PARA HealthCare Analytics Weekly eJournal July 29, 2020

July 29, 2020

PARA

WeeklyeJOURNAL NEWS FOR HEALTHCARE DECISION MAKERS

Coding Medical Isotopes Page

31 Answers About Price Transparency

11 Page

6 - M odif ier CS On C9803 - RHC Reimbursement For AWV And Medical Exam - Appen din g M odif ier CS To C9803 - Medical Coverage For Depression Medication

FAST LINKS

- PARA Cor on avir u s Codin g Updat ed 7-21-20 - OIG Audit: 5 Ways PARA Can Help - Codin g Sin u va Nasal Im plan t - MedLearn 7-23-20

- Administration: Pages 1-43 - HIM /Coding Staff: Pages 1-43 - Providers: Pages 2,11,13,15,18,23,31 - M ental Health: Pages 2,13 - Outpatient Svcs: Pages 3, 12 - Rural Health: Pages15,25,26

Su icidal Ideat ion s Page 2

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Price Transparency: Page 6 Compliance: Pages 6,22 Nuclear M edicine: Page 11 COVID-19 Resource: Page 27 COVID-19 Coding: Pages 15,18 ENT: Page 23 Cardiology: Page 31

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PARA Weekly eJournal: July 29, 2020

SUICIDAL IDEATIONS AS A DIAGNOSIS

I am having providers list suicidal ideations as a diagnosis with major depressive disorder or anxiety- basically a more definitive diagnosis is always listed. Usually on the 2nd or 3rd day the suicidal ideations are resolved and they don't add a more definitive diagnosis because they know from the start what it's due to. Should the suicidal ideation be listed as a diagnosis or be coded if that's the reason the patient was admitted?? I know we are not to code signs and symptoms, but I have been getting information to code and not code it so just want to hear your thoughts:) Answer: Recommend reporting R45.851, Suicidal ideations, as a secondary diagnosis. If the suicidal ideation is clarified as being not related to a definitive diagnosis and meets the definition of principal diagnosis, it may be reported as such.

In the Tabular there is a Chapter section Excludes 2 note under Symptoms and signs involving cognition, perception, emotional state and behavior (R40-R46) which states "symptoms and signs constituting part of a pattern of mental disorder (F01-F99)". ICD-10-CM Official Guidelines, Section I.A.12.b., Excludes 2 means that the code listed is ?Not included here.?

An excludes 2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes 2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate. Per the ICD-10-CM Official Guidelines Section II.A, "codes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established."

Please note previous ICD-9 advice, ICD-9-CM Coding Clinic, Fourth Quarter 2005 Page: 96, for suicidal ideation had code V62.84 which was created for "patients who have not attempted suicide, and who may not be considered a suicide risk, but who have indicated thoughts about suicide.

This code is a secondary code only. It may be used with another mental health code when appropriate."

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PARA Weekly eJournal: July 29, 2020

MODIFIER CS ON C9803

Is CS modifier only to be applied to C9803? Or can it be applied to the E/M CPT® codes?

For example, a patient comes to the ER and the ER charges for the facility and professional E/M CPT® code. We also have a specimen collection charge on the account.

Which code should the CS modifier go on?

Answer: Technically, the new 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) should not require a CS modifier, since it is reported solely for COVID-19 specimen collection.

Medicare updated it?s FAQ regarding the CS modifier today, July 24, 2020. Here?s a link and the pertinent excerpt: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

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PARA Weekly eJournal: July 29, 2020

MODIFIER CS ON C9803

All that aside, one California client gave us a copy of a Medicare remittance recently which applied coinsurance to the C9803 code. We have submitted the question to Medicare for clarification ? when we receive a reply, we will write about it in the PARA Weekly. Until we receive their reply, it might be safest to append modifier CS to C9803, just to make sure your MAC processes payment correctly.

As for the ED visit, the hospital should append modifier CS to the 9928x code if the decision to test for COVID-19 was made during the visit. Whether or not the COVID-19 test was available, or turned out to be negative, the cost-sharing is waived if the physician/non-physician provider determined the need to test at the visit.

By the way, if there?s an ED visit on the claim, the C9803 code won?t be separately paid by Medicare anyway ? under OPPS, payment for C9803 is ?packaged? to any other visit code. C9803 is paid only if there is no other visit on the claim.

Here?s what CMS wrote in the Interim Final Rule CMS 5531-IFC, April 30, 2020 (page 191): ?Finally, section 6002(a) of the Families First Coronavirus Response Act (Pub. L. 116-127) amended section 1833 of the Act by adding a new paragraph (DD) to section (a)(1) and a new paragraph (11) to section (b) to provide, respectively, that the payment amount for a specified COVID-19 testing-related service for which payment may be made under certain outpatient payment provisions will be 100 percent of the payment amount otherwise recognized and that the deductible for such a service will not apply.

These amendments mean that there is no beneficiary cost-sharing (coinsurance and deductible amounts) for COVID-19 testing-related services, which is defined in new section 1833(cc) of the Act as, among other requirements, are medical visits in any of several categories of HCPCS E/M service codes, including office and other outpatient services, that results in an order for or administration of a COVID-19 clinical diagnostic laboratory test described in section 1852(a)(1)(B)(iv)(IV) of the Act and relates to the furnishing or administration of such test or to the evaluation of such individual for purposes of determining the need of such individual for such test.

Because physicians and other practitioners will be using the level 1 E/M code for established patients, CPTÂŽ code 99211, to conduct testing related visits, there will not be beneficiary cost sharing when the practitioner?s office bills for this service, provided it results in an order for or administration of a COVID-19 test.

Similarly, because HOPDs will use HCPCS code C9803 to bill for a clinic visit for specimen collection, which we consider an E/M code in the office and other outpatient services category of HCPCS codes,beneficiary cost sharing will not apply for this service, provided it results in an order for or administration of a COVID-19 test and meets other requirements of the law.

We anticipate that a COVID-19 test will always be ordered or administered with HCPCS code C9803 because the descriptor for this code includes specimen collection for COVID-19.)

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PARA Weekly eJournal: July 29, 2020

RHC REIMBURSEMENT FOR AWV AND MEDICAL EXAM

If we are an Rural Health Clinic (RHC) can the two above wellness be done on the same DOS and receive payment for both?

Answer: For Medicare beneficiaries, no. An Annual Wellness Visit and a gynecologic medical exam are not separately reimbursed if performed on the same date of service.

The preface of Medicare?s RHC Preventive Services Charge sets that out in the first sentence: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/ RHC-Preventive-Services.pdf

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PARA Weekly eJournal: July 29, 2020

CMS/PARA PRICE TRANSPARENCY Q&A

Did You Miss PARA's Price Transparency Webin ar ?

Our experts answer your questions.

1. Can you com m en t on m in an d m ax f or t h e 300 sh oppable ser vices w h en t h e in dividu al is ask in g abou t h is or h er ben ef it s (ex-Aet n a w it h R200 dedu ct ible / $2,500 OOP M ax)?

The PARA Pr ice Tr an spar en cy Tool will incorporate the patient?s current position on deductibles, co-insurance, co-pay and max annual out of pocket costs with a successful EDI insurance query from the PARA system. These data points are automatically incorporated in the final quote.

2. Is or al su r ger y in clu ded in t h e r equ ir em en t ?

Oral surgery codes, neither the surgical CPTÂŽ/HCPCS codes or the dental ?D? codes are contained within the CMS mandatory 70 items shoppable list, however the facility could elect them in the 230+ facility defined supplement to the shoppable list.

If they are in the CDM, they will be required to be included in the machine readable CDM Listing.

3. How do you r ef lect con t r act ed r at es f or it em s t h at ar e bu n dled su ch as APCs/ APGs? The PARA contract model process will take the line items from a primary procedure and common associated ancillary charges and group into an APC, APR-DRG, MS-DRG or EAPG and price to payer specific negotiated rates.

4. Does t h is also apply t o pr escr ipt ion ben ef it billin g as w ell (su ch as pr escr ipt ion in su r an ce) or on ly m edical in su r an ce an d h ospit al billin g?

Currently, it is only for hospital billing.

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PARA Weekly eJournal: July 29, 2020

CMS/PARA PRICE TRANSPARENCY Q&A 5. Wh at abou t Case Rat e pr icin g - How can you accom plish t h is in you r or gan izat ion ? w h at abou t ch ar ges t h at ar e m an u ally post ed u sin g a m iscellan eou s Ch ar ge Code? Wh at is t o st op a payer t o com par e sh op an d st at e t h at t h ey w ill on ly pay w h at t h e ot h er payer s pay? Wh at does t h e r u le st at e if t h er e is n o con t r act w it h an y payer ?

PARA develops the ?case rates? using either the actual billing transactions plus the HIM ICD10 codes, 837 claim EDI files or the CY 2019 Medicare claim files. For each primary code PARA will know the common associated ancillary charges along with the average of the miscellaneous priced transactions by line, that detail ?bill? will then be priced to the payer specific negotiated rates.There is nothing in the rule to prevent a payer from ?learning? from the shoppable table and then renegotiating the managed care contract.

If the facility does not have a contract with the facility, the encounter will be ?out of network? the PARA EDI insurance will bring back the co-insurance and max out of pocket limits and apply them to the quote.

6. Can a Hospit al sh ow m or e f ields su ch as M edicar e an d M edicaid paym en t s, n ot ju st in su r an ce com pan ies?

Can in su r an ce com pan ies su e h ospit als n ot disclose t h e pr ices becau se w r it t en in con t r act t o n ot t o disclose?

Yes, the PARA Pr ice Tr an spar en cy Tool can be easily customized.

This is a federal-required disclosure, I would think it would supersede any specific contract language, that was one of the reasons for the AHA court challenge.

7. Is t h e $300 per day per f acilit y/ locat ion or f or t h e en t ir e h ealt h n et w or k ?

The penalty appears to be by Medicare provider number.

8. Is it you r u n der st an din g t h at f or t h e M ach in e-r eadable f ile r equ ir em en t t h at ch ar ges an d n egot iat ed r at es n eed t o in clu de t h ose of an y pr ovider -based locat ion s (Pr of ession al an d Facilit y ser vices)? For t h e M ach in e-Readable f or m at r equ ir em en t , if w e n egot iat ed r at es by DRG f or som e con t r act s, h ow ar e w e t o sh ow t h e gr oss ch ar ge? How w ou ld w e calcu lat e t h at as t h e ch ar ges w ou ld be var iable by pat ien t ?

It appears that any billing which is related to the facility will be required to report the payer specific negotiated rates.

This question points out the error in the charge description master portion of the requirement of the machine-readable file. You will not be able to calculate the payer negotiated rates at the line level, you will need to go to the second requirement of the primary procedure and commonly associated ancillary procedures to price accurately.

The PARA process is to develop template claims by each type of service to value to the payer specific negotiated rates.

9. Wh y w ou ldn't a pr ice est im at or w it h t h e opt ion t o pr ice m u lt iple payer s u pon r equ est n ot m eet t h e r equ ir em en t w it h a separ at e 300 sh oppable list ?

Based on PARA?s understanding of the rule, a price estimator will replace the ?TABLE II? requirement of the machine-readable file as long as the high, low and cash payment rates are posted along with the patient's specific payer negotiated rate.

10. Does Requ ir em en t #1 also h ave t o in clu de ser vice pack ages vs on ly CDM ch ar ges?

CMS requirement number 1 is only for the machine readable, priced charge master file, the service packages are in requirement number 2.

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PARA Weekly eJournal: July 29, 2020

CMS/PARA PRICE TRANSPARENCY Q&A 11. Is applyin g all t h e dat a (in clu din g payer n egot iat ed r at es) in excel spr eadsh eet s post ed on t h e w ebsit e accept able?

Yes. If you post both the entire charge master and the 300+ shoppable items along with the common ancillary procedures with each of the payer specific negotiated rates and the cash discount price.

12. How m u ch does t h is cost f or a cr it ical access h ospit al t h at does n ot h ave m u ch m on ey?

Less than CMS estimated. Please connect with a PARA Accou n t Execu t ive for a specific quote, the last page of this document has their contact information. Additionally, this would be an eligible cost to report on the Medicare Cost Report.

13. For t h e pr ice est im at or , h ow do you est im at e t h e dedu ct ible, as each plan w ill h ave a dif f er en t dedu ct ible? How do you in dicat e pr ices if a M edicar e or M edicaid advan t age plan pays 100% of M edicar e/ M edicaid an d pay vs APG or APG? The PARA system can generate an EDI query to the Patients insurance plan to collect the remaining annual deductible, co-insurance percentage, co-pay and remaining annual max out of pocket. These data points will then be incorporated in the charge quote for a final patient out of pocket quote.

14. Do you h ave a "st an d alon e" pr ice est im at or ? I w as u n der t h e im pr ession t h at h ospit als t h at do n ot em ploy t h e ph ysician do n ot h ave t o r epor t ph ysician ch ar ges.

PARA does have a ?stand alone? price and specific payer negotiated rates quotation system. The facility is not required to report the value of the professional/physician charges, but they required to report all additional claims associated with the requirement number 2 primary procedures.

15. Sor r y I w as lat e. Do you h ave a CDM solu t ion ?

Yes. PARA does have a charge master solution for requirement number 1 and a process to meet requirement number 2, without the intervention of the facility IT staff.

16. Does PARA h ave a pr icin g est im at or t h at in t er f aces w it h t h e h ospit al's EHR t h at cou ld be u sed by t h e f acilit y an d r esem ble t h e pr icin g t r an spar en cy t ool t h at cu st om er s w ou ld see. Is t h er e ver biage in dicat in g t h at t h e est im at e is t im e st am ped.... sin ce a dedu ct ible cou ld be m et by an ot h er claim t h at m ay dr op.

PARA can hand off to EHR systems the Patient and payer specific quote, and yes, the quotes are time stamped to lock in the deductible, co-insurance, co-pay and annual max out of pocket. The deductible, co-insurance, co-pay and remaining annual out of pocket values, are developed using the PARA EDI insurance query process.

17. If w e h ave a w eb-based, pu blic f acin g pr ice est im at or , w h at r equ ir em en t (s) does t h is f u lf ill? Does t h is allow u s t o avoid pr ovidin g ou r n egot iat ed f ees?

It appears you will meet requirement number 2, if you provide a payer specific negotiated rate quote, along with the high, low and cash negotiated rates.

You will still need to develop the payer specific rates plus the cash discounted price for the complete charge master list.

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PARA Weekly eJournal: July 29, 2020

CMS/PARA PRICE TRANSPARENCY Q&A 18. Is t h e NDC r equ ir ed f or Dr u gs?

The ?primary? code for billing is required, that would be the HCPCS code for high cost drugs (revenue code 0636), the NDC code may be required for those low cost common to the primary procedure ancillary charges (revenue code 025x), the NDC code and the ?unit multiplier ? are displayed in an example of the Table 2 required to meet the second portion of the CMS requirement.

19. How do you su ggest t h e h ospit als post t h eir n egot iat ed r at es f or im plan t s an d ot h er ser vices w h en it is logic based? For exam ple: 30% of t h e in voice cost if over cer t ain dollar am ou n t .

This will be an area where the facility will need to use an average to meet the requirement, PARA will assist facilities in developing the most accurate implant charge associated to the primary procedure.

20. Con sider in g Epic is t h e 500lb EHR gor illa in t h e r oom (cou n t r y), do you or t h e ven dor h ave a t ake on t h eir plan t o u t ilize t h eir Gu est Est im at es t ool t o m eet t h e 300 sh oppable ser vices r equ ir em en t ?

I have not seen any ?workable? solution to the CMS requirement from EPIC. 21. Wh at k in d of t r ain in g is available f or Healt h car e Tech n ology M an ager s t o align t h eir ef f or t s w it h t h e n ew cr it er ia?An y cer t if icat ion exam s t o r ef lect exper t ise?

Currently there are no certification processes or requirement, we are all learning this collectively.

22. How do you r epor t M S-DRG, APR-DRG, APC an d EAPGs? The PARA process is to group the primary procedure along with the common associated ancillary services to create the code, which will then be ?valued? to the payer specific regional rate using the PARA contract module.

23. Ar e pr of ession al billable r at es (M D, NP ch ar ges) also in clu ded in t h e pr ice t r an spar en cy act ?

The rates are not required, unless they are billed by the facility, this would be the case with Critical Access Hospital using Method II and some facility which combine their professional on to the UB04.

However, the rates may not be required, but the notification to the patient that a separate bill will be forthcoming is required.

24. Wh at ar e t h e r equ ir em en t s t o pr ovide M edicar e Advan t age an d m an aged car e con t r act specif ic r eim bu r sem en t by DRG in t h e Cost Repor t ?

In the Inpatient Prospective Payment Proposed Rule, there is a requirement for facilities to assemble the average reimbursement for Medicare Advantage plans plus the contracted managed care payers for reporting to CMS and to be included in the HCRIS (Healthcare Cost Report Information System)

25. On t h e list in g of n egot iat ed pr ices is it by payer or by t h e act u al payer con t r act , e.g., if you h ave t h r ee BC con t r act s do you h ave t o sh ow each con t r act pr ice?

We recommend you list the rates tied to each contract.

26. Ar e M edicar e an d M edicaid r at es r equ ir ed t o be disclosed alon gside t h e m an aged payer n egot iat ed r at es?

The Medicare and Medicaid rates are not negotiated. They do not appear to be a requirement.

27. Wh at qu alif ies as a h ospit al? We h ave a r u r al clin ic u n der ou r h ospit al licen se. Does t h at qu alif y?

Any facility which is state licensed as a hospital or registered with CMS as a hospital needs to report. We would recommend that you report these specific negotiated rates.

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PARA Weekly eJournal: July 29, 2020

CMS/PARA PRICE TRANSPARENCY Q&A 28. We h ave a r u r al h ealt h car e cen t er u n der ou r t ax id n u m ber bu t w it h a separ at e NPI. Does t h is RHC n eed t o com ply w it h pr ice t r an spar en cy?

Any facility which is state licensed as a hospital or registered with CMS as a hospital needs to report, we would recommend that you report these specific negotiated rates.

29. Is it par t of t h e r equ ir em en t t o ch eck pat ien t eligibilit y an d qu ot e t r u e ou t of pocket su ch as pat ien t copay an d dedu ct ibles?

It is not required under the regulations to check the Patient?s remaining annual deductible, co-insurance, co-pay or max annual out of pocket, but we would recommend it to reduce bad-debt and collection costs.

30. If w e u se a pr ice est im at or , does it n eed t o in clu de all con t r act s or ju st ou r t op 5 or so?

In reviewing page 14 of the CMS PowerPoint (link pasted below), as long as you have this tool, and you have the 70 CMS required and additional 230 shoppable services you have met the requirements of regulation #2. You will still need to post the charge master with all payer specific negotiated rates to meet regulation #1 requirement.

31. If you pr ovide a solu t ion f or on lin e pr ice est im at or , is it f or all ser vices or on ly t h e 300 det er m in ed sh oppable ser vices?

The price estimator tool must contain the 70 CMS required services plus the 230 facility add-on services at a minimum.

Addit ion al In f or m at ion : Webinar: Price Transparency-Clarifying the Unknown List of CMS 70 Shoppable Services PARA Price Transparency Tool MLN - Hospital Price Transparency Final Rule IPPS FY2021 Proposed Rule - Federal Register CMS Healthcare Cost Report Information System

To View a Pr ice Tr an spar en cy Dem o or f or m or e in f or m at ion , please con t act : Violet Ar ch u let a-Ch iu

San dr a LaPlace

Ran di Br an t n er

Senior Account Executive

Account Executive

Vice President, Analytics

varchuleta@para-hcfs.com

slaplace@para-hcfs.com

rbrantner@hfri.net

(800) 999-3332 ext 219

(800) 999-3332 ext 225

(719) 308-0883

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PARA Weekly eJournal: July 29, 2020

BUNDLING ISOTOPES INTO A PROCEDURE When considering whether or not there is any advantage or disadvantage to ?bundling? the cost of isotopes into the procedure charge for nuclear medicine, you must also consider that a Critical Access Hospital will be reimbursed the same cost-based percentage for its charges either reported individually or combined.

If a supply item is always required in the performance of a procedure, and that supply item has no HCPCS code (i.e. a syringe for administering contrast under pressure), there is no problem in bundling the cost of the supply item into the charge for the procedure. For non-coded supplies, bundling offers a more efficient charge capture process, and gives third-party auditors less information to dispute in the nature of billable vs. non-billable supplies.

However, the majority of isotopes have been assigned HCPCS codes by Medicare. If an item is eligible for a HCPCS code, we recommend reporting it, not bundling it into another procedure.

Medicare assigns HCPCS codes to drugs, implants, and other supplies for a variety of reasons, including for rate-setting purposes (OPPS) and to facilitate billing error detection. For example, Medicare claims processing edits catch billing errors with ?Medically Unlikely Units? for each HCPCS. While we fully recognize that CAHs are not paid under OPPS, and although isotopes are not separately paid under OPPS (with a few exceptions), we recommend that CAHs follow the same coding conventions followed by OPPS hospitals.

In other words, PARA strongly recommends reporting the isotope separately. This gives Medicare the information it clearly intended to obtain by creating the HCPCS code in the first place.

We presume the idea of ?bundling? the isotope charge into the nuclear medicine procedure was inspired by the efficiency of charge capture ? it is easier to ensure one charge is captured rather than two.

However, if the dollar value of the charge for the procedure includes the cost of the isotope, a disadvantage to ?bundling? is that your price for the procedure may appear higher than competitors which separately report isotopes. In the current regulatory atmosphere promoting price transparency, it is far better to charge separately for the isotopes than to conceal its contribution to the total charges for the encounter.

Attached is PARA's paper that points out that the Medicare pays an additional $10 per study dose for TC-99 isotopes procured from a non-highly enriched uranium source. This bonus payment is earned by reporting Q9969 on an additional line of the claim, along with the TC-99 code such as A9500 or A9503.

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PARA Weekly eJournal: July 29, 2020

APPENDING MODIFIER CS TO C9803 Effective March 1, 2020, HCPCS C9803 (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 29, 2020

MEDICARE COVERAGE FOR NEW DEPRESSION DRUG ADMINISTRATION In 2020, Medicare has added G-codes to offer reimbursement to hospital outpatient departments and physician clinics which administer a newly approved medication for treatment-resistant depression, esketamine nasal spray (SPRAVATO? .) Hospitals and clinics which offer behavioral health services may be interested in providing this service, but it has not been widely publicized by Medicare yet.

Effective 1/1/2020, Medicare established two new G-codes for use by either hospital outpatient departments or qualified practitioners supervising the patient?s self-administration in a clinic setting: - G2082 - office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation; - G2083 - office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified health care professional and provision of greater than 56 mg esketamine nasal self-administration, includes 2 hours post-administration observation.

Reimbursement rates for physician clinics and OPPS hospitals are just slightly more than the cost of the medication.Patients must be monitored for two hours after the administration of this nasal spray to observe for adverse reactions; although adverse reactions are rare, they can be serious

Here?s a website from the drug manufacturer that explains the drug and the treatment process: https://www.spravatohcp.com/dosing-and-administration According to the manufacturer, SPRAVATO? can only be administered at healthcare settings certified in the SPRAVATO? Risk Evaluation and Management Strategy (REMS) Program and to patients enrolled in the program.

More information on the requirements of the program are found on the manufacturer?s website.

Here?s a link and and an excerpt on the following page:

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PARA Weekly eJournal: July 29, 2020

MEDICARE COVERAGE FOR NEW DEPRESSION DRUG ADMINISTRATION

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PARA Weekly eJournal: July 29, 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 29, 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 29, 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 29, 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 29, 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 29, 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 29, 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 29, 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 29, 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.

1

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).

2 3

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.

4

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

5

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 29, 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 29, 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 29, 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.

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PARA Weekly eJournal: July 29, 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.

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PARA Weekly eJournal: July 29, 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)

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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: July 29, 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: July 29, 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: July 29, 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 23, 2020 New s

·Peripheral Vascular Intervention for Claudication: Comparative Billing Report ·Physician Compare Preview Period Open through August 20

Claim s, Pr icer s & Codes

·SNF Patient Driven Payment Model Interrupted Stay Issue

Even t s

·Telemedicine Hack: A 10-Week Learning Community to Accelerate Telemedicine Implementation for Ambulatory Providers: July 22?September 23 ·National CMS/CDC Nursing Home COVID-19 Training Series Webcast ? July 23

M LN M at t er s® Ar t icles

·Change to the Payment of Allogeneic Stem Cell Acquisition Services ·July 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) ? Revised

M u lt im edia

·Part A Cost Report Call: Audio Recording and Transcript

View t h is edit ion as PDF (PDF)

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PARA Weekly eJournal: July 29, 2020

There were THREE new or revised MedLearns released this week.

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

3

FIND ALL THESE MEDLEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eJournal: July 29, 2020

The link to this MedLearn MM11916

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PARA Weekly eJournal: July 29, 2020

The link to this MedLearn MM11927

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PARA Weekly eJournal: July 29, 2020

The link to this MedLearn MM11580

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PARA Weekly eJournal: July 29, 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

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PARA Weekly eJournal: July 29, 2020

The link to this Transmittal R10239PI

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The link to this Transmittal R10228PI

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The link to this Transmittal R10230CP

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The link to this Transmittal R10231OTN

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PARA Weekly eJournal: July 29, 2020

The link to this Transmittal R10233CP

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PARA Weekly eJournal: July 29, 2020

The link to this Transmittal R10229CP

42

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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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