OTA/COTA. Common OT activities or ?occupations? that could be performed as part of a treatment plan by an OTA/COTA: - Assisting disabled children to fully participate socially and in their education at school - Assisting trauma or injury victim?s recovery by regaining their cognitive ability and other life skills - Assisting elderly that are experiencing various mental, physical, and various cognitive disabilities such as Alzheimer?s and Dementia - Evaluating a variety of unique patients and their families to help determine a plan with goals for Occupational Therapy Interventions - Implementation of their individual therapy plans to assist the patient to improve their ability to perform their daily activities and meet the suggested goals - Monitoring the outcomes and making adjustments to the therapy plan as needed to ensure suggest goals are met

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PARA Weekly eJournal: September 9, 2020

OTA AND COTA DESIGNATIONS Reimbursement of an OTA vs COTA: Currently in proposal (Bipartisan Budget Act 2018 (BBA2018) is a large bill that contains proposals to change the way services provided by an OTA/COTA are paid under Medicare Part B. The same proposals are applied to a physical therapy assistant (PTA) payment.

In this proposal, there is a long list of ?offsets?, or ways to pay for increases for rural health, hospitals, ambulance services, and other programs like federal health centers. Among this long list of ?offsets? are cuts to the home health payment system, which will also have an impact on occupational therapy.

In the first of two parts to the proposal, it requires that all occupational therapy or physical therapy claims indicate whether the provider was an OT or OTA, or PT or PTA, beginning in FY 2020. The modifiers that were established by CMS are CO and CQ.

In the second part, providers will see language that proposes to reduce payments for OTAs and PTAs for services provided under the Medicare Physician Fee Schedule (MPFS) to 85% or what is paid for services provided by a therapist (OT and PT) in FY 2022. This proposed reimbursement change will align to the current reimbursement for physician assistants (PAs) and nurse practitioners (NPs) which are reimbursed at 85% of what physicians are reimbursed.

Beginning in CY 2022, therapy services provided by an OTA/COTA will be reimbursed at 85% of the typical payment rate. However,this change does not impact when services are rendered in the following settings: - Part A Skilled Nursing Facility (SNF) stays - Home Health - Hospice - Inpatient rehabilitation hospitals - Other certified Medicare providers covered under Part A

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PARA Weekly eJournal: September 9, 2020

OTA AND COTA DESIGNATIONS Reference: https://www.congress.gov/bill/115th-congress/house-bill/1892

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PARA Weekly eJournal: September 9, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE Visit ? Evaluation and Management Levels Physician, Nursing and Rehab Therapists Procedures Hyperbaric Oxygen Therapy (HBO) Diagnostic testing Application of Skin Substitutes High Cost Skin Substitute HCPCS List ? as of October 1, 2020 Low Cost Skin Substitute HCPCS List ? as of October 1, 2020 Medications Medical supplies/Dressings Mechanically Powered Negative Pressure Wound Therapy Local Coverage Determinations Wound Care Coding Scenarios Scenario #1: An established patient presents with an open wound along an incision in the right lower extremity, and an open wound of the left lower extremity. Our usual weekly visit services include debridement of devitalized tissue to both sites, then application of Unna boots to both lower extremities.

Usually we would charge one selective debridement and one Unna boot.

Scenario #2: Patient presents with five wounds and sutures on the right lower extremity. The physician examines the patient and orders sutures to be removed, continue the Unna boots. Can we charge an E/M level 3 (follow-up, 2-5 wounds, suture removal =60 points) AND for 2 Unna boot applications?

Scenario 3: An established patient came in for her first wound care visit, referred by her family physician.The wound clinic RN assessed and called the physician for orders.The patient requires a Hoyer lift, therefore additional staff is required, and patient is unable to assist with undressing or dressing.Culture was obtained, pulses assessed -- care takes well over an hour, no procedure was performed.Are we limited to charge only a nursing visit E/M level 99211, or can we charge a higher level such as 99212-99215?

Scenario 4: We have been seeing a patient for debridement of lower extremity ulcers and application of Unna boots bilaterally.During the visit, the patient is measured for a pressure garment.The patient requires assistance in dressing, and additional staff to help transfer the patient to and from a wheelchair is required.Can we charge a level 3 E/M and the procedure code?

Scenario 5: We have been seeing a patient who presents with no new signs or symptoms; we performdebridement to wounds on the lower extremities and apply Unna boots bilaterally.Additional staff is required due to the emotional state of the patient.During the visit, the physician examines the patient and decides to do a puncture biopsy.Can we charge a level 2 E/M (99212) and the puncture biopsy as well as the debridement?

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PARA Weekly eJournal: September 9, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE

Visit ? Evalu at ion an d M an agem en t Levels E&M levels are divided into two types of patient, new and established.For facility fee billing, a new patient is one who has not been a patient at the facility within the last three years. There are five levels for both the new and established patient visits; for facility fee billing, the E/M level assignment is determined by hospital policy.

PARA recommends facility fee E/M level assignment in keeping with time spent in delivering face-to-face care. Although the level of E/M is important for commercial billing, Medicare requires OPPS facilities to report only one code regardless of the visit level, G0463.

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PARA Weekly eJournal: September 9, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE

Modifier 25: In general, an E&M level should not be charged if the visit is scheduled to perform a procedure.If there is a separate and distinct reason for an E&M service which is beyond the routine patient interaction required to properly perform a procedure, such as a new diagnosis or condition or a new wound, a separate E&M may be billed.If an E&M is billed on the same date as a procedure, modifier ?25 - separate and distinct? must be appended to the E&M code to qualify for payment.

Download The Entire 20-Page Updated Document By Clicking The Icon To The Right.

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PARA Weekly eJournal: September 9, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN CMS is delaying use of Advance Beneficiary Notice (ABN) Form, CMS-R-131 due to COVID-19 concerns.

The form may be implemented prior to the mandatory deadline, but CMS has extended the deadline from August 31, 2020 to January 1, 2021. The expiration date of the new form is 06/30/2023.

The updated ABN form, in both PDF and Microsoft Word versions with instructions in English and Spanish are available for download using the link below: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN

Chapter 30 of the Medicare Claims Processing Manual beginning Section 50.3 provides information and instructions on the requirements of completing and issuing an Advance Beneficiary Notice: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf

Providers must issue an ABN when a service to a Medicare beneficiary is expected to be denied.Medicare lists three ?triggering events? when ABNs are appropriate.

- Initiations: Noncovered or non reasonable and necessary services beginning a new treatment - Reductions: Medicare has determined a reduction in frequency of treatment is appropriate, but beneficiary chooses to continue with care at same rate or frequency higher than approved by Medicare, knowing that the care is no longer considered medically reasonable and necessary - Terminations: The beneficiary wants to continue with no longer medically reasonable and necessary services after meeting treatment goals

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PARA Weekly eJournal: September 9, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN

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PARA Weekly eJournal: September 9, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN

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PARA Weekly eJournal: September 9, 2020

COV ID-19 august , t w ent y-t w ent y

Special

publication

Questions about how to manage the COVID-19 emergency are multiplying almost as fast as the virus itself.

This Resource Guide is brought to you by PARA Healt hCare Analyt ics and Healt hcare Financial Resources (HFRI), the experts answer coding and financial questions.

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PARA Weekly eJournal: September 9, 2020

COVID-19 Resou r ce Gu ide Coronavirus

For healt h care facilit ies

When President Trump declared a national emergency on March 13, 2020,CMS took action nationwide to aggressively respond to Cororavirus.

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2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios (PDF)(4/13/20)

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Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs): FAQs, Considerations for Patient Triage, Placement, Limits to Visitation and Availability of 1135 waivers(4/8/20)

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Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Outpatient Settings: FAQs and Considerations(4/8/20)

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Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs)(4/8/20)

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Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19)UPDATED (4/8/20)

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- CMS Non-Emergent, Elective Medical Services, and Treatment Recommendations (PDF)(4/6/20)

Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Dialysis FacilitiesUPDATED (4/8/20)

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COVID-19 Long-Term Care Facility Guidance (PDF)(4/3/20)

- CMS Adult Elective Surgery and Procedures Recommendations (PDF)(3/19/20)

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Accelerated and Advanced Payments Fact Sheet (PDF)(3/28/2020)

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Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes-REVISED (PDF)(3/13/20)

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Guidance for Use of Certain Industrial Respirators by Health Care Personnel(3/10/20)

¡You can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF)UPDATED (4/9/20).

Secretary Azar used his authority in the Public Health Service Act to declare a public health emergency (PHE) in the entire United States on January 31, 2020 giving us the flexibility to support our beneficiaries, effective January 27, 2020 Get waiver & flexibilit y informat ion General informat ion & updat es: - Coronavirus.gov is the source for the latest information about COVID-19 prevention, symptoms, and answers to common questions.

- USA.gov has the latest information about what the U.S. Government is doing in response to COVID-19.

- ¡CDC.gov/coronavirus has the latest public health and safety information from CDC and for the overarching medical and health provider community on COVID-19.

Clinical & t echnical guidance: For all clinicians - CMS Dear Clinician Letter (PDF) (4/6/20) For all healt h care providers

- Fact sheet:Additional Background: Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge(3/30/20) - Guidance memo - Exceptions and Extensions for Quality Reporting and Value-based Purchasing Programs (PDF)(3/27/20)

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PARA Weekly eJournal: September 9, 2020

COVID-19 Resou r ce Gu ide - Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) by Hospice Agencies(3/9/20)

- Fact sheet:Medicare Telemedicine Healthcare Provider Fact Sheet(3/17/20) - Medicare Telehealth Frequently Asked Questions(3/17/20)

- Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge(3/4/20)

- MLN Matters article:Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (PDF)(3/17/20)

- Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCoV)(2/6/20)

- Frequently Asked Questions about Medicare Fee-for-Service Emergency-Related Policies and ProceduresW it hout an 1135 Waiver (PDF)(3/16/20)

For Labs - Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency (PDF)(3/27/20)

- Frequently Asked Questions about Medicare Fee-for-Service Emergency-Related Policies and ProceduresW it han 1135 Waiver (PDF)(3/16/20)

- Notification to Surveyors of the Authorization for Emergency Use of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel Assay and Guidance for Authorized Laboratories(2/6/20)

- Fact sheet:Medicare Administrative Contractor (MAC) COVID-19 Test Pricing (PDF)(3/13/20)

For Programs of All-Inclusive Care for t he Elderly (PACE) Organizat ions

- Fact sheet:Medicaid and CHIP Coverage and Payment Related to COVID-19 (PDF)(3/5/20)COVID-19: New ICD-10-CM Code and Interim Coding Guidance(2/20/20)

- Frequently Asked Questions from the PACE Community (PDF)(4/14/20) - Guidance for PACE Organizations Regarding Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) (PDF)(3/17/20)

For Healt h Care Facilit ies -

2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios (PDF)(4/13/20)

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Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs): FAQs, Considerations for Patient Triage, Placement, Limits to Visitation and Availability of 1135 waivers(4/8/20)

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Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Outpatient Settings: FAQs and Considerations(4/8/20)

Billing And Coding Guidance: - Frequently Asked Questions to Assist Medicare Providers (PDF)UPDATED (4/11/20) - CMS Dear Clinician Letter (PDF)(4/6/20) - Fact sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During COVID-19 Emergency (PDF)(3/30/20) - Fact sheet:Medicare Coverage and Payment Related to COVID-19 (PDF)UPDATED (3/23/20)

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PARA Weekly eJournal: September 9, 2020

COVID-19 Resou r ce Gu ide Survey And Cert ificat ion Guidance:

- FAQs on Essential Health Benefit Coverage and the Coronavirus (COVID-19) (PDF)(3/13/20)

- Clinical Laboratory Improvement Amendments (CLIA) Laboratory Guidance During COVID-19 Public Health Emergency(3/27/20)

- Guidance to help Medicare Advantage and Part D Plans Respond to COVID-19 (PDF)(3/10/20)

- Prioritization of Survey Activities(3/23/20)

- Fact sheet:Medicaid and CHIP Coverage and Payment Related to COVID-19 (PDF)(3/5/20)

- Frequently Asked Questions for State Survey Agency and Accrediting Organization Coronavirus Disease 2019 (COVID-19) (PDF)(3/10/20)

- Fact sheet:Individual and Small Group Market Insurance Coverage (PDF)(3/5/20)

- Frequently Asked Questions and Answers on EMTALA (PDF)(3/9/20)

Provider Enrollment Guidance: -

Guidance for Processing Attestations from Ambulatory Surgery Centers (ASCs) Temporarily Enrolling as Hospitals During the COVID-19 Public Health Emergency(4/3/20)

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Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)-UPDATED (3/30/20) (PDF)

- Suspension of Survey Activities(3/4/20) Coverage Guidance: - Frequently Asked Questions to Assist Medicare Providers (PDF)UPDATED (4/11/20) - VIDEO-MLN Medicare Coverage and Payment of Virtual Services(4/10/20)

Medicaid & CHIP Guidance: - Families First Coronavirus Response Act (FFCRA), Public Law No. 116-127 Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law No. 116-136 Frequently Asked Questions (FAQs)(4/15/20)

- CMS Dear Clinician Letter (PDF)(4/6/20) - Long-Term Care Nursing Homes Telehealth and Telemedicine Toolkit (PDF)(3/27/20)

- Federal Medical Percentage Map (FMAP)&Families First Coronavirus Response Act ? Increased FMAP FAQs3/27/20

- Fact sheet:Medicare Coverage and Payment Related to COVID-19 (PDF)UPDATED (3/23/20)

- State Medicaid Director Letter (SMDL) #20-002 with New Section 1115 Demonstration Opportunity to Aid States With Addressing the Public Health Emergency(3/22/20)

- General Telemedicine Toolkit (PDF)(3/20/20) - End-Stage Renal Disease (ESRD) Provider Telehealth and Telemedicine Toolkit (PDF)(3/20/20)

- Section 1135 Waiver Checklist (3/22/20)

- FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19) (PDF)(3/19/20)

- Section 1915 Waiver, Appendix K Template(3/22/20)

- Fact sheet:Medicare Telemedicine Healthcare Provider Fact Sheet(3/17/20)

- State Plan Flexibilities(3/22/20)

- Medicare Telehealth Frequently Asked Questions(3/17/20)

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PARA Weekly eJournal: September 9, 2020

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!

Th u r sday, Sept em ber 3, 2020 New s

·CMS Acts to Spur Innovation for America?s Seniors ·Hospital Opioid Toolkit ·CMS Offers Comprehensive Support for California due to Wildfires ·PEPPERs for Short-term Acute Care Hospitals ·Office Visits by Nurse Practitioners: Comparative Billing Report Even t s

·Dementia Care Call ? September 22 M LN M at t er s® Ar t icles

·2021 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments ·Annual Clotting Factor Furnishing Fee Update 2021 ·Claim Status Category and Claim Status Codes Update ·Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC) and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE ·Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Updates for Fiscal Year (FY) 2021 ·The Intravenous Immune Globulin (IVIG) Demonstration: Demonstration is ending on December 31, 2020 ·October 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.3 ·October Quarterly Update for 2020 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule ·Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment ? Revised

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PARA Weekly eJournal: September 9, 2020

There were FOUR new or revised MedLearns released this week.

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

4

FIND ALL THESE MEDLEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eJournal: September 9, 2020

The link to this MedLearn MM11945

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PARA Weekly eJournal: September 9, 2020

The link to this MedLearn MM11935

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PARA Weekly eJournal: September 9, 2020

The link to this MedLearn MM11932

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PARA Weekly eJournal: September 9, 2020

The link to this MedLearn MM11852

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PARA Weekly eJournal: September 9, 2020

There were FIVE new or revised Transmittals released this week.

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

5

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eJournal: September 9, 2020

The link to this Transmittal R10329CP

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PARA Weekly eJournal: September 9, 2020

The link to this Transmittal R10323CP

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PARA Weekly eJournal: September 9, 2020

The link to this Transmittal R10342MSP

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PARA Weekly eJournal: September 9, 2020

The link to this Transmittal R10343P

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PARA Weekly eJournal: September 9, 2020

The link to this Transmittal R10341CP

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PARA Weekly eJournal: September 9, 2020

Special Notice PDE Ch ar ge Qu ot e/ Sh ar e Of Cost Updat es In an ongoing effort to increase pricing transparency, PARA has made some upgrades to the Charge Quote/Share of Cost module within the PDE.In addition to increasing functionality in Medicare Critical Access Hospital settlement, quote creators now have more flexibility in choosing what prices appear within the quote itself.

With the increased transparency in price selection, some functionality has changed.Prices will no longer automatically load into the quote, unless the item is a single line item in the chargemaster. If there are multiple line items in the chargemaster with the same CPTÂŽ code, users will be presented with all line items for selection, instead of an average price being calculated.Users will be required to select a line item for the price to be added to the quote:

All Prices, revenue codes, department codes and usage quantity appear, allowing the creator to select the most appropriate item for addition to the quote.Client and Peer market averages are also still available, as is the multiple of Medicare option.Selection of packages and the Search function have not been affected.

If you have any questions or need assistance with any of the new functionality, please contact Mary McDonnell at (800) 999-3332 ext. 216 or mmcdonnell@para-hcfs.com.

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PARA Weekly eJournal: September 9, 2020 Get power on your side and maintain your cash flow.

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CONTACT OUR EXPERTS Violet -Archulet a-Chiu Senior Account Executive

Sandra LaPlace Account Executive

800.999.3332 X219

Randi Brant ner Vice President of Analytics 719.308.0883

varchuleta@para-hcfs.com 800.999.3332 X225 slaplace@para-hcfs.com

rbrantner@hfri.net

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