PARA HealthCare Analytics Weekly eJournal May 19, 2021

M ay 19, 2021

PARA

WeeklyeJOURNAL NEWS FOR HEALTHCARE DECISION MAKERS

Bi l l i n g EPO On Ou t pat i en t Hospi t al Cl ai m

Patient Access To Medical Records

Page 14 - UPDATED COVID-19 Billin g & Codin g - CMS Price Transparency Advisory - CM S Updat es For COVID-19 M on oclon al An t ibody Th er apy - Finding Cash

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© 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: May 19, 2021

PATIENT ACCESS TO RECORDS

This is to provide additional information per your inquiry about new timeliness standards for sharing health information with authorized parties (such as the patient) upon request for such information.

Answer: The basic premise of the Information Blocking law, which is part of the 21st Century Cures Act, is that parties controlling health information should make it available to authorized recipients electronically, promptly, and without cost to patients.

While HIPAA allows up to 30 days to fulfill an authorized request for medical records, the Cures Act does not allow that time frame to be used as a shield against an unnecessary delay.

Here are a couple of excerpts from the FAQ website which touch on your question:

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PARA Weekly eJournal: May 19, 2021

PATIENT ACCESS TO RECORDS

The Final Rule narrative mentions that providers should not be penalized for withholding information which is not finalized ? and excuses an actor from responding to requests that are infeasible. Here?s an excerpt from the Final Rule on that topic: https://www.federalregister.gov/d/2020-07419/p-25 Comments. One comment submission highlighted a tension between the data-provision preferences of health care providers requesting data and other actors (such as other providers and their health IT developers) from whom data is requested. This commenter indicated providers requesting data, such as long-term/post-acute providers caring for patients after a hospital stay, may currently have to wait days to receive any of the patient's clinical data from the hospital stay because the hospital or its health IT developer refuses to generate and send the C-CDA document until every last data element is finalized. The commenter suggested we clarify whether §?171.201 would apply to such circumstances.

Response. An actor's practice of delaying fulfillment of an otherwise feasible and legally permissible request for exchange, access, or use of EHI that is finalized and available to the actor merely because the actor knows more EHI for that patient will become available at some later date would not satisfy the conditions of §?171.201. As we stated in the Proposed Rule, we do not view mere incompleteness of a patient record as rendering the remainder of the patient's record inaccurate (84 FR 7524). We recognize that specific data points may not be appropriate to disclose or exchange until they are finalized. Such data points would include, but are not necessarily limited to: Laboratory results pending confirmation or otherwise not yet considered by the hospital reliable for purposes of clinical decision making; or notes that the clinician has begun to draft but cannot finalize until they receive (confirmed) laboratory or pathology results or other information needed to complete their decision making.

We hope it is, and will be increasingly, rare that an actor cannot effectively sequester non-finalized EHI from finalized EHI. However, we cannot rule out the possibility that some actors may face that problem at some point. If an actor cannot effectively sequester non-finalized EHI from a particular access, exchange, or use where inclusion of non-finalized EHI would not be appropriate, the actor should refer to the new Content and Manner Exception (finalized in §?171.301) or the Infeasibility Exception finalized in §?171.204.

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PARA Weekly eJournal: May 19, 2021

PATIENT ACCESS TO RECORDS

Attached a document that explains the 8 exceptions to the rule found at: Cures Act Final Rule: Information Blocking Exceptions (healthit.gov)

The Cures Act authorizes HHS to impose ?appropriate disincentives? on health care provider who engage in information blocking, but regulations (not yet issued) are required to implement HHS?approach to these disincentives.

Here?s a link and an excerpt from the Information Blocking provisions of the law (42 USC §300jj?52):

[USC02] 42 USC 300jj-52: Information blocking (house.gov) (a) Definition (1) In general In this section, the term "information blocking" means a practice that(A) except as required by law or specified by the Secretary pursuant to rulemaking under paragraph (3), is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information; and (B)(i) if conducted by a health information technology developer, exchange, or network, such developer, exchange, or network knows, or should know, that such practice is likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information; or (ii) if conducted by a health care provider, such provider knows that such practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.

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PARA Weekly eJournal: May 19, 2021

PATIENT ACCESS TO RECORDS

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(2) Penalties (A) Developers, networks, and exchanges Any individual or entity described in subparagraph (A) or (C) of paragraph (1) that the Inspector General, following an investigation conducted under this subsection, determines to have committed information blocking shall be subject to a civil monetary penalty determined by the Secretary for all such violations identified through such investigation, which may not exceed $1,000,000 per violation. Such determination shall take into account factors such as the nature and extent of the information blocking and harm resulting from such information blocking, including, where applicable, the number of patients affected, the number of providers affected, and the number of days the information blocking persisted.

(B) Providers Any individual or entity described in subparagraph (B) of paragraph (1) determined by the Inspector General to have committed information blocking shall be referred to the appropriate agency to be subject to appropriate disincentives using authorities under applicable Federal law, as the Secretary sets forth through notice and comment rulemaking.

According to an FAQ document found on the Office of the National Coordinator for Health IT?s website, regulations establishing ?disincentives? to healthcare providers for blocking information are not yet finalized: Information Blocking FAQs (healthit.gov) Enforcement of the information blocking regulations depends upon the individual or entity that is subject of an enforcement action or "actor." For health IT developers and health information networks/HIEs, the HHS Office of the Inspector General is currently engaged in rulemaking to establish

enforcement dates. For health care providers, HHS must engage in future rulemaking to establish appropriate disincentives as directed by the 21st Century Cures Act.

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PARA Weekly eJournal: May 19, 2021

COVID-19 UPDATE

PARA Healt h Car e An alyt ics continues to update COVID-19 coding and billing information based on frequently changing guidelines and regulations from CMS and payers. All coding must be supported by medical documentation.

Download the updated Guidebook by clicking here.

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PARA Weekly eJournal: May 19, 2021

CMS PRICE TRANSPARENCY COMPLIANCE UPDATE

On M ay 3, 2021, t h e Am er ican Hospit al Associat ion (AHA) r eleased a M em ber Advisor y r egar din g n on com plian ce w it h t h e Cen t er s f or M edicar e & M edicaid Ser vices?(CM S) Hospit al Pr ice Tr an spar en cy r equ ir em en t s. In it , t h ey n ot e t h at CM S h as lau n ch ed pr oact ive au dit s of h ospit al w ebsit es an d h ave evalu at ed com plain t s pr esen t ed t o CM S by con su m er s.

According to the publication, CMS started with auditing larger acute care hospitals and have now expanded their examination of random hospitals.The first set of warning letters were issued the week of April 19th.However, CMS has indicated that they will not announce the list of hospitals that have received warning letters but will publish the identities of the hospitals that remain non-compliant and receive a monetary penalty if they have not addressed the issues within 90 days.

PARA HealthCare Analytics, an HFRI Company, is among the leaders in supporting hospitals in achieving readiness for CMS Price Transparency regulations, which will help consumers make more informed healthcare purchasing decisions. To ensure consumers will be able to browse for healthcare services in the same way they shop for other goods and services online, PARA has developed robust and accurate pricing capabilities for area healthcare consumers. The PARA solution includes a patient-facing estimator that delivers user-friendly, procedure-level estimates reflecting patients?specific coverage limits and is updated quarterly for the facility.

As a reminder, the CMS Hospital Price Transparency rule requires that hospitals publish detailed pricing information online to help consumers make accurate cost comparisons for a range of treatments and procedures.

The rule contains two types of price transparency requirements: - Hospitals must post their entire array of standard charges online in a machine-readable file that is easily accessible from their public website.

- Hospitals must publish a document listing pricing for 300 specific shoppable healthcare services.

Of these 300 items, 70 have been pre-defined by CMS, while the remaining 230 can be selected at the discretion of the hospital.

For both requirements, a range of different price categories must be shown, including gross charges, payer-specific negotiated rates, self-pay discounted rates, and de-identified minimum and maximum negotiated charges. The files also must contain any ancillary charges that are customarily included for the specific shoppable service, such as the costs associated with additional related procedures, tasks, allied services, supplies, or drugs, as well as any professional fees billed separately from the facility bill.

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PARA Weekly eJournal: May 19, 2021

CMS PRICE TRANSPARENCY COMPLIANCE UPDATE

These requirements present challenges when it comes the sheer data mining and payer contract analytics required to deliver on the mandates. PARA?s payer contract models accommodate a variety of settlement methodologies by patient type including MS-DRG, APR-DRG, EAPG, ASC Levels, APC packaging, and percent of charge, among others.

For a typical hospital with a 10,000-line chargemaster, seven patient types, and 20 payer contracts, this could mean 1.4M calculations needed to fulfill the mandate. According to an HFMA Article on the topic, this detailed approach could cost a hospital several hundred thousand dollars to contract with a consulting firm.

However, PARA's Price Transparency Tool, which uses the actual payer contract language as outlined in the CMS requirements to make those millions of calculations, costs under $30,000 in the first year, with nominal (under $3,000) quarterly maintenance fees thereafter.It is the most cost-effective and comprehensive solution out there today.

Consumers expect to shop for healthcare the same way they shop for other goods and services and healthcare providers must be ready to meet that need.

Therefore, PARA HealthCare Analytics, has partnered with hospitals across the nation to empower them in providing this required information in a consumer-friendly, intuitive manner.

The team at PARA HealthCare Analytics believes that price transparency and Patient Price Estimators are a useful and important component of healthcare consumerism and have spent the past year preparing for the release of these requirements.In speaking with hospital associations, clients, and business vendor groups, we are finding that we are one of the only vendors who can completely satisfy, to the spirit and letter of the law, both CMS requirements in a fully customizable manner.

According to Peter Ripper, CEO of PARA, ?The President?s Executive Order in June 2019 promoted increased availability of meaningful pricing information for Patients. The key word here is meaningful.

Therefore, since the release of the CMS requirements, we?ve focused on creating an approach to these obligations that would lessen confusion for patients and support the hospital in fulfilling the mandates.With a healthcare environment riddled with various pressures including thin operating margins, health plan competition, and a shortage of resources due to a pandemic, PARA has done the heavy lifting to deliver the best solution possible for our Hospital Partners.?

PARA has done the heavy lifting to deliver the best solution possible for our Hospital Partners.

To f in d ou t m or e abou t ou r solu t ion , please con t act on e of ou r exper t s. .

San dr a LaPlace

Violet Ar ch u let -Ch iu

Account Executive

Senior Account Executive

splace@para-hcfs.com

varchuleta@para-hcfs.com

800.999.3332 x 225

800.999.3332 x219

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES FOR COVID-19 MONOCLONAL ANTIBODY THERAPY

On May 6, 2021 CMS announced CMS has increase its payment under Medicare Part B COVID-19 vaccine benefit for the administration monoclonal antibody therapy.Providers must administer the injections consistent with FDA Emergency Use Authorization (EUA.)The national average payment increased from $310 to $450 in most healthcare settings. https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines -and-monoclonal-antibodies

*For Claims with Dates of Service 11/21/2020 ? 05/05/2021 ** For Claims with Dates of Service on or after 05/06/2021 Infusion at Home Also beginning May 6, 2021, CMS provides coding and a higher payment for COVID-19 monoclonal antibody therapy administered in a patient?s home or temporary residence or homeless shelter or other temporary lodging established as provider-based to a hospital during the COVID-19 Public Health Emergency (PHE.)

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES FOR COVID-19 MONOCLONAL ANTIBODY THERAPY

https://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusion

Medicare updated its COVID-19 FAQ on May 6, 2021.A link and excerpt follow. https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf

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PARA Weekly eJournal: May 19, 2021

FINDING CASH IN UNLIKELY REVENUE STREAM

A Case St u dy In Aged Accou n t s How A Large Health System Reduced Extremely-Aged Account Write-Offs With High Success Rate OVERVIEW A large health system in California, whose fiscal year-end was fast approaching, was faced with a large subset of inventory at 386 days old. It is well known that the longer a claim goes unresolved, the less money there is to collect and the general consensus for aged claims exceeding a year is to write it off. The system wasn?t ready to accept the losses and was not in the position to add resources. The system decided to partner with Healthcare Financial Resources (HFRI) to collect any amount that could be saved, and signed on for a one-time, fiscal year-end project.

BACKGROUND The California health system?s fiscal year-end was at the end of March, and upon agreement, HFRI received the placements the first week of February with a four month agreement to boost their year-end collections. This left HFRI with two months to collect as much of the $9 million in placements as possible before the year end, plus an extra two months to collect anything else that could be reclaimed. The age of the accounts and the denial mix were two major contributors to the challenge of resolving this inventory. 31% of the accounts were Managed Medicare and Medicaid with an average age of 409 days. The non-government payers consisted of 69% of the accounts and had an average age of 376 days. Out of the total denial mix, 40% were inpatient contractual reviews and 33% were clinical based rejections.

EXECUTION HFRI utilized their process of combined robotic analytics and intelligent automation along with specialized representative experts to collect on the $9 million inventory that was over 386 days old. This process allowed HFRI to quickly identify that out of the $9 million in inventory, $7 million had a chance of collectability while the remaining $2 million was labeled dead inventory. In order to accomplish the goal of making low collectible accounts collectible, strict oversight was required.

HFRI organized and distributed the collectible inventory to the remediation specialists whose skill set matched that of the inventory and had them challenge the carriers to the highest degree. The dead inventory was distributed to the analyst team to complete the proper adjustments and to identify exactly what went wrong. After the analysts identified the actual root causes, the problems were compiled into a presentation for the health system, explaining the pain points and how the system could avoid these denials in the future.

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PARA Weekly eJournal: May 19, 2021

FINDING CASH IN UNLIKELY REVENUE STREAM

Following the set up of the structure of collecting on these accounts, experienced management constantly monitored and calibrated the staff to optimize for efficiency. This strategy proved to be so successful that the health system requested an extension of the contract to have HFRI continue to collect on the accounts.

RESULTS The fiscal year-end project lead with 9 million in placements at 386 days and HFRI was able to obtain a 34% net collection rate, with a 27% gross rate over a 9-month period. In the four months HFRI was originally given to work the accounts, a collection growth of $500k per month was achieved for totals of: - $980k by the end of March - $1.5 million by the end of April - $2 million by the end of May At the end of the four months, HFRI collected $2 million and identified that there was $2 million in opportunities remaining and continued to collect on them as the one-time service had grown into a true partnership. After pushing back on the insurance carriers for lack of payment, HFRI was able to collect $2.5 million for a net collection rate of 34%.

In addition to bringing in the system?s hard-earned cash, HFRI also provided trending insights into the denials that impacted their bottom line and how to avoid these denials in the future. This included detailed trending on top denial areas including: clinical (37%), contractual underpayments (30%), coding, billing, and rebilling (27%), and coverage and registration issues (6%).

In the end, HFRI successfully collected on a subset of inventory that is not typically highly collectible with a good turnaround. HFRI can succeed where others have been unable to and areas that are not necessarily thought of as collectible. ?Some people call themselves vendors when they have no business calling themselves vendors, but HFRI does,? said Corporate Director of Patient Financial Services.

CONCLUSION HFRI?s scalable, client-specific accounts receivable resolution and recovery solutions allow hospitals to systematically address problem claims across the full AR spectrum- from long term to a project basis.

With the addition of our proprietary intelligent automation working alongside our remediation specialists, we?re able to resolve all claims, regardless of size or age- bringing in the cash and providing real-time trending presentations to provide insight into what is truly driving your delayed payments and offering solutions to prevent these occurrences from happening in the future.

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PARA Weekly eJournal: May 19, 2021

FINDING CASH IN UNLIKELY REVENUE STREAM

If you?re looking for a new AR recovery and resolution provider to partner with long term or on a project basis and would like to see a demo of our system and how it guides our reps to truly allow us to capture missing payments on aged inventory, contact us today to learn more about how we can help your organization accelerate its financial transformation. Our rates are contingency based, so there are no hidden fees and you can cancel at any time for any reason.

Our capabilities include: Fiscal year-end projects: We pursue the AR backlogs that your existing staff will not be able to complete by the end of the fiscal year to increase cash collection and reduce write-offs. A time of 3+ months will produce the best results.

Primary AR recovery and resolution: We pursue aging and small-balance claims identified by your staff as problematic. If a claim has previously been worked internally, referring it to HFRI?s dedicated, specialized teams can help ensure quicker cash conversion and a reduction of bad debt reserves.

Pre write-off AR recovery and resolution: In addition to primary AR recovery and management services, HFRI also offers pre write-off (often known as secondary) insurance AR recovery to help you collect highly aged claims and minimize write-offs.

Legacy system conversions: Transitioning to a new system can slow down the claims process and create problems for hospital personnel who must work between two billing platforms. HFRI can provide interim solutions to help you accelerate pre-conversion cash and assist with post-conversion AR resolution.

AR recovery projects: HFRI is available to assist you on a temporary project basis to address AR backlogs that can?t be worked by your existing staff.

HFRI, a nationwide leader in accounts receivable recovery and resolution, works as a virtual extension of your hospital central billing office to help you resolve and collect more of your insurance accounts receivable faster and improves operating margins through a seamless and collaborative partnership with your internal team.

For more information, visit: www.hfri.net 2500 Westfield Dr. Suite 2-300 | Elgin, IL 60124 888.971.9309 | Email Us

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PARA Weekly eJournal: May 19, 2021

BILLING EPO ON AN OUTPATIENT HOSPITAL CLAIM

Epoet in Alf a (EPO) an d Dar bepoet in Alf a (Ar an esp), k n ow n as Er yt h r opoiesis-St im u lat in g Agen t s (ESAs), m ay be cover ed by M edicar e f or t h e t r eat m en t of an em ia t h at of t en r esu lt s f r om ch r on ic k idn ey disease, ch em ot h er apy, an d cer t ain ot h er con dit ion s.ESAs m im ic h u m an pr ot ein er yt h r opoiet in t o st im u lat e a pat ien t ?s bon e m ar r ow , w h ich pr odu ces r ed blood cells.

Medicare requires specific codes and modifiers which differ depending on whether the patient is an End-Stage Renal Disease (ESRD) patient or a non-ESRD patient.

Non-ESRD Patients When an outpatient hospital administers an ESA to anon-ESRDpatient, the ESA is reported under revenue code 0636 with either HCPCS J0881 or J0885: J0881 ? injection darbepoetin alfa, 1 microgram (non-ESRD use) (Aranesp) J0885 ? injection, epoetin alfa (for non-ESRD use), 1000 units (EPO) Modifiers must be appended to the Erythropoiesis Stimulating Agents (ESA) J0881 or J0885 as follows: EA: ESA, anemia, chemo-induced EB: ESA, anemia, radio-induced EC: ESA, anemia, non-chemo/radio The full modifier description is available on the PARA Data Editor Calculator tab, Modifier Lookup feature: 14

PARA Weekly eJournal: May 19, 2021

BILLING EPO ON AN OUTPATIENT HOSPITAL CLAIM

Although Medicare also requests an additional modifier to indicate the route of administration of an ESA, in addition to the EA/EB/EC modifier, they will process claims without the JA or JB modifier: JA: Intravenous administration JB: Subcutaneous administration The PARA Data Editor includes claims data procured from Medicare (without PHI); the EPO line item in the claim below was processed by Medicare, indicating payment on J0881 with modifier EC (but no JA or JB modifier):

Value Codes --: When billing the administration of an ESA, the claim must also include the patient?s most recent hematocrit or hemoglobin reading.On an institutional claim, report the hemoglobin using value code 48 and a hematocrit reading with value code 49.On a professional claim, report results in Loop 2400 MEA segment of the CMS-1500.MEA01=TR (for test results), MEA02=R1 (for hemoglobin) or R2 (for hematocrit), and MEA03=the test results.Additional information on medical necessity, reporting, and billing of ESAs for non-ESRD patients begins in paragraph 80.8 of the Medicare Claims Processing Manual, Chapter 17 ? Drugs and Biologicals:

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PARA Weekly eJournal: May 19, 2021

BILLING EPO ON AN OUTPATIENT HOSPITAL CLAIM

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c17.pdf

CMS provides further guidance for hospitals that provide EPO when also billing for unscheduled or emergency dialysis,HCPCS G0257.

A link and an excerpt from the Medicare Claims Processing Manual, Chapter 4 -- Part B Hospital (Including Inpatient Hospital Part B and OPPS) provides guidance on billing emergency dialysis:

200.2 - Hospital Dialysis Services For Patients With and Without End Stage Renal Disease (ESRD) (Rev. 2455, Issued: 04-26-12, Effective: 10-01-12, Implementation; 10-01-12) Effective with claims with dates of service on or after August 1, 2000, hospital-based End Stage Renal Disease (ESRD) facilities must submit services covered under the ESRD benefit in 42 CFR 413.174 (maintenance dialysis and those items and services directly related to dialysis such as drugs, supplies) on a separate claim from services not covered under the ESRD benefit. Items and services not covered under the ESRD benefit must be billed by the hospital using the hospital bill type.

Medicare will pay them under the Outpatient Prospective Payment System (OPPS) or to a CAH at reasonable cost. Services covered under the ESRD benefit in 42 CFR 413.174 must be billed on the ESRD bill type and paid under the ESRD PPS. This requirement is necessary to properly pay only unrelated ESRD services (those not covered under the ESRD benefit) under OPPS (or to a CAH at reasonable cost).

Medicare does not allow payment for routine or related dialysis treatments covered and paid under the ESRD PPS when furnished to ESRD patients in the outpatient department of a hospital.

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PARA Weekly eJournal: May 19, 2021

BILLING EPO ON AN OUTPATIENT HOSPITAL CLAIM

CMS may, however, cover certain medical situations in which the ESRD outpatient cannot obtain her or his regularly scheduled dialysis treatment at a certified ESRD facility.While Medicare does not cover non-routine dialysis treatments under the ESRD benefit, the OPPS rule for 2003 allows payment for non-routine dialysis treatments furnished to ESRD outpatients in the outpatient department of a hospital. Payment for unscheduled dialysis furnished to ESRD outpatients and paid under the OPPS is limited to the following circumstances: - Dialysis performed following or in connection with a dialysis-related procedure such as vascular access procedure or blood transfusions; - Dialysis performed following treatment for an unrelated medical emergency; e.g., if a patient goes to the emergency room for chest pains and misses a regularly scheduled dialysis treatment that cannot be rescheduled, CMS allows the hospital to provide and bill Medicare for the dialysis treatment; or -

Emergency dialysis for ESRD patients who would otherwise have to be admitted as inpatients for the hospital to receive payment.In these situations, non-ESRD certified hospital outpatient facilities may bill Medicare using the Healthcare Common Procedure Coding System (HCPCS) code G0257 (Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility.)

HCPCS code G0257 may only be reported on type of bill 13X (hospital outpatient service) or type of bill 85X (critical access hospital).HCPCS code G0257 only reports services for hospital outpatients with ESRD. Beginning on and after October 1, 2012, claims containing HCPCS code G0257 on a type of bill other than 13X for outpatient hospital (or 85X for critical access hospital) will be returned to the provider for correction.

HCPCS code 90935 (Hemodialysis procedure with single physician evaluation) may be reported and paid only if one of the following two conditions is met: - The patient is a hospital inpatient with or without ESRD and has no coverage under Part A, but has Part B coverage. The charge for hemodialysis is a charge for the use of a prosthetic device. See Benefits Policy Manual 100-02 Chapter 15 section 120. A. The service must be reported on a type of bill 12X or type of bill 85X. See the Benefits Policy Manual 100-02 Chapter 6 section 10 (Medical and Other Health Services Furnished to Inpatients of Participating Hospitals) for the criteria that must be met for services to be paid when a hospital inpatient has Part B coverage but does not have coverage under Part A; or - A hospital outpatient does not have ESRD and is receiving hemodialysis in the hospital outpatient department. The service is reported on a type of bill 13X or type of bill 85X.

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HCPCS code 90945 (Dialysis procedure other than hemodialysis (e.g. peritoneal dialysis, hemofiltration, or other continuous replacement therapies)), with single physician evaluation, may be reported by a hospital paid under the OPPS or CAH method I or method II on type of bill 12X, 13X or 85X.

ESRD Patients Medicare bundles reimbursement all outpatient renal dialysis services to an ESRD facility under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS).ESRD facilities must provide or arrange all outpatientmaintenance dialysisservices, equipment, and supplies. When a non-ERSD entity provides ERSD-related services, including many lab tests, for an ESRD beneficiary, that provider should bill the ERSD facility, not the Medicare Administrative Contractor (MAC).

However, Medicare pays hospitals for emergencyESRD-related services, including lab testing, unscheduled dialysis, Epoetin Alfa (EPO) and Darbepoetin Alfa (Aranesp) provided in an outpatient hospital setting. (Note: if the date of service for the emergency room charge reported under revenue code 0450 does not match the ESRD-related lab services,modifier ET must be appended to the labs to report they are related to the emergency room visit.)

Additional information on ESRD billing may be found in the Medicare Claims Processing Manual, Chapter 8 ? Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Chain. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c08.pdf#

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Additional Resources National Coverage Determination 110.21 https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=322&ncdver= 1&DocID=110.21&bc=gAAAAAgAAAAA&

Local Coverage Billing and Coding Article ?CGS https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=56462&ContrTypeId= 9&ContrId=238&ContrVer=2&CntrctrSelected=238*2&ver=11&ContrNum=15202&SearchType=Advanced&CoverageSelection= Local&ArticleType=Ed|Key|SAD|FAQ&PolicyType=Both&s=---&Cntrctr=238&ICD=&CptHcpcsCodeJ0881&kq= true&bc=IAAAACAAAAAA&

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PARA Weekly eJournal: May 19, 2021

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Local Coverage Billing and Coding Article ?FCSO https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=57628&ContrTypeId=12&ContrId= 372&ContrVer=1&CntrctrSelected=372*1&ver=8&ContrNum=09302&SearchType=Advanced&CoverageSelection= Local&ArticleType=Ed|Key|SAD|FAQ&PolicyType=Both&s=---&Cntrctr=372&ICD=&CptHcpcsCodeJ0881&kq=t rue&bc=IAAAACAAAAAA&

Local Coverage Billing and Coding Article ?WPS https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId= 56795&ContrTypeId=9&ContrId=267&ContrVer=1&CntrctrSelected=267* 1&ver=14&ContrNum= 08202&SearchType=Advanced&CoverageSelection=Local&ArticleType= Ed| Key| SAD| FAQ&PolicyType=Both&s=---&Cntrctr=267&ICD=&CptHcpcsCodeJ0881&kq= true&bc=IAAAACAAAAAA&

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

This paper summarizes ?General Care Management? programs which Rural Health Clinics and Federally Qualified Health Clinics may provide.

Care management costs are separately reimbursed on a fee schedule. The costs related to care management are reported in the non-reimbursable section of the cost report and are not used in determining the RHC AIR or the FQHC PPS rate.

These programs are described in Chapter 13 of the Medicare Benefit Policy Manual; the Manual may be accessed at the link below:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c13.pdf#

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

Common Features of CCM, BHI, and PCM? services rendered under these three programs are reported on RHC/FQHC claims with the same HCPCS (G0511), and paid by Medicare using the same payment rate.

G0511 - Rural Health Clinic or Federally Qualified Health Center (RHC OR FQHC) only, general care management, 20 minutes or more of clinical staff time for chronic care management services or behavioral health integration services directed by an RHC or FQHC practitioner (physician, NP, PA, or CNM), per calendar month.

No Double-Dipping: RHCs and FQHCs may not bill for General Care Management and TCM services, or another program that provides additional payment for care management services (outside of the RHC AIR or FQHC PPS payment), for the same beneficiary during the same time period.HCPCS G0511, which reports services under CCM, BHI, or PCM services, can be billed only once per month per beneficiary when all requirements are met and at least the following time-based services have been furnished: - 20 minutes of CCM services, or - at least 30 minutes of PCM services, or - at least 20 minutes of general BHI services Initiating Visit -- A separately billable initiating visit with an RHC or FQHC primary care practitioner (physician, NP, PA, or CNM) is required before care management services can be furnished.

- The visit can be an E/M, AWV, or IPPE visit, and must occur no more than one-year prior to commencing care management services - Care management services do not need to have been discussed during the initiating visit, and the same initiating visit can be used for CCM and BHI services as long as it occurs with an RHC or FQHC primary care practitioner within one year of commencement of care management services.

- Beneficiary consent to receive care management services must be obtained either by or under the direct supervision of the RHC or FQHC primary care practitioner, may be written or verbal and must be documented in the patient?s medical record before CCM or BHI services are furnished.

- The medical record should document that the beneficiary has been informed about the availability of care management services, has given permission to consult with relevant specialists as needed, and has been informed of all of the following: - There may be cost-sharing (e.g. deductible and coinsurance in RHCs, and coinsurance in FQHCs) for both in-person and non-face-to-face services that are provided; - Only one practitioner/facility can furnish and be paid for these services during a calendar month; and - They can stop care management services at any time, effective at the end of the calendar month.

Following the initiating visit and patient consent, the General Care Management Services programs (CCM, BHI, or PCM)do not require face-to-face visits. Each program requires documentation of certain non-face-to-face services performed by the RHC clinician or auxiliary staff.

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

Payment Rate: G0511 is paid at the average of the national non-facility Medicare Physician Fee Schedule payment rate for CPT® codes 99490, 99487, 99484, 99491, and HCPCS codes G2064 and G2065. General care management HCPCS code G0511 is separately payable on an RHC or FQHC claim, either alone or with other payable services. The payment rate for HCPCS code G0511 is updated annually based on the PFS amounts for these codes.

Effective 1/1/2021, the payment rate for G0511 is the average of the following CPT®/HCPCS:

Coinsurance for care management services is 20 percent of the lesser of submitted charges or the payment rate for G0511.

Chronic Care Management (CCM) ? Effective January 1, 2016, RHCs and FQHCs are paid for CCM services when a minimum of 20 minutes of qualifying CCM services during a calendar month is furnished. CCM services may be furnished to patients with multiple chronic conditions that are expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

CCM service requirements include: - Structured recording of patient health information using Certified EHR Technology including demographics, problems, medications, and medication allergies that inform the care plan, care coordination, and ongoing clinical care; - 24/7 access to physicians or other qualified health care professionals or clinical staff including providing patients/caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week, and continuity of care with a designated member of the care team with whom the patient is able to schedule successive routine appointments; - Comprehensive care management including systematic assessment of the patient?s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of patient self-management of medications; - Comprehensive care plan including the creation, revision, and/or monitoring of an electronic care plan based on a physical, mental, cognitive, psychosocial, functional, and environmental (re)assessment and an inventory of resources and supports; a comprehensive care plan for all health issues with particular focus on the chronic conditions being managed; - Care plan information made available electronically (including fax) in a timely manner within and outside the RHC or FQHC as appropriate and a copy of the plan of care given to the patient and/or caregiver; - Management of care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and follow-up after discharges from hospitals, skilled nursing facilities, or other health care facilities; timely creation and exchange/transmit continuity of care document(s) with other practitioners and providers; - Coordination with home- and community-based clinical service providers, and documentation of communication to and from home- and community-based providers regarding the patient?s psychosocial needs and functional deficits in the patient?s medical record; and - Enhanced opportunities for the patient and any caregiver to communicate with the practitioner regarding the patient?s care through not only telephone access, but also through the use of secure messaging, Internet, or other asynchronous non-face-to-face consultation methods.

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

Principal Care Management (PCM) -- Effective January 1, 2021, RHCs and FQHCs are paid for PCM services when a minimum of 30 minutes of qualifying PCM services are furnished during a calendar month.The CMS transmittal which updates the Benefit Policy Manual is found at: https://www.cms.gov/files/document/r10729bp.pdf

PCM services may be furnished to patients with a single high-risk or complex condition that is expected to last at least 3 months and may have led to a recent hospitalization, and/or placed the patient at significant risk of death.

PCM service requirements include: - A single complex chronic condition lasting at least 3 months, which is the focus of the care plan; - The condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization; - The condition requires development or revision of disease-specific care plan; - The condition requires frequent adjustments in the medication regiment; and - The condition is unusually complex due to comorbidities.

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

Behavioral Health Integration (BHI) BHI is a team-based, collaborative approach to care that focuses on integrative treatment of patients with primary care and mental or behavioral health conditions. Effective January 1, 2018, RHCs and FQHCs are paid for general BHI services when a minimum of 20 minutes of qualifying general BHI services during a calendar month is furnished to patients with one or more new or pre-existing behavioral health or psychiatric conditions being treated by the RHC or FQHC primary care practitioner, including substance use disorders, that, in the clinical judgment of the RHC or FQHC primary care practitioner, warrants BHI services.

General BHI service requirements include: - An initial assessment and ongoing monitoring using validated clinical rating scales; - Behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; - Facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and - Continuity of care with a designated member of the care team Transitional Care Management (TCM) TCM services must be furnished within 30 days of the date of the patient?s discharge from a hospital (including outpatient observation or partial hospitalization), SNF, or community mental health center.

Communication (direct contact, telephone, or electronic) with the patient or caregiver must commence within 2 business days of discharge, and a face-to-face visit must occur within 14 days of discharge for moderate complexity decision making (CPT® code 99495), or within 7 days of discharge for high complexity decision making (CPT® code 99496). A Transitional Care Management (TCM) service can also be an RHC or FQHC visit.

The TCM visit is billed on the day that the TCM visit takes place, and only one TCM visit may be paid per beneficiary for services furnished during that 30 day post-discharge period.

TCM services are billed by adding CPT® code 99495 or CPT® code 99496 to an RHC or FQHC claim, either alone or with other payable services. If it is the only medical service provided on that day with an RHC or FQHC practitioner it is paid as a stand-alone billable visit. If it is furnished on the same day as another visit, only one visit is paid.In other words, a Transitional Care Management (TCM) service can also be a RHC visit.

Psychiatric Collaborative Care Model (CoCM) Psychiatric CoCM is a specific model of care provided by a primary care team consisting of a primary care provider and a health care manager who work in collaboration with a psychiatric consultant to integrate primary health care services with care management support for patients receiving behavioral health treatment. It includes regular psychiatric inter-specialty consultation with the primary care team, particularly regarding patients whose conditions are not improving.

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

The primary care team regularly reviews the beneficiary?s treatment plan and status with the psychiatric consultant and maintains or adjusts treatment, including referral to behavioral health specialty care, as needed. Patients with mental health, behavioral health, or psychiatric conditions, including substance use disorders, who are being treated by an RHC or FQHC practitioner may be eligible for psychiatric CoCM services, as determined by the RHC or FQHC primary care practitioner.

A separately billable initiating visit with an RHC or FQHC primary care practitioner (physician, NP, PA, or CNM) is required before psychiatric CoCM services can be furnished. This visit can be an E/M, AWV, or IPPE visit, and must occur no more than one-year prior to commencing care management services.

Psychiatric CoCM services do not need to have been discussed during the initiating visit, and the same initiating visit can be used for psychiatric CoCM as for CCM and BHI services, as long as it occurs with an RHC or FQHC primary care practitioner within one year of commencement of psychiatric CoCM services.

Beneficiary consent to receive care management services must be obtained either by or under the direct supervision of the RHC or FQHC primary care practitioner, may be written or verbal and must be documented in the patient?s medical record before psychiatric CoCM services are furnished. The medical record should document that the beneficiary has been informed about the availability of care management services, has given permission to consult with relevant specialists as needed, and has been informed of all of the following: - There may be cost-sharing (e.g. deductible and coinsurance in RHCs, and coinsurance in FQHCs) for both in-person and non-face-to-face services that are provided; - Only one practitioner/facility can furnish and be paid for these services during a calendar month; and - They can stop care management services at any time, effective at the end of the calendar month Beneficiary consent remains in effect unless the beneficiary opts out of receiving care management services. If the beneficiary chooses to resume care management services after opting out, beneficiary consent is required before care management services can resume. If the beneficiary has not opted out of care management services but there has been a period where no care management services were furnished, a new beneficiary consent is not required.

CoCM RHC or FQHC Practitioner Requirements -- The RHC or FQHC practitioner is a primary care physician, NP, PA, or CNM who: - Directs the behavioral health care manager and any other clinical staff; - Oversees the beneficiary?s care, including prescribing medications, providing treatments for medical conditions, and making referrals to specialty care when needed; and - Remains involved through ongoing oversight, management, collaboration and reassessment.

Behavioral Health Care Manager Requirements

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

CoCM Behavioral Health Care Manager is a designated individual with formal education or specialized training in behavioral health, including social work, nursing, or psychology, and has a minimum of a bachelor?s degree in a behavioral health field (such as in clinical social work or psychology), or is a clinician with behavioral health training, including RNs and LPNs. The behavioral health care manager furnishes both face-to-face and non-face-to-face services under the general supervision of the RHC or FQHC practitioner and may be employed by or working under contract to the RHC or FQHC. The behavioral health care manager: - Provides assessment and care management services, including the administration of validated rating scales; - Provides behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; - Provides brief psychosocial interventions; - Maintains ongoing collaboration with the RHC or FQHC practitioner; - Maintains a registry that tracks patient follow-up and progress; - Acts in consultation with the psychiatric consultant; - Is available to provide services face-to-face with the beneficiary; and - Has a continuous relationship with the patient and a collaborative, integrated relationship with the rest of the care team CoCM Psychiatric Consultant Requirements -- The psychiatric consultant is a medical professional trained in psychiatry and qualified to prescribe the full range of medications. The psychiatric consultant is not required to be on site or to have direct contact with the patient and does not prescribe medications or furnish treatment to the beneficiary directly. The psychiatric consultant: - Participates in regular reviews of the clinical status of patients receiving psychiatric CoCM services; - Advises the RHC or FQHC practitioner regarding diagnosis and options for resolving issues with beneficiary adherence and tolerance of behavioral health treatment; making adjustments to behavioral health treatment for beneficiaries who are not progressing; managing any negative interactions between beneficiaries?behavioral health and medical treatments; and - Facilitates referral for direct provision of psychiatric care when clinically indicated.

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PARA Weekly eJournal: May 19, 2021

RHC/FQHC BILLING FOR GENERAL CARE MANAGEMENT SERVICES

Payment for Psychiatric CoCM Psychiatric CoCM services furnished on or after January 1, 2019, are paid at the average of the national non-facility PFS payment rate for CPT® codes 99492 (70 minutes or more of initial psychiatric CoCM services) and CPT® code 99493 (60 minutes or more of subsequent psychiatric CoCM services) when psychiatric CoCM HCPCS code, G0512, is on an RHC or FQHC claim, either alone or with other payable services. This rate is updated annually based on the PFS amounts for these codes.

At least 70 minutes in the first calendar month, and at least 60 minutes in subsequent calendar months, of psychiatric CoCM services must have been furnished in order to bill for this service.

Coinsurance for psychiatric CoCM services is 20 percent of the lesser of submitted charges or the payment rate for G0512.

Psychiatric CoCM costs are reported in the non-reimbursable section of the cost report and are not used in determining the RHC AIR or the FQHC PPS rate.

G0512 can be billed once per month per beneficiary when all requirements have been met. Only services furnished by an RHC or FQHC practitioner or auxiliary personnel that are within the scope of service elements can be counted toward the minimum 60 minutes that is required to bill for psychiatric CoCM services and does not include administrative activities such as transcription or translation services.

Additional information is available at the following link, although this FAQ has not yet been updated to add Principal Care Management, which became effective on 1/1/2021: https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/FQHCPPS/ Downloads/FQHC-RHC-FAQs.pdf

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES LTC & SNF EMERGENCY REGULATORY WAIVERS

On April 09, 2021, CMS added more regulatory flexibilities to help contain the spread of COVID-19, but they also discontinued several waiver provisions that affect Long Term Care Facilities (LTCs)and Skilled Nursing Facilities (SNFs.) The new regulatory flexibilities were issued under 1135 waivers and were made to be effective retroactively beginning March 01, 2020 until the end of the emergency declaration. https://www.cms.gov/files/document/covid-19-emergency-declaration-waivers.pdf

The waiver provisions that CMS will end effective May 10, 2021 are detailed below:

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES LTC & SNF EMERGENCY REGULATORY WAIVERS

This blanket waiver was intended to assist nursing homes to take swift action to implement transmissionbased precautions and cohort residents who have been exposed or potentially exposed to COVID-19, CMS waived requirements to provide advance notice prior to transfers or discharges and prior to room or roommate changes.

Prior to the emergency blanket waiver, facilities were required to provide notice when transferring or discharging residents. Facilities were required to provide notice of the transfer or discharge to the resident/representative 30 days in advance, or as soon as practicable prior to the transfer or discharge.

At this time, CMS believes nursing homes have developed practices that have made them able to efficiently cohort residents and provide the required notice in advance. In view of this, facilities are now required to resume providing notice as required in the regulations: - With 30 days advanced notice, or as soon as practicable before the transfer or discharge of a resident; and - Before a room or roommate change Providers please note: CMS is only ending the waivers at (42CFR 483.10) (6) for providing written notice before a room/roommate change, and at 42CFR 483.15(c) (4)(ii) for timing of notification of transfer or discharge. All other related waivers, which continue to allow facilities to transfer or discharge, and change rooms for the sole purpose of cohorting remain in effect. https://www.govregs.com/regulations/title42_chapterIV-i3_part483_subpartB_section483.15

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES LTC & SNF EMERGENCY REGULATORY WAIVERS

Currently, Federal Regulations require a nursing home complete a baseline care plan and comprehensive care plan within 48 hours and seven days of admission to the facility.

In light of the PHE, CMS intended this waiver to aid Nursing Home Facilities implement transmissionbased precautions and cohort residents who have been exposed or potentially exposed to COVID-19.

CMS waived these requirements when transferring or discharging residents to another long-term care facility requirements for the certain cohorting purposes of admission, after a comprehensive MDS. CMS believes that nursing homes have developed processes for completing these important care planning tasks which is the CMS rationale for ending this emergency blanket waiver for 42 CFR 483.21 (a)(1)(i), (a)(2)(i) and (b)(2)(i). https://www.govregs.com/regulations/title42_chapterIV-i3_part483_subpartB_section483.21

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES LTC & SNF EMERGENCY REGULATORY WAIVERS

CMS waived the MDS timeframe requirements at 42 CFR 483.20 for assessments to allow providers flexibility in completing and transmitting assessments. CMS intended this waiver to allow facilities to prioritize infection control efforts in response to PHE. In monitoring, CMS found the majority of facilities have been completing and transmitting assessments timely, therefore, CMS believes all providers should be able to complete and transmit MDS assessments as required at 42 CFR 483.20.

In addition, CMS believes nursing homes should have developed practices for completing these assessments timely, which are critical for resident care planning. https://www.govregs.com/regulations/title42_chapterIV-i3_part483_subpartB_section483.20

Note: The waiver at 42CFR 483.20(k) relating to Pre-Admission Screening and Annual Resident Preview (PASARR) will NOT end at this time (a link and excerpt are provided on the next page.)

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PARA Weekly eJournal: May 19, 2021

CMS UPDATES LTC & SNF EMERGENCY REGULATORY WAIVERS

https://www.govregs.com/regulations/title42_chapterIV-i3_part483_subpartB_section483.20

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PARA Weekly eJournal: May 19, 2021

A GUIDE COMPLIANCE

FOR

LABORATORIES & HOSPITALS Protecting Access To Medicare Act Laboratory Private Payer Rate Reporting Requirements

Pr icin g | Codin g | Reim bu r sem en t | Com plian ce 36

PARA Weekly eJournal: May 19, 2021

BACKGROUND

"

"

PAMA stands for Pr ot ect in g Access t o M edicar e Act of 2014 and was published by The White House Office of Management and Budget to modify the Medicare reimbursement rate methodology for lab services.

In t r odu ct ion CMS created the CLFS to guarantee the new fee schedule continues to ensure adequate access to lab services for Medicare beneficiaries. But, the pre-PAMA Medicare Clinical Lab Fee Schedule (CLFS) payments were based on 1984 cost data and sometimes updated for inflation.

A limited reconsideration process was in place for new tests.The hope for the new CLFS was that by performing a market-based pricing exercise, pricing could be brought up to date and in-line with current practices.

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PARA Weekly eJournal: May 19, 2021

THE DETAILS

"

PAMA reporting requirements apply to any ?applicable laboratory.? An applicable laboratory is a laboratory that receives a majority of its Medicare revenue under the CLFS, the Physician Fee Schedule (?PFS?), or the new section 1834A of the Social Security Act, as added by PAMA.

"

Wh at 's An Applicable Lab? - A laboratory, as defined in CLIA, that bills Medicare Part B under its own NPI

Hospital Labs Serving: - Inpatients - Outpatients - Non-Patients (?Outreach?)

Physician Office Labs Performing: - Point of Care/Traditional Tests - Provider-Performed Microscopy - Pathologists?Practices

Independent Labs Performing: - Standard Tests - Drug Abuse Testing - Molecular Diagnostics 38

- And receives the majority of its Medicare revenue from the PFS or CLFS - And receives more than $12,500 Medicare revenue from the CLFS in a year - The $12,500 threshold does not apply to a single laboratory that furnishes an ADLT (but does apply to any CDLTs that the laboratory performs)

PARA Weekly eJournal: May 19, 2021

THE COST OF NON-COM PLIANCE

CM Ps

WHAT LEADERS NEED TO KNOW

?We are revising the certification and CMP (Civil Monetary Penalties) policies in the final rule to require that the accuracy of the data be certified by the President, CEO, or CFO of the reporting entity, or an individual who has been designated to sign for, and who reports directly to such an officer.

Similarly, the reporting entity will be subject to CMPs for the failure to report or the misrepresentation or omission in reporting applicable information.?

Current CM P Rate: $10,017 Per Day. 39

PARA Weekly eJournal: May 19, 2021

REQUIREM ENTS CAN BE CONFUSING

LETPARAPOINTTHE WAYTHROUGHTHE LABPAYMENT REPORTINGMAZE 40

PARA Weekly eJournal: May 19, 2021

HELP IS HERE

PARA has developed a 30-minute online presentation that can help keep you compliant with PAMA laboratory rate and reporting requirements. It's vital information for all clinical laboratories.

Click t h e sign s t o w at ch .

Th en con t act you r PARA Accou n t Execu t ive f or m or e in f or m at ion .

Our amazingguides.

Ran di Br an t n er

San dr a LaPlace

Violet Ar ch u let -Ch iu

Vice President of Analytics

Account Executive

Senior Account Executive

rbrantner@hfri.net

splace@para-hcfs.com

varchuleta@para-hcfs.com

719.308.0883

800.999.3332 x 225

800.999.3332 x219

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PARA Weekly eJournal: May 19, 2021

NSG OFFERS FREE MEDICARE PART A BILLER TRAINING

PARA reminds our readers that National Government Services (NGS) offers Medicare Part A web-based training sessions to all Part A providers free of cost.A list of the upcoming sessions is available through the following link: http://view.email.ngsmedicare.com/?qs=3eb841224ce3455aef5739714fdecca8 36161f6406ffaa1d7d507e327278090c149804501a1c476a6f951dee71284d554 b292171f77f16e71a73906837be352e790b14558b 766b00b045b2e44a07e8105c166d67e82ae5a5

NGS also offers computer-based training through its Medicare University portal.To access these sessions, you must register and create a log in. Once logged in, registrars have access to thousands of courses.

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PARA Weekly eJournal: May 19, 2021

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, M ay 13, 2021

New s -

Cognitive Impairment: Medicare Provides Opportunities to Detect & Diagnose Open Payments: Review & Dispute Data by May 15 Medicare Shared Savings Program Application: NOIA Opens June1 Women?s Health: Medicare Covers Preventive Services

Com plian ce - Outpatient Rehabilitation Therapy Services: Comply with Medicare Billing Requirements

Claim s, Pr icer s, & Codes - FY 2021 SNF PC Pricer

Even t s - IRF Quality Reporting Program: Achieving a Full AIF Webinar ? May 19 - Medicare Shared Savings Program: Establishing a Repayment Mechanism Webcast ? May 27

M LN M at t er s® Ar t icles - Update to Rural Health Clinic (RHC) Payment Limits ? Revised

M u lt im edia - Community Champions Video Launch - SNF: Cognitive & Mood Assessment Web-Based Training Series - Part A Cost Reports Webcast: Audio Recording & Transcript View this edition as PDF (PDF)

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PARA Weekly eJournal: May 19, 2021

There was 1 new or revised MedLearns released this week.

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

1

FIND ALL THESE MEDLEARNS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eJournal: May 19, 2021

The link to this MedLearn MM12124

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PARA Weekly eJournal: May 19, 2021

There were 5 new or revised Transmittals released this week.

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

5

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eJournal: May 19, 2021

The link to this Transmittal R10804OTN

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PARA Weekly eJournal: May 19, 2021

The link to this Transmittal R10720OTN

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PARA Weekly eJournal: May 19, 2021

The link to this Transmittal R10802DEMO

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PARA Weekly eJournal: May 19, 2021

The link to this Transmittal R10789OTN

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PARA Weekly eJournal: May 19, 2021

The link to this Transmittal R10781OTN

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PARA Weekly eJournal: May 19, 2021

719.308.0883

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