PARA Weekly eJournal May 29, 2019

PARAWeekly -

eJOURNAL

PRICING CODING REIM BURSEM ENT COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS M ay 29, 2019

Feat ur ing

IN THIS ISSUE QUESTIONS & ANSWERS - Revenue Code For Q0091 - Elastography Orders - Albumin Infusion With Paracentesis - Patient Health Questionnaire With Telemedicine MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE UPDATE FOR HOME HEALTH FORM CHANGES FOR NON-COVERAGE PHARMACY PRICING PROCESS

Ph ar m acy Pr icin g Pr ocess

1

Hospit al ph ar m acy m ar k u ps n eed t o k eep pace w it h cost basis, payer m ix an d clin ical dat a r equ ir em en t s.

Fin d ou t h ow o n Page 15

The number of new or revised Med Learn articles released this week.

9

The number of new or revised Transmittals released this week.

Diabet es Prevent ion Program

M edi -Cal Updat e

Page 17

CALIFORNIA UPDATE:2019 DIABETES PREVENTION PROGRAM RURAL HOSPITAL GRANTS -- UPDATED MLN CONNECTS NEWSLETTER

PARA COMPANY NEWS

SERVICES

ABOUT PARA

CONTACT US

Page 7

FAST LINKS

-

Administration: Pages 1-37 HIM /Coding Staff: Pages 1-37 Laboratory: Page 2 Imaging: Pages, 3,4,33 Surgical Svcs: Pages 4,19 Telehealth: Page 6 Behavioral Health: Page 7

-

Home Health: Pages 14,25,35 Finance: Pages 15,18,27,29 PDE Users: Pages 15,23 Ambulatory Svcs: Page 17 Diabetic Care: Page 18 Rural HealthCare: Page 21 CAH: Page 31

© PARA Healt h Car e An alyt ics 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 29, 2019

REVENUE CODE FOR Q0091

Our question is about what is the correct revenue code to use for Q0091.

Answer: Apparently the folks that write the UB Manual are not on the same page with Medicare. Attached is a Medicare publication that instructs hospitals to report Pap tests (i.e. Q0091) in revenue code 0311 (LABORATORY PATHOLOGY ? CYTOLOGY) on institutional claims, including CAH claim type 85X. The pelvic exam, which is the G-code, should be reported in rev code 0770: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/Screening-PapPelvic-Examinations.pdf

The UB manual is the resource PARA uses to populate our revenue code lookup. Here?s an excerpt from the UB Manual:

Sometimes, albeit rarely, the UB manual HCPCS to revenue code crosswalk has a slip-up. We have updated the PARA Data Editor to reflect 0311 as the appropriate revenue code for Q0091. In the meantime, if you?re still struggling with that claim, try revenue code 0311 ?LABORATORY PATHOLOGY ?

CYTOLOGY? for Q0091.

2

PARA Weekly eJournal: May 29, 2019

ELASTOGRAPHY ORDERS

For elastography, I need to know from PARA if we can add the elastography charge to an ultrasound study if the ultrasound tech thinks it is necessary, or do we need to mention in the report about elastography needed and have the patient return for the test after the physician specifically orders it?

Another scenario is what if the physician writes the US liver order with the phrase ?elastography if needed? Does that suffice?

Answer: The American College of Radiology (ACR) offers guidance on when it is acceptable for a radiologist to add additional studies to an original order or to change the imaging order of a treating physician.

However, the guidance addresses modifications to orders decided upon by a physician radiologist, not a radiology tech. We don?t find that a charge for additional studies will be supported in the absence of an order from a physician or non-physician practitioner, such as an MD, PA, or Nurse Practitioner.

The order with the phrase ?elastography if needed? is insufficient. A conditional order (?elastography if ? ?) might be acceptable if it provided specific criteria for adding an elastography study. ?If needed? might be modified to state ?if needed in the opinion of the interpreting radiologist.?

However, the determination as to whether elastography is needed should not be left to the radiology tech.

Here is an excerpt from the ACR website: https://www.acr.org/ Advocacy-and-Economics/ Coding-Source/ ACR-Radiology-CodingSource-May-June-2007 ?An order may conditionally request an additional diagnostic test for a particular beneficiary if the initial ordered test result yields a certain value (i.e., if test X is negative, then perform test Y). ?As requested by the ACR, CMS also clarified in Section 15021 (E) of the MCM that a radiologist may perform the following without notifying the treating physician: ?Unless specified in the order, set the protocol for a given diagnostic, interventional, or therapeutic procedure ordered (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media). ?Modify an order with clear and obvious errors (e.g., x-ray of wrong foot ordered). ?Cancel an order because the beneficiary?s physical condition at the time of the diagnostic testing will not permit performance of the test. Any medically necessary preliminary or scout studies performed prior to the cancelled order should be coded."

3

PARA Weekly eJournal: May 29, 2019

ALBUMIN INFUSION WITH PARACENTESIS

We are getting a denial for the infusion of albumin when done on the same day as a paracentesis (49083). The albumin infusion is done in ambulatory care and the paracentesis is done in radiology.

They are paying for the drug (P9047) but not the infusion code (96365). Is the infusion considered bundled with the paracentesis even if it is done in a different department of the hospital?

Answer: The department of the hospital in which a procedure is performed is not a consideration when determining whether two procedures may be reported together in the same encounter.

There is a CCI edit between 96365 and both of the paracentesis codes (49082 is without imaging guidance, and 49083 is with imaging guidance):

The payer?s denial cites language from the 2019 CMS National Correct Coding Initiative Manual: https://apps.para-hcfs.com/para/documents/CHAP11-CPTcodes90000-99999_final103118.pdf 12. Under Medicare Global Surgery Rules, drug administration services (CPT® codes 96360-96377) are not separately reportable by the physician performing a procedure for drug administration services related to the procedure.

Under the OPPS drug administration services related to operative procedures are included in the associated procedural HCPCS/CPT® codes. Examples of such drug administration services include, but are not limited to, anesthesia (local or other), hydration, and medications such as anxiolytics or antibiotics. Providers shall not report CPT® codes 96360-96377 for these services. ?

If a physician performing an operative procedure provides a drug administration service (CPT® codes 96360-96375) for a purpose unrelated to anesthesia, intra-operative care, or post-procedure pain management, the drug administration service (CPT® codes 96360-96375) may be reported with an NCCI-associated modifier if performed in a non-facility site of service.

We checked a number of other providers who reported both 49083 and P9047 on Medicare claims in the period Jan-Jun 2018, and find that typically, they did not also report 96365. Your facility reported several claims with both 49083 and no P9047 in 2018, as well.

The question of whether the infusion administration code 96365 should be separately reported revolves around whether the administration of the infusion is ?integral to? the surgical procedure. PARA offers a guideline at the link below to test whether a second service is ?integral to? the first: https://apps.para-hcfs.com/pde/documents/PARA_ Opinion_Integral_To_Concepts.pdf 4

PARA Weekly eJournal: May 29, 2019

ALBUMIN INFUSION WITH PARACENTESIS

While an albumin transfusion is not always performed with paracentesis, it is common. We checked our national database of claims submitted to Medicare. P9047 was billed together with 49082 on 60% of all claims submitted to Medicare in the Jan-Jun 2018 period, and over 40% of the time on claims reported 49083. However, 96365 was reported far less frequently than albumin on the same data set -- in other words, it is fairly common to report albumin with paracentesis, but not as common to also claim reimbursement for 96365.

We found clinical guidelines from the American Association of Liver Disease (AASLD) that indicate an albumin infusion should be performed as standard practice when the paracentesis removes a large volume of fluid. https://www.aasld.org/sites/default/files/guideline_documents/141020_Guideline_Ascites_4UFb_2015.pdf

Since the guideline indicates that studies show an infusion of albumin improves survival, it may be considered unsafe to remove a large volume of fluid via paracentesis without also administering the albumin.

Consequently, we find that the administration of albumin is ?integral to? paracentesis procedures, and should not be separately reported.

5

PARA Weekly eJournal: May 29, 2019

PATIENT HEALTH QUESTIONNAIRE WITH TELEMEDICINE

Providers are performing telehealth behavioral health services in conjunction with PHQ (Patient Health Questionnaire) and/or GAD (Generalized Anxiety Disorder) Assessment.

When this occurs, the RN administers the PHQ and GAD, results are shared with the provider via telehealth.

Given that PHQ/GAD 96127 is not listed as telehealth services by Medicare MedLearn January 2019, what should the billing place of service for the PHQ/GAD be?

Answer: As you know, the facility should report the Telehealth Originating Site HCPCS, Q3014. Although there is not clear direction within the Medicare Claims Processing Manual on this question, it is our opinion that the facility fee for 96127 may also be reported on the hospital claim, provided that the telehealth physician has recorded an order for the collection of the PHQ and/or GAD in the hospital?s medical record.

If two standardized questionnaires are administered, the hospital may report two units, since the code represents ?Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale) with scoring and documentation, per standardized instrument.?

The location of service on the facility fee claim (UB04/837i) should be the address where the service was performed. Do not report 96127 on the professional fee claim, since it is not approved for telehealth services performed by a remote physician.

Report one of the appropriate Telehealth service codes (i.e. 96150-96154, 90791-90792) on the professional fee claim for the physician at the remote location on CMS1500/837p, with place of service code 02, telemedicine.

6

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

M

edicat ion assist ed t r eat m en t (M AT) is of f er ed t o pat ien t s w h o h ave a cu r r en t diagn osis of opioid u se disor der (OUD), m oder at e or sever e, an d w h o m eet pr e-det er m in ed cr it er ia f or par t icipat ion . Th e dr u g of ch oice f or t h is paper is bu pr en or ph in e/ n aloxon e, h ow ever , t h e sam e gu idelin es w ou ld apply acr oss all dr u gs u sed in t h e opioid depen den ce.

Pr ovider s sh ou ld n ot e; t h e except ion is m et h adon e, as t h is is n ot a Par t D dr u g w h en u sed f or t r eat m en t of opioid depen den ce becau se it can n ot be dispen sed f or t h is pu r pose u pon a pr escr ipt ion at a r et ail ph ar m acy.

Th e m edicat ion of ch oice is bu pr en or ph in e/ n aloxon e f or n on -pr egn an t par t icipan t s an d bu pr en or ph in e sin gle in gr edien t f or pr egn an t par t icipan t s. Pr e-au t h or izat ion by in su r an ce is r equ ir ed as som e payer s h ave specif ic br an d pr ef er en ces f or bu pr en or ph in e/ n aloxon e com bin at ion m edicat ion .

Nat ion al an d st at e gu idelin es su ggest M AT pr ogr am par t icipat ion be m an aged as elect ive t r eat m en t an d sh ou ld h ave a specif ic sign ed in f or m ed con sen t .

7

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

There are two options for setting up a successful program that will assist the patient from - the first steps of induction phase, moving on to - stabilization phase and ending with - maintenance phase For each of these steps, the best practice would be to include a full treatment team that includes: - Front office nursing - Prescriber - Medical records/billing - Program administrator Option 1 approach suggestion: The nursing team complete most of the paperwork, screening and diagnostic forms, medication history, and withdrawal scales.

The prescriber meets with the patient for a face-to-face encounter to confirm diagnosis, treatment plan and write appropriate prescriptions.

Under this option, this will typically be a lower level of service code (99213-99214 (Induction phase)).

8

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

Option 2 approach suggestion: The prescriber meets face-to-face with the program participant on the day of induction, completes the history and physical, administers the first buprenorphine dose, and then continues to monitor and observe the patient over a period extending 1-2 hours in a clinic setting.

This option will result in a higher level of service code (99215 plus extended care 99354). It is important to note, if using the higher level of care option, documentation by the prescriber must meet the criteria of the patient?s current treatment plan.

Recommended diagnosis for MAT claims is F11.20 = Opioid dependence.

The following are examples of structured visits for MAT. Pre-Induction visit: - Visit type: Adult Wellness Visit (AWV) or acute visit for Opioid Use Disorder/ Dependence - Comprehensive evaluation of new patient or established patient for suitability for buprenorphine treatment - New patient code 99205 - Established patient code 99215 9

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

Induction Visit - Visit type: MAT medication induction - Any of the new patient evaluation and management (E/M) codes can be used for induction visits.

Codes are listed in order of increasing length of time with the patient and/or the severity level of the patient problems - Established patient codes 99212-99215 - Prolonged visits codes (99354 ? 99355) may also be reported as an add-on code to the assigned E/M code for services that extend beyond the typical service time, with or without face-to-face contact. Time spent does not need to be continuous - 30-74 minutes is typical for 99354 - 75-104 minutes is typical for 99355 - 105+ minutes would be typical for 99354 and 99355 X2 Maintenance Visit - Visit type: MAT medication. Acute visit for OUD/opioid dependence - Any of the established patient E/M codes can be used for maintenance visits - Counseling codes are more common in coding for maintenance visits, since counseling and coordination of service with addiction specialists comprise the majority of the follow-up visits.

- Established visit codes 99212-99215 Screening, Brief Intervention and Referral for Treatment (SBIRT) can be offered and is billable for naloxone education.

For commercial payer plans provider report 99408:

10

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

Medicare providers can report G2011, G0396 or G0397:

Coding examples for participants of MAT programs with Behavioral Health Problems (BHPs) Counseling and coordination of services with MAT BHPs are going to fall within the maintenance visit phase of the program. Counseling codes should be used in place of E/M codes (99212-99215) when more than 50% of a visit is dedicated to counseling or coordination of care. Coding is then based on the total visit time, not just the time spent counseling or coordinating the care.

Assessment visits (MAT Intake): - Visit type: Diagnostic Evaluation - New or established patient: 90791

Induction Visits - Visit type: MAT BH - Mental Health Assessment by a Non-Physician: H0031 Maintenance Visits - Visit type: MAT BH - BH consult during MAT med visits - Mental Health Assessment by a Non-Physician: H0031 11

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

- Psychotherapy: For use in all settings with patient or family (with no medical evaluations and management) - 30 (16-37) minutes: 90832 - 45 (38-52) minutes: 90834 - 60 (53+) minutes: 90837 Screening, Brief Intervention and Referral for Treatment (SBIRT) can be offered and is billable for naloxone education with MAT BHP participants (99408).

Billing considerations that should be reviewed and noted by providers: - Extent to which medication is covered by payer - Medicaid covers office-based buprenorphine treatment. Prior authorization is required - Medicare may not cover office-based buprenorphine induction and maintenance visits - Medicare Part D may cover the cost of the buprenorphine tablets - Prior authorization is require--however, only some Medicare providers will reimburse - Almost all major insurances cover the cost of the prescription. Some private health insurers have standard billing codes for buprenorphine treatment services - For example, Cigna requires that clinicians use H0033 for buprenorphine related visits

- Patients who do not have coverage or are uninsured can apply for a patient assistance program (PAP) for buprenorphine through the pharmaceutical company - Some program participants may qualify for free medications for up to one year References: https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra /Downloads/Part-D-Benefits-Manual-Chapter-6.pdf

12

PARA Weekly eJournal: May 29, 2019

MEDICATION ASSISTED TREATMENT FOR SUBSTANCE ABUSE

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE18004.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles /Downloads/SE18016.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM11063.pdf

13

PARA Weekly eJournal: May 29, 2019

UPDATE FOR HOME HEALTH: FORM CHANGES FOR NON-COVERAGE

In an update announcement by CMS effective July 01, 2019, all Home Health Agencies (HHA) will be required to use the renewed form Home Health Change of Care (HHCCN) with the expiration date of 04/30/2022.

The old form will be accepted by CMS until June 30, 2019. There have been no changes to the form, except for the added expiration date.

The link to the new form has been inserted below:

https://www.cms.gov/Medicare/Medicare-General-Information/BNI/HHCCN.html

14

PARA Weekly eJournal: May 29, 2019

PDE SERVICE: PHARMACY PRICING PROCESS

PARA HealthCare Analytics makes every effort to remain abreast of industry trends and issues through continuing education opportunities. One avenue includes reviewing the Bill of the Month releases from NPR (https://www.npr.org/series/651784144/bill-of-the-month). Occasionally, these articles trigger a need for further research, review, and response from PARA staff.

The April 2019 article, Summer Bummer: A Young Camper's $142,938 Snakebite, highlights an issue commonly found in drug pricing for hospitals.

In the article, the patient was charged $67,957 for four vials of CroFab antivenin. The current cost of CroFab is approximately $3,198 per vial. This means that the hospital had a 5.3 times cost markup against this product, at the time of this case.

In our experience, this product was significantly more expensive fifteen years ago, $6,000-10,000 per vial, depending on the purchasing contract.

In our opinion, this could be a case where the hospital did not update prices when their purchasing cost decreased. This is something we see many times when reviewing pharmacy markups for our clients. Our recommendation is to ensure that updated pharmacy costs are used to reprice items at least annually.

Here's how PARA can assist in this effort.

15

PARA Weekly eJournal: May 29, 2019

PDE SERVICE: PHARMACY PRICING PROCESS

THE PARA SOLUTION: The PARA Pharmacy Pricing Process assists facilities in creating a rational, cost-based pharmacy markup that remains sensitive to self-administered drugs and uses a nationally recognized cost basis.

Details of this project including purpose, data requirements, method, timeline, and deliverables are as follows. If you would like more information, please contact your Account Executive.

PURPOSE: The purpose of the PARA Pharmacy Pricing Process is to create a rational, cost-based pharmacy markup using the cost-basis and charge categories as determined by the client according to the information presented above. The project focuses on reducing self-administered drugs while increasing injectable items to meet the revenue goals of the organization.

DATA REQUIREMENTS: The required data tables and fields for the PARA Pharmacy Pricing Process are as follows: - Pharmacy Clinical Data: National Drug Codes (NDC), drug type/charge category/route of administration and charge code - Pharmacy Markup: Charge category, multipliers, minimums, and additional fees - Charge Master: Charge code, current charge/price, HCPCS Code - Cost Basis: NDC and AWP/ACQ/ASP as found in the pharmacy system - Transaction Data: Detailed patient level claims data Payer Contract Matrix- Managed care contract settlement terms METHOD: PARA Data Staff will tie these tables together and load into the PARA Data Editor. The client will complete a Pharmacy Markup/Pricing Goals questionnaire to outline preferences in charge category, cost basis, revenue goals, and other important aspects of the analysis.

The PARA Analytics staff will create a markup to meet the goals of the project and calculate the gross and net revenue opportunity of the proposed markup. The client will review the proposed markup and identify any areas where changes would like to be made.

After the final markup has been approved, the client will either implement or engage PARA to implement the markup as outlined above. After implementation, PARA will perform an impact analysis after one month of implementation and every quarter through the length of the engagement.

16

PARA Weekly eJournal: May 29, 2019

PDE SERVICE: PHARMACY PRICING PROCESS

TIMELINE:

DELIVERABLES: The PARA Pharmacy Pricing Process deliverables to the client include a proposed markup, gross and net revenue projections, an item-specific detailed spreadsheet proposed changes, and a full write-up of techniques and findings.

Contact Violet Archuleta-Chiu at varchuleta@para-hcfs.com or Sandra LaPlace at slaplace@para-hcfs.com for more information.

17

PARA Weekly eJournal: May 29, 2019

MEDI-CAL 2019 DIABETES PREVENTION PROGRAM

California Update The Diabetes Prevention Program (DPP) is a program that is designed to assist Medi-Cal beneficiaries in preventing or delaying the onset of Type 2 Diabetes.

The program is for beneficiaries that have been diagnosed with pre-diabetes and is an evidence-based lifestyle program to assist patients with their health and wellness.

Effective January 1, 2019, the DPP will be a covered Medi-Cal benefit. The Medi-Cal program will follow the Federal Centers for Disease Control (CDC) and Prevention guidelines and will also include several components of the Medicare DPP program.

Medi-Cal providers who choose to offer DPP services must comply with CDC guidelines and must obtain CDC recognition in association with the National Diabetes Prevention Recognition Program.

The MediCal DPP program will consist of at minimum, 22 peer coaching sessions over a 12-month period and will be provided regardless of participant weight loss. Those participants who achieve and maintain the required minimum weight loss of 5 percent from the first set of core sessions will be eligible to receive ongoing monitoring and maintenance sessions after the initial 12-month period.

Provider requirements for participation in the DPP program can be found at the following link: https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP _OIL_Enclosure_A_Webpage.pdf DPP recognized providers may bill one of the following payable codes (also accessible at the link on the next page), as long as the requirements for billing the codes are met, including but not limited to the session attendance for specific core and ongoing maintenance session intervals and achievement of weight loss as applicable to the specific codes.

18

PARA Weekly eJournal: May 29, 2019

MEDI-CAL 2019 DIABETES PREVENTION PROGRAM

California Update https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP_OIL_Enclosure_A_Webpage.pdf

19

PARA Weekly eJournal: May 29, 2019

MEDI-CAL 2019 DIABETES PREVENTION PROGRAM

California Update Currently, DHCS is still finalizing the claims adjudication system for DPP services. Although DPP services are available to beneficiaries effective January 1, 2019, providers should hold all Medi-Cal FFS DPP claims until DHCS releases final billing policy, which will provide instructions for claims submission.

Medi-Cal has provided a Frequently-Asked-Questions document which includes helpful information for billing guidelines and answers a multitude of questions about the DPP program. https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP_FAQ_Clean.pdf

For providers interested in enrolling in the DPP program with DHCS, access the DPP website at the following link: https://www.dhcs.ca.gov/services/medi-cal/Pages/Diabetes-Prevention-Program.aspx

20

PARA Weekly eJournal: May 29, 2019

RURAL HOSPITAL PROGRAM GRANTS AVAILABLE

Rural hospitals and clinics face their own set of unique and burdensome challenges when it comes to program development, cash management and maintaining volume. That's why it's great when they can get some assistance from external funding sources.

At PARA, we've found an excellent source of funding opportunities for rural healthcare facilities.

Here are some examples.

340B Drug Pricing Program - The program provides prescription drugs at a reduced cost to eligible entities. Participation in the Program results in significant savings estimated to be 20% to 50% on the cost of pharmaceuticals for safety-net providers.

- Registration periods are open 4 times throughout the year, and are processed in quarterly cycles.

- Funding cycles are as follows: July 1 - July 15 for an October 1 start date; October 1 - October 15 for a January 1 start date

Rural Health And Safety Education Competitive Grants Program Provides up to $350,000 to increase individual or family motivation to take responsibility for their own health.

Application Deadline: June 10, 2019

Small Ambulatory Program For Native Americans And Alaska Natives Provides up to $2,000,000 to fund ambulatory healthcare facilities on municipal, private or Tribal land to provide healthcare services to eligible Native Americans. Can be used for modernization or expansion of existing facilities, or new or replacement facilities.

Application Deadline: June 28, 2019

21

PARA Weekly eJournal: May 29, 2019

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!

Thursday, May 24, 2019 New s & An n ou n cem en t s

· No Shortcuts to Safer Opioids Prescribing: CDC Commentary · CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency · SNF Provider Preview Reports: Review Your Data by May 30 · Draft 2020 QRDA Category III Implementation Guide: Submit Comments by June 5 · Medicare Shared Savings Program: Do You Plan to Apply to be an ACO? · Promoting Interoperability Program: 2015 Edition CEHRT Required · April ? June Quarterly Provider Update · Break Free from Osteoporosis Com plian ce

· Provider Minute Video: The Importance of Proper Documentation Claim s, Pr icer s & Codes

· Medicare Diabetes Prevention Program: Valid Claims Even t s

· DMEPOS Competitive Bidding: Round 2021 Webcast Series ? Updated Schedule · Post-Acute Care QRPs: Reporting Requirements and Resources Call ? June 5 · Emergency Department Services: Comparative Billing Report Webinar ? June 11 · Hospice Quality Reporting Program: Review and Correct Report Webinar ? June 11 M LN M at t er s® Ar t icles

· Claim Status Category and Claim Status Codes Update · Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes ? July 2019 Update · Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update · Reporting the HCPCS Level II Modifiers of the Patient Relationship Categories and Codes · Proper Use of Modifier 59 ? Revised Pu blicat ion s · Provider Compliance Tips for Positive Airway Pressure (PAP) Devices and Accessories Including Continuous Positive Airway Pressure (CPAP) ? Revised

· Medicare Basics: Commonly Used Acronyms ? Reminder View this edition as a PDF [PDF, 254KB] 22

PARA Weekly eJournal: May 29, 2019

WEEKLY IT UPDATE

PARA HealthCare Analytics has provided a list of enhancements and updates that our Information Technology (IT) team has made to the PARA Data Editor this past week.

The following tables includes which version of the PDE was updated, the location within the PDE, and a description of the enhancement.

Week ly IT Updat e

Prev ious Updates

23

PARA Weekly eJournal: May 29, 2019

There was ONE new or revised Med Learn (MLN Matters) article released this week.

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

FIND ALL THESE MED LEARNS IN THE ADVISOR TAB OF THE PDE

24

1

PARA Weekly eJournal: May 29, 2019

The link to this Med Learn MM11272

25

PARA Weekly eJournal: May 29, 2019

There were 9 new or revised Transmittals released this week.

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

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

26

9

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R310CP

27

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R189SOMA

28

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R316FM

29

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R2311OTN

30

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R882PI

31

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R4309CP

32

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R4313CP

33

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R4314CP

34

PARA Weekly eJournal: May 29, 2019

The link to this Transmittal R4312CP

35

PARA Weekly eJournal: May 29, 2019

Con t act Ou r Team

Peter Ripper

M onica Lelevich

Randi Brantner

President

Director Audit Services

Director Financial Analytics

m lelevich@para-hcfs.com

rbrantner@para-hcfs.com

pripper@para-hcfs.com

Violet Archuleta-Chiu Senior Account Executive

Sandra LaPlace

Steve M aldonado

Account Executive

Director Marketing

slaplace@para-hcfs.com

smaldonado@para-hcfs.com

varchuleta@para-hcfs.com

Nikki Graves

Sonya Sestili

Deann M ay

Senior Revenue Cycle Consultant

Chargemaster Client Manager

Claim Review Specialist

ngraves@para-hcfs.com

ssestili@para-hcfs.com

dmay@para-hcfs.com

M ary M cDonnell

Patti Lew is

Director, PDE Training & Development

Director Business Operations

mmcdonnell@para-hcfs.com

plewis@para-hcfs.com

36

PARA Weekly eJournal: May 29, 2019

37