PARA HealthCare Analytics Weekly eJournal July 22, 2010

July 22, 2020

PARA

WeeklyeJOURNAL NEWS FOR HEALTHCARE DECISION MAKERS

The Clock Is Ticking on Price Transparency Page

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Goin g Som ew h er e?

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Aor t ogr am Angioplasty With Fistula No Cost Dr u gs PARA Coronavirus Coding Update 7-21-20 - OIG Au dit s Ou t lier s - Sinuva Nasal Implant Coding Update

FAST LINKS

- New Except ion s To RHC Pr odu ct ivit y - Revised Advance Beneficiary Notice Form - Hom e In f u sion Th er apy - Rural Healthcare

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Administration: Pages 1-48 HIM /Coding Staff: Pages 1-48 Providers: Pages 2,3,5,9,18,25 Cardiology: Pages 2,3 Travel M edicine: Page 4 Pharmacy: Pages 5,25,40,47 Oncology: Page 5 1

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Compliance: Pages 7,16,22,32 Outpatient Svcs: Pages 8,39 COVID-19 Resource: Page 33 COVID-19 Coding: Page 9 ENT: Page 18 Rural Health: Pages 19,31 Laboratory: Page 37

© 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: July 22, 2020

AORTOGRAM

What are the appropriate code(s) for a selective angiogram with aortogram? We are considering 76937, 75625 - XU, 75710 - XU, 36247, 75774 vs 36200, 36140.

Answer: Report CPT® codes 36247, 75625, 75710 and 76937. The documentation indicates placement in the initial third order, which includes more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family. Therefore, CPT® code 36247 is supported.

CPT® code 36200 and 36140 should not be reported since they do not describe 3rd order selections. CPT® code 36140 is for a direct puncture and 36200 is for a nonselective catheterization. Dr Z's Interventional Radiology Code Book pages 85-96 states, ?Nonselective catheterizations are not reported when the higher selectivity is documented?.

The documentation supports unilateral extremity angiography (75710) and abdominal aortography (75625). The documentation does not support a CPT® code 75774. Do not use code 75774 for additional veins selectively studied after basic examination.

Use this code only when there is true need for additional diagnostic imaging after the basic/primary study. Dr Z's Interventional Radiology Code Book pages 85-96 states, ?Physician documentation should clearly state the medical necessity for this additional selective imaging.? Please refer to the PARA Data Editor code descriptions.

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PARA Weekly eJournal: July 22, 2020

ANGIOPLASTY WITH FISTULA

What is the appropriate code(s) for an arterial angioplasty with angioplasty of fistula? We are considering 36902 - XU, 36140 - XU, 37246.

Answer: Report CPT® codes 36902, 37246 and 36140-XU. The documentation indicated the fistula was accessed via puncture at the wrist radial artery site, with fistulogram and angiogram performed at this site.

The angioplasty of the radial artery is reported with CPT® code 37246, as this is not part of the fistula. The procedure note states that the "brachial artery" was treated, however this is the site of the stenosis of the radial artery that was angioplastied.

The site of the access for the angioplasty work was the radial artery, rather than a direct puncture of the arteriovenous fistula itself. CPT® code 36140 best describes this access, as no other selective catheterization, other than the fistula itself, was performed. AMA CPT® Assistant, June 2009 Page: 10 advises code 36140 for retrograde introduction of a needle or intracatheter into an extremity artery for injection purposes. The fistulogram is reported with CPT® code 36902. Please refer to the PARA Data Editor code descriptions and AMA CPT® Assistant june 2009.

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PARA Weekly eJournal: July 22, 2020

TRAVEL VACCINES

For ten years we partnered with a traveling clinic vendor and they are now going to stop the service. Can you provide us with guidelines and billing information for travel clinics?

Answer: The Centers for Disease Control and Prevention (CDC) provides many resources for travel vaccines. They separate vaccines into routine (all travelers), required (most travelers), and recommended (some travelers), dependent on which country/countries will be visited.

The CDC recommends patients receive vaccinations no closer than two weeks before travel to allow most vaccinations to be in full effect. However, a traveler should be vaccinated four to six weeks before departure when some vaccines are necessary (such as hepatitis A and typhoid). https://wwwnc.cdc.gov/travel/page/travel-vaccines

The CDC website also links to Massachusetts General Hospital ?Global TravEpiNet? which is designed for providers to prepare a US traveling patient with the most up-to-date travel information. The provider completes a questionnaire on the patient. Then, the site returns a customized clinical guidance listing recommended vaccines and travel advice for the traveler. https://gten.travel/prep/prep

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PARA Weekly eJournal: July 22, 2020

TRAVEL VACCINES

Medicare Part D covers most immunizations and vaccines. Medicare covers some vaccinations under Part B (i.e., pneumonia, hepatitis B, and influenza). However, private health insurances do not cover quite a few recommended travel vaccinations, so a traveler should be expected to pay out of pocket. The CDC lists which vaccines health insurance typically covers, but the traveler needs to check with his or her plan to verify coverage. https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html A bit of research on traveling clinics found that several require an initial consultation fee (typically $75 to $100) at the time of service. The traveler should bring to the consultation his/her immunization records, travel itinerary, and a list of the names and doses of medications. Many clinics bill the insurance first then bill the traveler for uncovered vaccines. However, we also found many clinics that required payment in full at the time of vaccinations. Some of the clinics provide their costs on their websites. We would recommend the clinic provide an ABN for Medicare beneficiaries.

Included is PARA's paper on coding vaccines that should be helpful as you implement your clinic.

In addition to the vaccines, most travel clinics offer specific travel advice based on the country the traveler is visiting. This additional information may include water safety, sea/air sickness, insect precautions.

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PARA Weekly eJournal: July 22, 2020

NO-COST DRUGS

At our cancer center there are patients who receive assistance with some of the chemo drugs. The drugs are no cost to the hospital, but we need them to go on the claim. The pharmacy has some sort of pricing schedule in their system that will apply a $0.10 charge for these types of situations.

It can be on any drug that is at no cost to the hospital or patient. The billing office stated that we should be apply an FB modifier for Medicare in this situation to tell Medicare that the drugs are at no cost, but that they are on the claim with a $0.10 charge. We hae to have some minimal dollar amount for the charge to hit the claim. Is an FB modifier correct to append to these drug charges? If not, what is the correct one to use?

Answer: Attached is PARA's paper which discusses billing for brown bag/white bag drugs. Reporting the drug with a nominal cost, such as $0.10, is acceptable. Medicare reimburses separately payable drugs at the lesser of the reported charge or the APC rate.

Modifier FB is not appropriate. This is used for no-cost or discounted-cost implantable devices. The modifier is appended to the procedure code, not the device. It lets the MAC know that the APC rate should be reduced to compensate for the lower cost to the provider. Here?s the section of the Medicare Claims Processing Manual that explains the use of modifier FB: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf

Also attached PARA's paper on correctly reporting reduced-cost implants for both inpatient and outpatient claims.

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PARA Weekly eJournal: July 22, 2020

Th e Clock Is Tick in g on Price Transparency Be pr epar ed t o m eet t h e CM S r equ ir em en t s Becker's Hospital Review and PARA Healt h Car e An alyt ics, an HFRI com pan y, invite you to attend this exciting new webinar.

Pr ice Tr an spar en cy: Clar if yin g Th e Un k n ow n Fr iday, Ju ly 24t h , 2020 | 1:00 pm - 2:00 pm CT

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PARA Weekly eJournal: July 22, 2020

APPENDING MODIFIER CS TO C9803 Effective March 1, 2020, HCPCSC 9803 (hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2)(coronavirus disease [covid-19]), any specimen source)) may be reported by outpatient hospitals for collecting COVID-19 test swabs.

According to Medicare?s Interim Final Rule with Comment Period (CMS-5531-IFC), HCPCS code C9803 was created as an evaluation and management (E/M) code only for the purposes of COVID-19 testing.

Payment for C9803 is conditionally packaged under OPPS; it is paid separately only when no other APC is payable on the same claim.This code may be reported for both nasal swab collection and blood draws for antibody testing.A link to the IFC and an excerpt from page 189 is provided below: https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf ?In light of the tremendous need for testing created by this PHE and the resource needs to provide extensive symptom assessment for specimen collection, we are creating a new E/M code solely to support COVID-19 testing for the PHE, HCPCS code C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source).?

Providers should append modifier CS to C9803 when billing medically necessary COVID-19 testing.This modifier ensures that the patient cost share is waived. Under the Families First Coronavirus Response Act (FFCRA), Medicare and the majority of commercial payers are required to waive patient cost-sharing liability for certain evaluation and management services related to COVID-19 testing.

The services must result either in an order or administration of COVID-19 testing or were provided to determine the need for a COVID-19 test. The evaluation and management may be provided either in person or through telehealth services. To waive the cost share, providers must append modifier CS to the E/M service. Since C9803 is considered Medicare to be an E/M service, modifier CS is appropriate.

Medicare updated the official description of modifier CS to ?COVID-19 Testing Related Service? within the July 1, 2020 update to the Integrated Outpatient Code Editor: https://www.cms.gov/files/document/r10165cp.pdf

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) PARA continues to update COVID-19 coding information based on rapidly changing guidelines regulations from CMS and payers. Changes from our PARA Coronavirus Coding paper (updated on 6-5-2020) are in red font. As always, the code selection 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.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf Confirmed Cases For confirmed cases of COVID-19, report ICD-10 CM code U07.1 (COVID-19). On Wednesday, March 18, 2020, the Centers for Disease Control (CDC) announced that the ICD-10 CM diagnosis code, previously slated to be effective October 1, 2020, will now be effective April 1, 2020. Report U07.1 for confirmed or presumptive positive COVID-19 cases.

Presumptive positive tests are those that have shown positive at the state or local level; the Centers for Disease Control does not have to confirm the result.

Except in cases of obstetric patients, sequence U07.1 first, followed by appropriate codes for associated manifestation(s).Patients who are admitted or present for a healthcare encounter because of confirmed COVID-19 during pregnancy, childbirth, or post-partum should be reported with a principal diagnosis of O98.5 (Other viral diseases complicating pregnancy, childbirth and the puerperium.)U07.1 should follow O98.5 then any appropriate codes for associated manifestation(s).

- Pneumonia confirmed as due to the COVID-19 - assign codes U07.1 (COVID-19) and J12.89 (other viral pneumonia) - Acute bronchitis confirmed as due to COVID-19, assign codes U07.1 (COVID-19) and J20.8 (acute bronchitis due to other specified organisms) - Bronchitis Not Otherwise Specified (NOS) due to the COVID-19, assign codes U07.1 (COVID-19) and J40 (bronchitis, not specified as acute or chronic) - Lower respiratory infection NOS confirmed as due to COVID-19, assign codes U07.1 (COVID-19) and J22 (unspecified acute lower respiratory infection) - Respiratory infection NOS confirmed as due to COVID-19, assign codes U07.1 (COVID-19) and J98.8 (other specified respiratory disorders) - Acute respiratory distress syndrome (ARDS), assign codes U07.1 (COVID-19) and J80 (acute respiratory distress syndrome)

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) Exposure to COVID-19 Report Z03.818 (encounter for observation for suspected exposure to other biological agents ruled out) when there is a concern of possible exposure to COVID-19, but after evaluation of the patient was ruled out.

Report Z20.828 (contact with and (suspected/possible) exposure to other viral communicable diseases) when there is actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19 and the test on the patient is either negative or unknown. Report any signs or symptoms associated with COVID-19 if present in the patient.

Report P00.2 (Newborn affected by maternal infectious and parasitic diseases) when a newborn is born to a COVID-positive mother and the baby?s COVID-19 status is unknown.

Screening for COVID-19 Report Z11.59 (encounter for screening for other viral diseases) for COVID-19 screening of asymptomatic patients who have had no known virus exposure and the test results are either unknown or negative.

Signs and symptoms without a definitive diagnosis of COVID-19 For patients presenting with signs or symptoms of COVID-19 but do not have a definitive diagnosis of COVID-19, report the appropriate code(s) for any associated manifestations.

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) COVID-19 Swab Collection Effective March 1, 2020, HCPCSC 9803 (hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2)(coronavirus disease [covid-19]), any specimen source)) may be reported by outpatient hospitals for collecting COVID-19 test swabs.

Per CMS-5531-IFC C9803 was created as an evaluation and management (E/M) code only for the purposes of COVID-19 testing.Below is the link to the IFC and an excerpt that can be found on page 189: https://www.cms.gov/files/document/covid-medicare-and-medicaid-ifc2.pdf ?In light of the tremendous need for testing created by this PHE and the resource needs to provide extensive symptom assessment for specimen collection, we are creating a new E/M code solely to support COVID-19 testing for the PHE, HCPCS code C9803 (Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [COVID-19]), any specimen source).?

Free-standing physician practices may report evaluation and management code CPTÂŽ 99211 for COVID-19 swab collection for both new and established patients when no other E/M service is rendered.

Independent labs may report G2023 (specimen collection for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source) and 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).

Append modifier CS to C8903 to ensure that patient liability is waived for medically necessary COVID-19 testing.

COVID-19 Lab Tests Code selection depends on the payer and the test performed. Contact your local third-party payer directly to determine their specific reporting guidelines.

For Medicare, report the code that matches the test source (CDC or non-CDC) or the technique.

They offer guidance at the link below: https://www.cms.gov/files/document/ 03052020-medicare-covid-19-fact-sheet.pdf

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) ?There are two new HCPCS codes for healthcare providers who need to test patients for Coronavirus. Healthcare providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) 2019-nCoV Coronavirus, SARS- CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non- CDC can also be used by laboratories and healthcare facilities.

Both codes can be used to bill Medicare as well as by other health insurers that choose to utilize and accept the code. ?Additionally, on March 13, 2020, the American Medical Association (AMA) Current Procedural Terminology (CPT® ) Editorial Panel has created CPT® code 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). For more information on how to use the CPT® code, please visit https://www.ama-assn.org/press-center/press-releases/new-cpt-code-announced-report-novel-coronavirus-test.

Laboratories can also use this CPT® code to bill Medicare if your laboratory uses the method specified by CPT® 87635.?

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) High throughput COVID-19 testing: A high-throughput machine requires specialized technical training. It can process more than 200 specimens a day.

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).

Report U0003 in place of tests that were reported as 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)when high-throughput technology is used.

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.) HCPCS U0004 should be reported in place of U0002(2019-ncov Coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc.)when high-throughput technology is used.

Medicare will pay $100 under the Clinical Lab Fee Schedule for Part B services. These codes should not be used when testing for COVID-19 antibodies.CMS provides a partial list of accepted technology high-throughput machines In Ruling2020-1-Rdated April 14, 2020: https://www.cms.gov/files/document/cms-2020-01-r.pdf

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) COVID-19 Antibody Testing: Medicare instructs that for COVID-19 antibody testing performed in a single step (often a strip) with all critical components for the assay, 86328 is the most appropriate code to report. COVID-19 antibody testing reported as 86769 may involve multi-steps where a diluted sample is incubated in a sample plate.

Payment rates for U0001, U0002, 87635, and the antibody testing are determined at the MAC level. They may vary by a few cents until Medicare establishes national payment rates using its annual process later this year. Payment information, by MAC, is at the following link: https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf

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PARA Weekly eJournal: July 22, 2020

PARA CORONAVIRUS CODING (UPDATED 7-21-2020) Modifiers and Condition Codes during the PHE Modifier CS ?Effective March 18, 2020, under the under the Families First Coronavirus Response Act (FFCRA), Medicare will waive cost-sharing liability for certain evaluation and management services related to COVID-19 testing. The services must result either in an order or administration of COVID-19 testing or were provided to determine the need for a COVID-19 test. The evaluation and management may be provided either in person or through telehealth services.

Modifier CS may be appended to C9803 (hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2)(coronavirus disease [covid-19]), any specimen source) because it is considered an E/M code related to COVID-19 testing.

Condition Code DR/Modifier CR CMS has instructed providers to report these codes when care is provided under one of the Section 1135 waivers to address the Public Health Emergency. These codes do not affect payment.They are not necessary on Medicare telehealth services.

When all services or items billed on the claim are related to a COVID-19 waiver, Condition Code DR is used by institutional providers and Modifier CR is for both institutional and non-institutional providers.

On July 15, 2020, CMS revised its documenton the use of these modifiers and condition code DR in MLN SE20011 ?Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19).?

This can be accessed at the following link: https://www.cms.gov/files/document/se20011.pdf CMS continues to update billing and coding guidance through their ?Frequently Asked Questions to Assist Medicare Providers? document published on their Current Emergencies page: https://www.cms.gov/About-CMS/Agency-Information/ Emergency/EPRO/Current-Emergencies/ Current-Emergencies-page

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PARA Weekly eJournal: July 22, 2020

OIG AUDITS OUTLIER PAYMENTS: HOW PARA CAN HELP In a February 2020 report from the US Department of Health and Human Services (DHS), the Office of Inspector General (OIG) outlined results of an Outpatient Outlier Payment Audit of CHI St Vincent Infirmary in Little Rock, Arkansas.

Medicare outlier payments are supplemental payments to hospitals designed to protect facilities from substantial financial loss resulting from patient cases that are unusually expensive. These payments are directly impacted by hospital charges.

CHI St Vincent Infirmary was selected for audited because the facility?s outpatient outlier payments increased six-fold from $216,484 in 2013 to over $1.4M the following year.

The methodology of the audit was as follows: - Reviewed applicable Federal laws, regulations, and guidance - Obtained outpatient outlier payments from National Claims History file - Selected a stratified random sample of outpatient outlier payments from the sampling frame - Sent the claims related to the selected outlier payments to hospital - Requested hospital review the documentation supporting these claims to verify that an outlier should have been paid - Reviewed codes and charges on the claims related to the selected outlier payments to look for inconsistencies - Reviewed documentation obtained from facility to determine if billing errors contributed to outlier payments - Discussed the results of audit with facility Of the 120 sampled claims with outlier payments, the hospital only billed 17 correctly. The remaining 103 sampled claims resulted in improper outlier payments to the facility totaling over $580,000 due to 173 billing errors.

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PARA Weekly eJournal: July 22, 2020

OIG AUDITS OUTLIER PAYMENTS: HOW PARA CAN HELP The OIG determined that the ?billing errors primarily occurred because St Vincent did not have adequate controls to prevent errors related to overcharged time, charge errors, and coding errors.?

Of the claims reviewed, 32 claims included 47 errors related to overcharged time in Operating Room, Anesthesia, Recovery Room, and Observation time. In fact, on claim charged for 98 hours of operating room time rather than the 2.5 hours in the medical record.The facility cited user error in updating the end date/time of the procedure.

The facility also had 24 charge errors on 24 claims where billing codes did not follow established facility pricing policies, incorrect code assignment, and inconsistent billing units. The facility cited human or system set-up errors for most of these issues.

The audit also found 102 coding errors on 87 claims including recovery charges billed with conscious sedation, improper use of modifiers to bypass NCCI edits, charges not supported by documentation resulting in overcharging and undercharging, and inaccurate coding that under-coded the procedures.

The facility cited human error for all these coding errors.

Five PARA Solu t ion s Th a t Cou ld H a ve Sa ve d CH I St Vin ce n t In f ir m a r y Since 1985, PARA HealthCare Analytics, has supported hospitals in improving revenue cycles and ensuring consistent, compliant charging practices.

PARA's Solutions, from our web-based PARA Data Editor (PDE) Revenue Cycle tool, to our complete Revenue Integrity Program, ensure that facilities are aware of, and can correct, issues like those identified in the OIG?s Audit of St Vincent Infirmary.

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Perioperative Charge Analysis Create a perioperative charging process that captures the eight components of surgical services charging (e.g. Pre-Operative Care, Anesthesia, Operating Room Time Charges, Equipment Charges, Recovery/Post-Anesthesia Care Unit (PACU), Supplies, Drugs and Post PACU Care).

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Comprehensive Claim Review Identify missing charges, compliance problems, and billing issues.

Market Based Pricing Review Remain price competitive, identify line items in the charge master which have exposure due to high prices or opportunities due to low prices and establish prices based on fee schedule reimbursement, cost or competitive market pricing data.

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CDM Desk Audit Review each active charge line item for correct codes, descriptions, pricing and reimbursement.

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Revenue Integrity Program Audit and enhance each aspect of the revenue cycle process to ensure that all appropriate revenue is created, captured, coded, priced and paid correctly within compliance guidelines.

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PARA Weekly eJournal: July 22, 2020

JULY 1, 2020 CODING UPDATE: SINUVA NASAL IMPLANT Effective July 1, 2020, Sinuva ? a nasal implant delivering the medication mometasone furoate ? should be reported with HCPCS C9122, which is separately payable under OPPS. Here's the reimbursement information ? note that reported in units of 10 micrograms:

The NDC for Sinuva indicates that the implant contains 1,350 micrograms of mometasone furoate, therefore 135 units would be reported for one implant as described on the Sinuva website:

https://www.sinuva.com/hcp/ Hospitals should be mindful that there is another HCPCS, J7401, for an implantable form of the medication mometasone furoate.Be sure to report C9122 for the brand name implantable ?SINUVA? to receive appropriate Medicare reimbursement.

Neither Medicare nor the UB04 committee has issued guidance on the revenue code that is appropriate for this implantable medication.Many hospitals find that reporting the correct number of units (135) is a function of the pharmacy subsystem, therefore PARA recommends revenue code 0636.However, 0278 is also acceptable.

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PARA Weekly eJournal: July 22, 2020

NEW EXCEPTIONS TO RHC PRODUCTIVITY DUE TO COVID-19

Medicare announced a new opportunity for Rural Health Clinics (RHCs) to apply for an exception to RHC provider productivity standards due to the effects of the COVID-19 National Health Emergency.

Productivity standards are vital to the life of the RHC because they are used to determine the average cost per patient for Medicare reimbursement. Practitioners in the RHC (physicians, nurse practitioners, physician assistants and certified midwives) are held to a minimum number of visits per FTE, and are expected to furnish services within the RHC. If statistics reflect failure to meet this minimum, it could indicate the RHC is operating at an excessive staffing level, which results in excessive cost.

At the end of the RHC?s cost reporting year, the A/B MAC, calculates the RHC?s all inclusive rate (AIR) by dividing the total allowable costs across all of the reported patient types by the number of visits for all patient types. Patient visits are defined as Medicare, Medicaid, Medicare Advantage, private payers, etc.

These patient visit types are included in the determining calculation for the RHC?s productivity. If the final results reflect a fewer number of expected visits have been furnished, the A/B MAC substitutes the expected number of visits for the denominator and will instead use the actual number of visits. The total allowable costs would be divided by the higher, expected number of visits. In the case of low productivity, the calculation could result in lowering the AIR per-visit rate.

Due to COVID-19, RHCs were faced with fewer face-to-face visits, as remote services (e.g. telehealth and virtual check-ins) became the choice of care delivery whenever possible. As a result, some RHCs may have difficulty meeting the established productivity standards. In light of this PHE, CMS will allow MACs to use discretion to make an exception to the productivity standards for a one-year period based on individual circumstances. RHCs that seek an exception must submit a written request after the provider?s fiscal year end, with justification for failure to meet the productivity requirements.

The RHC is expected to provide the following information in the prepared request: - A summary of the facility?s hours of operation - A summary of the physician and mid-level practitioner hours and FTE calculations. Any non-RHC hours must be excluded from the calculation of the FTEs, including any contracted hours, administrative hours, hours of service spent in the hospital, etc.

- A summary of the year-end total RHC visit for each practitioner position (physician, physician assistant and/or nurse practitioner - The exception percentage and/or standard being requested per practitioner position - Any additional documentation or narrative that provides support for the exception request.

Links and contacts for the various Medicare Administrative Contractor contacts for submitting exception requests are provided on the following page.

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PARA Weekly eJournal: July 22, 2020

NEW EXCEPTIONS TO RHC PRODUCTIVITY DUE TO COVID-19 National Government Services (NGS) providers should direct exception requests to the email address ngsprovbaseddeterminations@anthem.com.

Exceptions article

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PARA Weekly eJournal: July 22, 2020

NEW EXCEPTIONS TO RHC PRODUCTIVITY DUE TO COVID-19 First Coast Service Options Medicare Providers should direct exception requests as instructed at this link: https://medicare.fcso.com/PARD_provider_reimbursement/0462066.asp

Novitas JH (AR, CO, LA, MS, NM, OK, TX, Indian Health Services and Veterans Medicare Providers) should direct exception requests to: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00228302

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PARA Weekly eJournal: July 22, 2020

REVISED ADVANCE BENEFICIARY NOTICE FORM REQUIRED 8/31/2020 CMS has issued an update to the Advance Beneficiary Notice (ABN) Form, CMS-R-131, which will be mandatory beginning August 31, 2020.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 22

PARA Weekly eJournal: July 22, 2020

REVISED ADVANCE BENEFICIARY NOTICE FORM REQUIRED 8/31/2020

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PARA Weekly eJournal: July 22, 2020

REVISED ADVANCE BENEFICIARY NOTICE FORM REQUIRED 8/31/2020

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PARA Weekly eJournal: July 22, 2020

NEW MEDICARE SUPPLIER TYPE: HOME INFUSION THERAPY

The 21st Century Cures Act established a new Medicare home infusion therapy benefit, which is separate from the Home Health benefit.Details of the new provider type and requirements are found in the proposed rule [CMS-1730-P] for FY 2021, which updates the Medicare payment rates for Home Health Agencies (HHAs).

The proposed rule is available on the PARA Data Editor Advisor tab:

A home infusion therapy supplier would be required to meet all of the following requirements: - Furnish infusion therapy to individuals with acute or chronic conditions requiring administration of home infusion drugs - Ensure the safe and effective provision and administration of home infusion therapy on a 7-day-a-week, 24-hour-a-day basis - Is accredited by an organization designated by the Secretary in accordance with section 1834(u)(5) of the Act.Is enrolled in Medicare as a home infusion therapy supplier consistent with the provisions of ยง 424.68 and part 424, subpart P Assuming the proposed rule is finalized, enrollment will be accomplished through submitting an 855B ?Medicare Enrollment Application -- Clinics/Group Practices and Certain Other Suppliers? form, or its equivalent on the CMS PECOS system.

The application fee will be $595.All of the home infusion therapy supplier?s patients must have a plan of care established by a physician that prescribes the type, amount, and duration of the home infusion therapy services to be furnished. Section 486.525, meanwhile, lists specific services that the home infusion therapy supplier must furnish.

25

PARA Weekly eJournal: July 22, 2020

NEW MEDICARE SUPPLIER TYPE: HOME INFUSION THERAPY Medicare will base its Home infusion encounter reimbursement on the Medicare Physician Fee Schedule, with some adjustments for initial and subsequent visits, in three different categories: Category 1: Includes certain intravenous infusion drugs for therapy, prophylaxis, or diagnosis, including antifungals and antivirals; inotropic and pulmonary hypertension drugs; pain management drugs; chelation drugs; and other intravenous drugs as added to the durable medicare equipment local coverage determination (DME LCD) for external infusion pumps.Payment equals 1 unit of 96365 plus 4 units of 96366.

Category 2: Includes certain subcutaneous infusion drugs for therapy or prophylaxis, including certain subcutaneous immunotherapy infusions.Payment equals 1 unit of 96369 plus 4 units of 96370.

Category 3: Includes intravenous chemotherapy infusions, including certain chemotherapy drugs and biologicals.Payment equals 1 unit of 96413 plus 4 units of 96415.An estimate of reimbursement for each category of care (one unit of the primary code, four units of the add-on code) based on the 2020 Medicare Physician Fee Schedule is displayed in the chart below:

Links and excerpts from Title 42 of the Code of Federal Regulations which authorize the establishment of home infusion supplier types and the requirements pertaining thereto are provided here and on the next page: https://ecfr.io/Title-42/se42.5.486_1520

26

PARA Weekly eJournal: July 22, 2020

NEW MEDICARE SUPPLIER TYPE: HOME INFUSION THERAPY § 486.520 Plan of care.

The quali fi ed hom e i nfusi on therapy suppli er ensures the follow i ng: (a) All pati ents m ust be under the care of an appli cable provi der. (b) All pati ents m ust have a plan of care establi shed by a physi ci an that prescri bes the type, am ount, and durati on of the hom e i nfusi on therapy servi ces that are to be furni shed. (c) The plan of care for each pati ent m ust be peri odi cally revi ew ed by the physi ci an.

https://ecfr.io/Title-42/se42.5.486_1525 § 486.525 Requi red servi ces. (a) The quali fi ed hom e i nfusi on therapy suppli er m ust provi de the follow i ng servi ces on a 7-day-a-w eek , 24-hour-a-day basi s i n accordance w i th the plan of care: (1) Professi onal servi ces, i ncludi ng nursi ng servi ces.

(2) Pati ent trai ni ng and educati on not otherw i se pai d for as durable m edi cal equi pm ent as descri bed i n § 424.57(c)(12) of thi s chapter.

(3) Rem ote m oni tori ng and m oni tori ng servi ces for the provi si on of hom e i nfusi on therapy servi ces and hom e i nfusi on drugs. (b) All hom e i nfusi on therapy suppli ers m ust provi de hom e i nfusi on therapy servi ces i n accordance w i th nati onally recogni zed standards of practi ce, and i n accordance w i th all appli cable state and federal law s and regulati ons.

https://ecfr.io/Title-42/Section-414.1505 414.1505 Requirement for payment. § 414.1505 Requi rement for payment.

In order for hom e i nfusi on therapy servi ces to quali fy for paym ent under the Medi care program the servi ces m ust be furni shed to an eli gi ble benefi ci ary by, or under arrangem ents w i th, a quali fi ed hom e i nfusi on therapy suppli er that m eets the follow i ng requi rem ents: (a) The health and safety standards for quali fi ed hom e i nfusi on therapy suppli ers at § 486.520(a) through (c) of thi s chapter. (b) All requi rem ents set forth i n §§ 414.1510 through 414.1550.

https://ecfr.io/Title-42/Section-414.1550 414.1550 Basis of payment. § 414.1550 Basi s of payment. (a) General rule. For hom e i nfusi on therapy servi ces furni shed on or after January 1, 2021, Medi care paym ent i s m ade on the basi s of 80 percent of the lesser of the follow i ng: (1) The actual charge for the i tem or servi ce.

27

PARA Weekly eJournal: July 22, 2020

NEW MEDICARE SUPPLIER TYPE: HOME INFUSION THERAPY (2) The fee schedule am ount for the i tem or servi ce, as determ i ned i n accordance w i th the provi si ons of thi s secti on. (b) Uni t of si ngle paym ent.A uni t of si ngle paym ent i s m ade for i tem s and servi ces furni shed by a

quali fi ed hom e i nfusi on therapy suppli er per paym ent category for each i nfusi on drug adm i ni strati on calendar day, as defi ned at ยง 486.505 of thi s chapter.

(1) Category 1. (i ) Includes certai n i ntravenous i nfusi on drugs for therapy, prophylaxi s, or di agnosi s, i ncludi ng anti fungals and anti vi rals; i notropi c and pulm onary hypertensi on drugs; pai n m anagem ent drugs; chelati on drugs; and other i ntravenous drugs as added to the durable m edi care equi pm ent local coverage determ i nati on (DME LCD) for external i nfusi on pum ps. (i i ) Paym ent equals 1 uni t of 96365 plus 4 uni ts of 96366.

(2) Category 2. (i ) Includes certai n subcutaneous i nfusi on drugs for therapy or prophylaxi s, i ncludi ng certai n subcutaneous i m m unotherapy i nfusi ons. (i i ) Paym ent equals 1 uni t of 96369 plus 4 uni ts of 96370.

(3) Category 3. (i ) Includes i ntravenous chem otherapy i nfusi ons, i ncludi ng certai n chem otherapy drugs and bi ologi cals. (i i ) Paym ent equals 1 uni t of 96413 plus 4 uni ts of 96415.

(4) Ini ti al vi si t. (i ) For each of the three categori es li sted i n paragraphs (c)(1) through (3) of thi s secti on, the paym ent am ounts are set hi gher for the fi rst vi si t by the quali fi ed hom e i nfusi on therapy suppli er to i ni ti ate the furni shi ng of hom e i nfusi on therapy servi ces i n the pati ent's hom e and low er for subsequent vi si ts i n the pati ent's hom e. The di fference i n paym ent am ounts i s a percentage based on the relati ve paym ent for a new pati ent rate over an exi sti ng pati ent rate usi ng the annual physi ci an fee schedule evaluati on and m anagem ent paym ent am ounts for a gi ven year and calculated i n a budget neutral m anner. (i i ) The fi rst vi si t paym ent am ount i s subject to the follow i ng requi rem ents i f a pati ent has previ ously recei ved hom e i nfusi on therapy servi ces: (A) The previ ous hom e i nfusi on therapy servi ces clai m m ust i nclude a pati ent status code to i ndi cate a di scharge.

(B) If a pati ent has a previ ous clai m for HIT servi ces, the fi rst vi si t hom e i nfusi on therapy servi ces clai m subsequent to the previ ous clai m m ust show a gap of m ore than 60 days betw een the last hom e i nfusi on therapy servi ces clai m and m ust i ndi cate a di scharge i n the previ ous peri od beforea HIT suppli er m ay subm i t a hom e i nfusi on therapy servi ces

clai m for the fi rst vi si t paym ent am ount.

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PARA Weekly eJournal: July 22, 2020

NEW MEDICARE SUPPLIER TYPE: HOME INFUSION THERAPY (d) Requi red paym ent adjustm ents.The si ngle paym ent am ount represents paym ent i n full for all costs associ ated w i th the furni shi ng of hom e i nfusi on therapy servi ces and i s subject to the follow i ng adjustm ents:(1) An adjustm ent for a geographi c w age i ndex and other costs that m ay vary by regi on, usi ng an appropri ate w age i ndex based on the si te of servi ce of the benefi ci ary.

(2) Begi nni ng i n 2022, an annual i ncrease i n the si ngle paym ent am ounts from the pri or year by the percentage i ncrease i n the Consum er Pri ce Index (CPI) for all urban consum ers (Uni ted States ci ty average) for the 12-m onth peri od endi ng w i th June of the precedi ng year.

(3)(i ) An annual reducti on i n the percentage i ncrease descri bed i n paragraph (d)(2) of thi s secti on by the producti vi ty adjustm ent descri bed i n secti on 1886(b)(3)(B)(xi )(II) of the Act. (i i ) The appli cati on of the paragraph (c)(3)(i ) of thi s secti on m ay result i n the both of the follow i ng: (A) A percentage bei ng less than zero for a year.

(B) Paym ent bei ng less than the paym ent rates for the precedi ng year. (e) Medi cal revi ew.All paym ents under thi s system m ay be subject to a m edi cal revi ew adjustm ent reflecti ng the follow i ng: (1) Benefi ci ary eli gi bi li ty.

(2) Plan of care requi rem ents.(3) Medi cal necessi ty determ i nati ons.

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PARA Weekly eJournal: July 22, 2020

CLARIFYING THE UNKNOWN ABOUT PRICE TRANSPARENCY

Becker's Hospital Review and PARA Healt h Car e An alyt ics, an HFRI com pan y, invite you to attend this exciting new webinar.

Pr ice Tr an spar en cy: Clar if yin g Th e Un k n ow n

Fr iday, Ju ly 24t h , 2020 | 1:00 pm - 2:00 pm CT

Click h er e t o r egist er f or t h is f r ee w ebin ar Featuring the experts from PARA HealthCare Analytics and HFRI

https://go.beckershospitalreview.com/price-transparency-clarifying-the-unknown

Object ives - Descr ibe pow er f u l pr icin g st r at egies t o r esolve t r an spar en cy con cer n s - An alyze t h e CM S Pr ice Tr an spar en cy gu idelin es as t h ey ar e w r it t en t oday - Cr eat e act ion able st eps t o pr ice t r an spar en cy If you have any questions, please email webinarinfo@beckershealthcare.com and they will be happy to assist you.

30

PARA Weekly eJournal: July 22, 2020

NEW FLEXIBILITIES FOR RURAL HEALTH CARE

Rural Health Clinics and Federally Qualified Health Clinics can enjoy new flexibilities with new payment methodologies, coding procedures and charge processes.

This new MLN Matters document provides more detail.

For the complete article and detailed guidance, click here.

31

PARA Weekly eJournal: July 22, 2020

PARA'S PRICE TRANSPARENCY TOOL ADVANTAGES Hospital price transparency is a requirement. And implementation can be a daunting task.

That's why PARA HealthCare Analytics has made it easy.

Here are 10 ways PARA's Pr ice Tr an spar en cy works for you.

1. En su r es com plian ce with the January 1, 2019 and January 1, 2021 CMS mandates for Price Transparency: - Post a listing of all services and prices available at the facility in a machine-readable format - Include payer specific reimbursement information for all services available at the facility 2. Pr ovides cu st om ized and meaningful information for patients. Takes the guess work out of obtaining an estimate.

3. Im pr oves collect ion s. Patients will know their liability before the service is provided. They can even prepay!

4. A Web-based solu t ion . Simple implementation. No software to install.

See A Dem o

By Click in g Th e Bu t t on

5. Com pr eh en sive t ool that pulls: - Top services at a facility - User ?s insurance information via Eligibility Checking - Registration information to return usage statistics readily available to the facility 6. High ly -

cu st om izable.

The style and functionality of the tool to be directly embedded on the facility website The services available on the Decision Tree and how they are presented (i.e. descriptions, categories) The Prices that are presented (e.g., Average Line Charge, Average Package Charge, Average CDM Charge, etc.)

- The programming to meet all expectations and functionality

7. Alw ays u p t o dat e with the latest information for all users,with no additional work on behalf of the hospital once implemented.Fully serviced and managed on PARA?s servers with all data and functionality accessible by the facility through the PARA Dat a Edit or .

8. On goin g f eat u r e u pgr ades and improvements that reflect changes in practice, technology, and services.

9. Repor t in g capabilit ies to review all activity on hospital website and what services are being shopped.

10. M ost cost -ef f ect ive solu t ion in the industry. PARA?s cost to deploy its solution is market competitive and in line with what CMS is saying healthcare organizations should pay for to implement a patient price estimator.

FOR DETAILS 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

rbrantner@hfri.net

32 800.999.3332 X225 slaplace@para-hcfs.com

PARA Weekly eJournal: July 22, 2020

COV ID-19 july, 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.

33

PARA Weekly eJournal: July 22, 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.

-

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

-

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)

-

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

-

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)

-

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

-

- 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)

-

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

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

-

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

-

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

-

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)

34

PARA Weekly eJournal: July 22, 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)

-

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)

-

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)

35

PARA Weekly eJournal: July 22, 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)

-

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)

36

PARA Weekly eJournal: July 22, 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, Ju ly 16, 2020 New s

·CMS Directs Additional Resources to Nursing Homes in COVID-19 Hotspot Areas ·Five Things About Nursing Homes During COVID-19 ·PEPPER for Short-term Acute Care Hospitals ·Lower Extremity Joint Replacement: Comparative Billing Report Even t s

·Nursing Home Training Series Webcasts: New Topic for July 16 ·COVID-19: Lessons from the Front Lines Call ? July 17 M LN M at t er s® Ar t icles

·Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2020 ·Influenza Vaccine Payment Allowances - Annual Update for 2020-2021 Season ·Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2021 ·October 2020 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files ·Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2020 Update ·July 2020 Update of the Ambulatory Surgical Center (ASC) Payment System ? Revised ·July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) ? Revised ·Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment ? Revised ·Claim Status Category Codes and Claim Status Codes Update ? Rescinded View t h is edit ion as PDF (PDF)

37

PARA Weekly eJournal: July 22, 2020

There were TWO new or revised MedLearns released this week.

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

2

FIND ALL THESE MEDLEARNS IN THE ADVISOR TAB OF THE PDE

38

PARA Weekly eJournal: July 22, 2020

The link to this MedLearn MM11814

39

PARA Weekly eJournal: July 22, 2020

The link to this MedLearn MM11882

40

PARA Weekly eJournal: July 22, 2020

There were SIX new or revised Transmittals released this week.

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

6

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

41

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10221CP

42

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10224CP

43

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10223OTN

44

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10222CP

45

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10220FM

46

PARA Weekly eJournal: July 22, 2020

The link to this Transmittal R10213CP

47

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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

48