PARA Weekly eMagazine April 10, 2019

PARA WEEKLY

eMAGAZINE

I mproving T he Business of H ealthCare Since 1985 April 10, 2019 PRICING

CODING

REIM BURSEM ENT

COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - L Codes - Correctly Reporting For Mitomycin J7315 And J9280 - IV Therapy Denials - Billing For Inpatient Vaccines SKILLED NURSING FACILITY OIG WORKPLAN FOR 2018 - 2019 COMING SOON! A NEW PDE

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The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

MEDI-CAL 2019 UPDATES FEATURED PRODUCTS: COMPLIMENTARY ASSESSMENTS BILLING LCSW PROFESSIONAL FEES HOSPITAL BEDS & ACCESSORIES: PROVIDER COMPLIANCE FACT SHEET

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Cor r ect Bi l l i n g Page 9

Administration: Pages 1-36 HIM /Coding Staff: Pages 1-36 DM E: Pages 2,27,32 PDE Users: Pages 2,12,25 Providers: Pages 2,4,9,13,16,29 Infusion Svcs: Page 6 Respiratory Svcs: Page 9

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Pharmacy: Pages 10,24,34 SNFs: Page 11 Finance: Pages 13,15,30,33 Behavioral Health: Page 16 M aterials M gmt: Page 22 Compliance: Page 22 Rural HealthCare: Page 23

© 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 eMagazine: April 10, 2019

L CODES

What is the best practice re billing DME codes L3020,L3030,L3040,L3060,L3334,L3908,L3923,L4350? We are not enrolled as a DME supplier.

Answer: For Medicare reimbursement, hospitals are not required to enroll separately as a DME supplier to bill durable medical equipment in the category of ?Prosthetics and Orthotics? (PO), so long as the DME is dispensed incident to other hospital services. In other words, you may not open a boutique selling the DME alone, it must be provided in concert with healthcare services of a hospital.

Attached is PARA's paper on DME which is billable by an OPPS hospital.

To determine if an L-Coded item is in the PO category, access the PARA Data Editor, navigate to the Calculator tab, enter the codes in the query field on the left and select the DME report on the right:

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PARA Weekly eMagazine: April 10, 2019

L CODES

The report returned will indicate in the first column whether it is billable under OPPS, and the category is also displayed:

https://apps.para-hcfs.com/para/Documents/DMEPOS_B illable_by_an_OPPS_Hospital_April_2016_edited.pdf

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PARA Weekly eMagazine: April 10, 2019

CORRECTLY REPORTING FOR MITOMYCIN J7315 & J9280

Currently we are using J3490 for the administration of Topical Mitomycin for Ophthalmic Surgery Procedures, can we also use this for Bladder Instillation?

Answer: There are 2 HCPCS code for Mitomycin: J7315, Mitomycin, Ophthalmic, 0.2 mg and J9280, Injection, Mitomycin 5mg. J7315 is specific to ophthalmic formulation of mitomycin and should be used for topical application, however J7315 can only be reported by a hospital if the hospital uses Mitomycin with the trade name of Mitoso ? any other topical Mitomycin should be reported under J3490.

J9280 is reported for injection however, hospital outpatient departments are not allowed to report J9280 for topical application of Mitomycin. J9280 is reported with a chemotherapy administration code 964XX, as Mitomycin administered in injectable form is indicated for treatment of cancer.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2903CP.pdf

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PARA Weekly eMagazine: April 10, 2019

CORRECTLY REPORTING FOR MITOMYCIN J7315 & J9280

If the instillation occurs in the operating room immediately after one of the following procedures, you should consider the chemotherapy installation as an integral part of the treatment: - 52224-Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of minor (less than 0.5 cm) lesion(s) with or without biopsy - 52234-Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; small bladder tumor(s) (0.5 up to 2.0 cm) - 52235-medium bladder tumor(s) (2.0 up to 5.0 cm) - 52240-large bladder tumor(s) Therefore, the installation isn?t separately billable. You can, however, consider 51720 (Bladder installation of anticarcinogenic agent [including detention time]) a separate procedure if your urologist performs the chemotherapy installation later in the day, such as in the recovery room or in the patient?s hospital room.

In this instance, you can report 51720 and append modifier 59 (Distinct procedural service) to show that the installation was separate from the resection of the bladder tumor and your urologist performed it at a separate encounter on the same day.

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PARA Weekly eMagazine: April 10, 2019

IV THERAPY DENIALS

This responds to your request for assistance in determining why Aetna has been denying lines on outpatient claims for IV therapy services.

Answer: It appears that these claims have CCI edits that were not resolved with modifiers prior to billing. Consequently, the CCI edits caused denials.

Here?s an excerpt of the IV therapy codes reported on the claim provided, the denied lines are highlighted:

Here are the definitions of the codes; the denied codes are outlined in red:

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PARA Weekly eMagazine: April 10, 2019

IV THERAPY DENIALS

The remittance from Aetna indicates remark code 1 on these denied lines ? the denied lines are considered ?mutually exclusive to another procedure performed on the same date of service?:

The same claim also reported an emergency department visit, some lab tests, and a CT scan -- 74177 COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S). There are CCI edits between the CT and the two IV therapy codes that were denied:

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PARA Weekly eMagazine: April 10, 2019

IV THERAPY DENIALS

Since the hospital did not append a modifier to 96360 or 96375, the CCI edit prevents payment. Here?s an excerpt from the NCCI edit manual explaining this edit: https://apps.para-hcfs.com/para/documents/CHAP9-CPTcodes70000-79999_final103118.pdf

If the hydration and the IV push were not related to the administration of contrast, the hospital could append modifier XU ? ?Unusual, non-overlapping service? to the IV therapy codes. You may want to check to see whether the claim scrubber identified the edits; it should have flagged the problem prior to billing. It is also possible that the system identified the edits but billers bypassed the edits without a modifier because they were not sure whether it was appropriate to append a modifier. All three of the claims you provided had the same fundamental problem ? a CT with contrast billed together with IV therapy, and no modifiers resolved the CCI edits.

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PARA Weekly eMagazine: April 10, 2019

ACAPELLA FLUTTER VALVES

Currently our respiratory therapy department does Secretion Management (chest physiotherapy CPTÂŽ 94667) and uses flutter valves. We charge for the therapy but not the valve since the valve is used each time they do the secretion management therapy.

Radiation Oncology/Palliative Care has asked to have a nurse trained so they can also perform Secretion Management for their patients.

They will be giving the patient the flutter valve and educating them on how to use it as well. The Acapella flutter valve that we purchase cost $39.75 each. Can we charge separately for the valve or not?

Answer: A supply which meets the four-question test of our ?Billing for Supplies? paper (attached) may be reported separately. However, when a billable procedure, such as 94667, always consumes the same supply item, we recommend including the cost of the supply into the billable procedure charge rather than charging it separately.

Since the respiratory therapy department has already established the practice of including the cost of the supply in the procedure charge, we recommend following that practice in all departments reporting the same procedure 94667.

https://apps.para-hcfs.com/pde/documents/Billing_ For_Supplies_April_2014.pdf

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PARA Weekly eMagazine: April 10, 2019

BILLING FOR INPATIENT VACCINES

We provide our vaccines to inpatients and SNF patient on date of discharge per CMS guidelines: ?10.2.2 - Bills Submitted to FIs/AB MACs. ?When vaccines are provided to inpatients of a hospital or SNF, they are covered under the vaccine benefit. However, the hospital bills the FI on bill type 12X using the discharge date of the hospital stay or the date benefits are exhausted. A SNF submits type of bill 22X for its Part A inpatients.?

We have an Inpatient Rehab Center here also. How should we report vaccine administration for IRC patients? Should it also be on date of discharge? Would the reimbursement be any different since IRC is reimbursed based on CMG? Answer: It is not necessary to delay administration of the vaccine to the date of discharge for inpatients during covered inpatient acute care or inpatient rehab stays. The vaccine may be administered on any day during the covered stay. Medicare simply requires, for claim processing purposes, that the date of discharge is reported on the separate claim for the vaccine and its administration. This enables the Medicare claims processing system to process separate payment, as appropriate, for this separately covered benefit. Hospitals should report the vaccine administration on the date of discharge, regardless of the date on which the vaccine was administered during the inpatient rehab visit. Reimbursement for the vaccine and its administration will be the same, regardless if it was administered during an outpatient encounter or during an inpatient stay (rehab or acute care.)

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PARA Weekly eMagazine: April 10, 2019

SKILLED NURSING FACILITY OIG WORKPLAN FOR 2018-2019

The following list of OIG audits, evaluations and inspections that are underway or planned as of March 27, 2019 include "skilled nursing facility" in the title or the body of the description. The entire workplan can be viewed at: https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp

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PARA Weekly eMagazine: April 10, 2019

COMING SOON: A NEW PDE

On April 14th, a new version of the PARA Data Editor (PDE) will go live. No action is required by users.

The same URLs will now direct traffic to the new version.

Unlike the original PDE, which was designed to work exclusively with Internet Explorer, this new iteration will be compatible with all current browsers (i.e. Google Chrome, Mozilla Firefox, Microsoft Edge).

Along with increased compatibility, this new version includes significant performance improvements.

Page load and query return times have been decreased throughout the website. Security has also been improved by utilizing the latest version of Microsoft .NET framework.

PARA continues to offer a wealth of information via the PDE, now faster and more secure than ever.

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PARA Weekly eMagazine: April 10, 2019

MEDI-CAL 2019 UPDATES

Historically, California has used local codes or HCPCS Level III codes for reimbursement of services and supplies. CPTÂŽ Category I codes and HCPCS Level II codes are more specific in nature and are considered HIPAA-Compliant National Codes. California Medi-Cal will be converting from HCPCS Level III codes to HIPAA-Compliant National Codes in order to meet the requirements set forth in the Health Insurance Accountability and Portability Act to meet the mandated billing requirements throughout 2019.

Medi-Cal will gradually implement the changes throughout 2019. The code conversions means that providers who currently submit local codes and HCPCS Level III codes on claims will be required to submit claims with the nationally recognized HIPAA-Compliant codes. Medi-Cal has posted a Frequently Asked Questions document and code conversion crosswalk on the website that provides pertinent information and implementation dates to providers: http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaaqa_general_code_conversions.asp

http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaacorrelations_home.asp

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PARA Weekly eMagazine: April 10, 2019

MEDI-CAL 2019 UPDATES

The code conversions that have gone into effect for 2019 include: - Sign Language Interpreter Services, effective January 1, 2019 - Early and Periodic Screening, Diagnosis and Treatment, effective January 1, 2019 Upcoming code conversions that have been announced include: - NICU and PICU services, effective June 1, 2019 - Physical and Occupational Therapy services, effective August 1, 2019 Treatment Authorization Requests (TAR) and Service Authorization Requests (SAR) requirements will still be applicable to the new codes and processes for submitting TARs will not change. TARs and SARs that are submitted after the effective date of the code conversion need to reflect the code change to the HIPAA-compliant national codes.

Medi-Cal has noted that some of the code conversions may allow for a grace period for TARs and SARs and code submission, depending on the applicable code conversion and services rendered. It is important to note that many of the CPTÂŽ Category I codes and the HCPCS Level II codes are already included in the Medi-Cal Fee schedule with payment rates, however, the code conversions may not be in effect yet. PARA will be providing updates on the upcoming code conversions and publishing those within the Weekly eMagazine as well as emails specific to California clients.

Topic Expan sion Exam ple

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PARA Weekly eMagazine: April 10, 2019

FEATURED PRODUCTS: COMPLIMENTARY ASSESSMENTS

PARA HealthCare Analytics clients enjoy a myriad of benefits that improve coding, pricing, compliance and reimbursement.

PARA differs from other revenue cycle consulting companies in that we offer a number of Initial Assessments as a complimentary introduction to PARA services.

Here are some of the Initial Complimentary Assessments available to potential clients, just by contacting one of our knowledgeable Account Executives.

Contact Violet Archulet-Chiu at varchuleta@para-hcfs.com or Sandra LaPlace at slaplace@para-hcfs.com to take advantage of these complimentary reports.

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PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

Professional fees of a hospital-employed licensed Clinical Social Worker (LCSW) are not separately reimbursed by Medicare for hospital inpatients.

However, hospitals may be reimbursed for both the facility fee and the professional fee for certain outpatient services provided by an LCSW (either employed or non-employed providing services ?under arrangement?) who has reassigned his/her Medicare payment benefits to the facility when the following conditions apply: - Services are medically necessary and referred by a qualified physician/non-physician practitioner - Services are NOT part of a partial hospitalization program (PHP), and - Services are within the scope of LCSW licensure under state regulations, and - Covered within the limitations of the Medicare Benefit Policy Manual Professional fees for LCSW services must be billed to the carrier by the facility on Form CMS-1500 or the electronic equivalent 837p. Append modifier AJ to each line of CPTÂŽ/HCPCS codes on the pro fee claim to indicate the reduced LCSW fee schedule applies. Covered outpatient LCSW services are reimbursed at 75% of the Medicare Physician Fee Schedule. The typical code set reported on LCSW professional fee claims in the non-Partial Hospitalization outpatient setting which are eligible for coverage and payment include:

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PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

The Medicare Learning Network publication ?Mental Health Services? (ICN 903195, September 2013) has been removed from the internet ? it summarized the covered services for each mental health provider type.

Here is the section that referred to LCSWs:

WPS, the Medicare Administrative Contractor (MAC) for Part A and Part B in multiple Midwest states, has published Local Coverage Article A54829 entitled ?Clinical Social Worker Services?

(A54829 which is instructive. A link and excerpts follow: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=54829&ver =12&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=All&KeyWord=Clinical+Social +Work&KeyWordLookUp=Title&KeyWordSearchType=And&bc=gAAAACAAAAAA& Article Text: Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.

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PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

Unless otherwise specified, the following A-F is taken from CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15 - Covered Medical and Other Health Services, 170 - Clinical Social Worker (CSW) Services.

A. Clinical Social Worker Defined Section 1861(hh) of the Act defines a ?Clinical Social Worker? as an individual who: - Possesses a master?s or doctor?s degree in social work; - Has performed at least two years of supervised clinical social work; and - Is licensed or certified as a Clinical Social Worker by the State in which the services are performed; or - In the case of an individual in a State that does not provide for licensure or certification, has completed at least 2 years or 3,000 hours of post master?s degree supervised clinical social work practice under the supervision of a master?s level social worker in an appropriate setting such as a hospital, SNF, or clinic B. Clinical Social Worker Services Defined Section 1861(hh)(2) of the Act defines ?Clinical Social Worker services? as those services that the CSW is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed for the diagnosis and treatment of mental illnesses.

Services furnished to an inpatient of a hospital or an inpatient of a SNF that the SNF is required to provide as a requirement for participation are not included. The services that are covered are those that are otherwise covered if furnished by a physician or as incident to a physician?s professional service.

C. Covered Services Coverage is limited to the services a CSW is legally authorized to perform in accordance with State law (or State regulatory mechanism established by State law). The services of a CSW may be covered under Part B if they are: - The type of services that are otherwise covered if furnished by a physician, or as incident to a physician?s service. (See 30 for a description of physicians?services and 70 of Pub 100-1, the Medicare general Information, Eligibility, and Entitlement Manual, Chapter 5, for the definition of a physician.); - Performed by a person who meets the definition of a CSW (see subsection A.); and - Not otherwise excluded from coverage.

Carriers should become familiar with the State law or regulatory mechanism governing a CSW?s scope of practice in their service area.

D. Non Covered Services Services of a CSW are not covered when furnished to inpatients of a hospital or to inpatients of a SNF if the services furnished in the SNF are those that the SNF is required to furnish as a condition of participation in Medicare. In addition, CSW services are not covered if they are otherwise excluded from Medicare coverage even though a CSW is authorized by State law to perform them. For example, the Medicare law excludes from coverage services that are not ?reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.?

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PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

E. Outpatient Mental Health Services Limitation All covered therapeutic services furnished by qualified CSWs are subject to the outpatient psychiatric services limitation in Pub 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 3, ?Deductibles, Coinsurance Amounts, and Payment Limitations,? (i.e., only 62 ½ percent of expenses for these services are considered incurred expenses for Medicare purposes). The limitation does not apply to diagnostic services.

F. Assignment Requirement Assignment is required.

Other Medicare Part B covers Clinical Social Worker services.

CSW services furnished to hospital outpatients are covered and paid under the CSW benefit when billed by the hospital to a Medicare Administrative contractor under the CSW?s National Provider identifier.

CSW services furnished to SNF inpatients and patients in Medicare-participating End-Stage Renal Disease facilities are not covered and paid under the CSW benefit if the services furnished are required under the respective requirements for participation.

CSW services furnished to patients under a Partial Hospitalization Program that is provided by a hospital outpatient department or Community Mental Health Center are not covered and paid under the CSW benefit.

Services furnished as an incident to CSW personal professional services are not covered.

(Medicare Learning Network Mental Health Services, ICN 903195, January 2015) As of July 1, 2014, RHCs (Rural Health Clinic) may contract with NPs, PAs, certified nurse midwives, clinical psychologists, or clinical social workers as long as at least one NP or PA is employed by the RHC (subject to the waiver provision for existing RHCs set forth at Section 1861(aa)(7) of the Social Security Act).(MLN Matters MM8981 and Change Request 8981) In addition, this contractor will cover the CSW services for Health and Behavior Assessment and Intervention.

The Medicare Benefit Policy Manual, Chapter 15 ? Covered Medical and Other Health Services, offers the following guidance: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf 170 - Clinical Social Worker (CSW) Services (Rev. 1, 10-01-03) B3-2152 See the Medicare Claims Processing Manual Chapter 12, Physician/Nonphysician Practitioners, §150, ?Clinical Social Worker Services,? for payment requirements.

A. Clinical Social Worker Defined Section 1861(hh) of the Act defines a ?clinical social worker? as an individual who: - Possesses a master?s or doctor?s degree in social work; - Has performed at least two years of supervised clinical social work; and - Is licensed or certified as a Clinical Social Worker by the State in which the services are performed; or In the case of an individual in a State that does not provide for licensure or certification, has completed at least 2 years or 3,000 hours of post master?s degree supervised clinical social work practice under the supervision of a master?s level social worker in an appropriate setting such as a hospital, SNF, or clinic 19

PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

B. Clinical Social Worker Services Defined Section 1861(hh)(2) of the Act defines ?Clinical Social Worker services? as those services that the CSW is legally authorized to perform under State law (or the State regulatory mechanism provided by State law) of the State in which such services are performed for the diagnosis and treatment of mental illnesses.

Services furnished to an inpatient of a hospital or an inpatient of a SNF that the SNF is required to provide as a requirement for participation are not included. The services that are covered are those that are otherwise covered if furnished by a physician or as incident to a physician?s professional service.

C. Covered Services Coverage is limited to the services a CSW is legally authorized to perform in accordance with State law (or State regulatory mechanism established by State law). The services of a CSW may be covered under Part B if they are: - The type of services that are otherwise covered if furnished by a physician, or as incident to a physician?s service. (See ยง30 for a description of physicians?services and ยง70 of Pub 100-1, the Medicare General Information, Eligibility, and Entitlement Manual, Chapter 5, for the definition of a physician); - Performed by a person who meets the definition of a CSW (See subsection A.); and - Not otherwise excluded from coverage A/B MACs (B) should become familiar with the State law or regulatory mechanism governing a CSW?s scope of practice in their service area.

D. Noncovered Services Services of a CSW are not covered when furnished to inpatients of a hospital or to inpatients of a SNF if the services furnished in the SNF are those that the SNF is required to furnish as a condition of participation in Medicare. In addition, CSW services are not covered if they are otherwise excluded from Medicare coverage even though a CSW is authorized by State law to perform them. For example, the Medicare law excludes from coverage services that are not ?reasonable and necessary for the diagnosis or treatment of an illness or injury or to improve the functioning of a malformed body member.?

E. Outpatient Mental Health Services Limitation All covered therapeutic services furnished by qualified CSWs are subject to the outpatient psychiatric services limitation in Pub 100-01, Medicare General Information, Eligibility, and Entitlement Manual, Chapter 3, ?Deductibles, Coinsurance Amounts, and Payment Limitations,? ยง30, (i.e., only 62 1/2 percent of expenses for these services are considered incurred expenses for Medicare purposes). The limitation does not apply to diagnostic services.

F. Assignment Requirement Assignment is required.

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PARA Weekly eMagazine: April 10, 2019

BILLING LCSW PROFESSIONAL FEES FOR HOSPITAL PATIENTS

Critical Access Hospital billing and payment for outpatient LCSW services is found in the Medicare Claims Processing Manual, Chapter 4 ?Part B Hospital (Including Inpatient Hospital Part B and OPPS).? A link and an excerpt are provided below: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf 250.14 ? Payment of Licensed Clinical Social Workers (LCSWs) in a Method II CAH (Rev. 2202, Issued: 04-27-11, Effective: 10-01-11, Implementation: 10-03-11) The services of a LCSW that has reassigned their billing rights to a Method II CAH are payable by Medicare when the procedure is billed on type of bill 85X with revenue code (RC) 96X, 97X, and/or 98X and the AJ modifier (clinical social worker).

Under Section 1834(g)(2)(B) of the Act, outpatient professional services performed in a Method II CAH are paid 115 percent of such amounts as would otherwise be paid under the Act if the services were not included in the outpatient CAH services.

Section 1833 (a)(1)(F) of the Act stipulates that payment for services performed by a LCSW shall be 80 percent of the lesser of the actual charges for the services or 75 percent of the amount determined for the payment of a psychologist.

Payment is calculated as follows: ((Facility specific MPFS amount times the LCSW reduction (75%)) minus (deductible and coinsurance)) times 115%.

Finally, the Medicare Claims Processing Manual, Chapter 12 - Physicians/Non-physician Practitioners, provides only brief mention of LCSW billing and payment: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf 150 - Clinical Social Worker (CSW) Services (Rev. 2656, Issuance: 02-07-13, Effective: 02-19-13, Implementation: 02-19-13) See Medicare Benefit Policy Manual, Chapter 15, for coverage requirements.

Assignment of benefits is required.

Payment is at 75 percent of the physician fee schedule.

CSWs are identified on the provider file by specialty code 80 and provider type 56. Medicare applies the outpatient mental health limitation to all covered therapeutic services furnished by qualified CSWs. Refer to ยง210, below, for a discussion of the outpatient mental health limitation.

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PARA Weekly eMagazine: April 10, 2019

HOSPITAL BEDS AND ACCESSORIES: PROVIDER COMPLIANCE TIPS

In 2017, t h e M edicar e Fee-For -Ser vice (FFS) im pr oper paym en t r at e f or h ospit al beds an d accessor ies w as 78.5 per cen t , w it h pr oject ed in accu r at e paym en t s of $66.2 m illion . Im pr oper paym en t s r esu lt ed f r om in su f f icien t docu m en t at ion .

Prevent denials by reviewing the Provider Compliance Tips for Hospital Beds and Accessories Fact Sheet, which details general requirements, coverage, and documentation requirements for: - Physician?s prescription - Variable height feature - Electric powered adjustments - Side rails

Dow n load you r copy of t h is Fact Sh eet by click in g on t h e ph ot o t o t h e lef t .

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PARA Weekly eMagazine: April 10, 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: April 1 - April 15 for a July 1 start date; 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 Completitive 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 Healthcare Provider Quality Improvement Program Provides up to $200,000 per year for three years to demonstrate improvement in rural healthcare, specifically for measuring patient outcomes, chronic disease management, increased engagement between providers and patients, and integration of mental/behavioral health programs in rural communities.

Application Deadline: April 22, 2019

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PARA Weekly eMagazine: April 10, 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, April 4, 2019 New s & An n ou n cem en t s

· New Part D Policies Address Opioid Epidemic · ?Qué está Cubierto? · Physician Compare: Supplemental Preview Period Open until April 27 · Open Payments: Review and Dispute Data by May 15 · Comparative Billing Report on Subsequent Hospital Visits · PEPPERs for Hospices, LTCHs, SNFs, IRFs, IPFs, and CAHs, · Hospice Visits when Death is Imminent Measure Pair · Mapping Medicare Disparities Tool: New Enhancements · Medicare-Medicaid Crossover Bad Debt Accounting Classification · Qualified Medicare Beneficiary Billing Requirements · National Minority Health Month: Active & Healthy · Looking for Educational Materials?

Com plian ce

· Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing Even t s

· Comparative Billing Report: Subsequent Hospital Visits Webinar ? April 11 M LN M at t er s® Ar t icles

· Activation of Systematic Validation Edits for OPPS Providers with Multiple Service Locations · ASP Medicare Part B Drug Pricing Files and Revisions: July 2019 · Changes to the Laboratory NCD Edit Software: July 2019 · Correction to FY 2019 IPPS Pricer · FY 2017 SSI/Medicare Beneficiary Data for IPPS Hospitals, IRFs, LTCHs · NCCI PTP Edits: Quarterly Update · E/M and Superficial Radiation Treatment ? Revised Pu blicat ion s

· Understanding the Medicare Beneficiary Identifier · Acute Care Hospital Inpatient Prospective Payment System ? Revised

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PARA Weekly eMagazine: April 10, 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

A pril 4, 2019 Update

Prev ious Updates

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PARA Weekly eMagazine: April 10, 2019

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

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

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

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PARA Weekly eMagazine: April 10, 2019

The link to this Med Learn MM11233

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PARA Weekly eMagazine: April 10, 2019

There were SIX new or revised Transmittals released this week.

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

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R4267CP

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R2275OTN

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R2276OTN

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R4275CP

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R312FM

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PARA Weekly eMagazine: April 10, 2019

The link to this Transmittal R875PI

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PARA Weekly eMagazine: April 10, 2019

Con t act Ou r Team Peter Ripper President

Randi Brantner

pripper @para-hcfs.com

Director Financial Analytics

M onica Lelevich

rbrantner @para-hcfs.com

Director Audit Services

Sonya Sesteli Chargemaster Client Manager ssesteli @para-hcfs.com

mlelevich @para-hcfs.com

Sandra LaPlace

M ary M cDonnell

Account Executive

Director PDE Training & Development

slaplace @para-hcfs.com

mmcdonnell @para-hcfs.com

Violet Archuleta-Chiu Deann M ay Claim Review Specialist

Senior Account Executive

Steve M aldonado

Patti Lew is

Director Marketing

Director Business Operations

smaldonado @para-hcfs.com

varchuleta @para-hcfs.com

dmay @para-hcfs.com 35

plewis @para-hcfs.com

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