PARA Weekly eMagazine Grayscale Version March 20, 2019

PARA WEEKLY eMAGAZINE

I mproving T he Business of H ealthCare Since 1985 M arch 20, 2019 PRICING

CODING

REIM BURSEM ENT

COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Intra-Abdominal Pressures - B4087 and B4088 - Lab Codes - IVs During Recovery - Covered Diagnoses - Medical Necessity for t-PA FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET HOSPITAL BEDS & ACCESSORIES: PROVIDER COMPLIANCE FACT SHEET

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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.

Local Coverage Det erminat ion

t -PA M EDICAL N ECESSITY Page 8

PARA DATA EDITOR UPGRADE CMS RELEASES OPIOID PRESCRIBING MAPPING TOOL CMS EXPANDS PRIVATE PAYOR LAB REIMBURSEMENT REPORTING

PARA COMPANY NEWS

SERVICES

ABOUT PARA

CONTACT US

FAST LINKS

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Administration: Pages 1-45 HIM /Coding Staff: Pages 1-45 Inpatient Svcs: Pages 2,4 M aterials M gmt: Page 3 Providers: Pages 2,5,8,18,20,35 Laboratory Svcs: Pages 3,21 Pharmacy Svcs: Pages 4,20

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Cardiology Svcs: Page 8 Compliance: Pages 9,20,28 Public Affairs: Pages 9,20,25 Finance: Pages 18,24,32,37 PDE Users: Pages 19,25,29 Rural Healthcare: Page 27 Hospice Care: Pages 31,40

© 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: March 20, 2019

INTRA-ABDOMINAL PRESSURES

I have the manager of one of our nursing units asking how to charge for the following service. Intra-Abdominal Pressures are used to measure a pressure that is related to abdominal compartment syndrome through a foley catheter.

Answer: The charge process depends on whether the service is performed on an inpatient by regularly assigned unit nursing staff; if so, we would consider it a component of the room rate, not separately chargeable. Attached is PARA's paper on billing for bedside procedures.

Since there is no code to characterize this service on an outpatient, we would recommend adding it to the facility criteria which assigns a visit level charge, i.e. emergency department visit (99281-99285) or outpatient hospital visit (99201-99215 or G0463 for Medicare) level.

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PARA Weekly eMagazine: March 20, 2019

B4087 AND B4088

Our MM department is appending HCPCS B4087 & B4088 at times to supply charges used during surgical procedures. I am uploading a B4087 example. Can you review and give your opinion on if that HCPCS was used appropriately or not?

Answer: No. B4087 and B4088 are not valid HCPCS for reporting on a hospital outpatient claim. These codes are used only by a DME supplier billing the DME MAC. Note that the PARA Data Editor HCPCS search on the Calculator tab identifies the OPPS Status Indicator, along with a brief description of the meaning of that indicator:

LAB CODES

Our lab is asking the following: When using CPTÂŽ 82340 urine quantitation, timed specimen for Calcium, would it be appropriate to also charge 81050 total volume or is this reimbursement included in the 82340?

Answer: CPTÂŽ code 81050 may be added at an additional charge for volume measurement, provided the physician ordered it. There is no CCI edit preventing these two codes from being billed together.

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PARA Weekly eMagazine: March 20, 2019

IVS DURING RECOVERY

We have a few questions regarding billing administration codes of infusions/hydrations after a procedure. Here's some background: We are finding some administration codes being entered after patient has a procedure but goes to the med/surg floor for phase II recovery, could be there for up to 23 hours post surgery.

Here are our questions: 1) Can we charge for the continuing of the IV from the procedure? Even if the patient is there for up to 23 hours? This is post procedure charging.

2) Can we charge for the administration if patient gets a medication after the procedure and on the med/surg (phase II recovery) floor? This would include something such as Zofran or anything else that might be needed post procedure.

Answer: We do not recommend reporting IV therapy performed during recovery from a surgical procedure, as that service is ?integral to? the surgical procedure. Medicare?s NCCI Edit Manual offers the following explanation: https://apps.para-hcfs.com/para/documents/CHAP1-gencorrectcodingpolicies_final103117.pdf

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PARA Weekly eMagazine: March 20, 2019

COVERED DIAGNOSES

We are receiving an error that the diagnosis does not cover for CPTÂŽ 78815 or A9552.

The doctor's office states that this diagnosis is always covered. Can you clarify?

Answer: The diagnoses on the claim are C34.91 and K80.80; we note that C34.91 is an ?unspecified? code; these often cause coverage issues:

To check the diagnosis codes, we used the PARA Data Editor ?LCD? search; this search returns NCDs as well. Enter the HCPCS in the search field:

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PARA Weekly eMagazine: March 20, 2019

COVERED DIAGNOSES

The results for 78815 indicates that there is no LCD, but two National Coverage Determinations apply.

Many NCDs also include ?Supporting Documentation? that Medicare separately publishes ? these are available in a separate hyperlink:

The ?Supporting Document? available for the second NCD, 220.6.17, offers a link to the covered diagnosis codes for tumors:

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PARA Weekly eMagazine: March 20, 2019

COVERED DIAGNOSES

Following that link, we find that the ?unspecified? code is not listed as a covered diagnosis, although several other codes with specified locations are covered: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/Downloads/ PETforSolidTumorsOncologicDxCodesAttachment_NCD220_6_17.pdf

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PARA Weekly eMagazine: March 20, 2019

MEDICAL NECESSITY FOR t-PA We ran into a medical necessity issue for t-PA being administered in the ED. The patient was transferred out. The diagnosis is stroke or ischemic infarct. If we code stroke or infarct, I639, the diagnosis does not meeting medical necessity for J2997. If we code acute cerebral ischemia, it codes to I6782 which does meet medical necessity. Please advise on why stroke or cerebral infarct, unspecified, does not meet medical necessity for J2997.

Answer: I can certainly understand frustration with this fine point in Medicare coverage of a very expensive medication.

Of course, it would have been appropriate to have brought your concern to the attention of the MAC during the comment period when the LCD was still in draft form (its last major revision, Draft LCD DL35428, was posted for comment on 01/22/2016. There have been minor updates since then.)

Here?s a link to the LCD in question: https://www.cms.gov/medicare-coverage -database/details/lcd-details.aspx?LCDId=35428&ContrTypeId=12&ver=59&ContrNum=07101&ContrId= 327&ContrVer=1&SearchType=Advanced&CoverageSelection=Local&ArticleType=Ed%7cKey%7cSAD% 7cFAQ&PolicyType=Both&s=---&Cntrctr=327&ICD=&CptHcpcsCodeJ2997&&kq=true&bc=IAAAACAAAAAA Here are our non-clinical observations: Cerebral infarction is caused by the cerebrovascular cavity blockage or narrowing ? if the cause is narrowing, a thrombolytic is not a useful treatment. Generally speaking, the covered diagnoses codes in the LCD report an embolism, occlusion, or thrombosis. In the absence of evidence of an embolism, occlusion, or thrombosis, the use of an expensive thrombolytic is not deemed medically necessary by Medicare in your region (not all regions have the same LCD, by the way.)

The larger problem underlying your question is that the MAC finalized an LCD, using a legitimate open comment process, but stakeholders (like you) didn?t know about it and aren?t on board with the final decision ? resulting in frustration with Medicare.

This is why PARA reviews draft LCDs with its Revenue Integrity clients in each monthly meeting; we hope to give clients better visibility of upcoming coverage issues and the opportunity to comment on draft LCDs before they are finalized. If Medicare proposes an LCD and no one comments, the LCD is finalized and it can be very difficult to undo through a reconsideration request.

On January 30, 2019 Medicare published a revised MLN Matters article announcing changes to the LCD development process due to concerns from stakeholders. CMS hopes to ensure the draft LCDs are more widely circulated and that providers are given greater opportunity for input, and made fully aware of the changes before LCDs are finalized.

Here?s a link to that article: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/MM10901.pdf 8

PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

Pricing transparency continues to be an important topic in the healthcare industry. Healthcare professionals are working to understand how pricing transparency can improve Patient satisfaction and reduce hospital bad debt.

The benefits of providing cost estimates prior to schedule services include: -

Providing pricing transparency Provide estimates prior to service, avoiding unexpected financial liability Reduce Patient dissatisfaction directed at the provider Increase self-pay collections while decreasing bad debt

Today?s patients are becoming informed consumers through a variety of channels including media exposĂŠs on healthcare costs and the continued progress of the Affordable Care Act. Patients require a clear picture of their financial obligation for services. Informing Patients of the cost of services is in the best interest of the facility.

Although generating a quote for services involves a variety of contractual discounts and health insurance plan information, some information can be readily available to the Patient with minimal employee intervention.

The PARA Patient Share of Cost Estimator Widget allows the Patient to determine their cost from a provider-based web portal.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

THE PARA SOLUTION: The PARA Patient Share of Cost Estimator Widget provides facilities with a system for generating Patient quotes of the top procedures for the facility.

Details of this project including purpose, method, timeline, and deliverables are as follows.

If you would like more information, please contact your Account Executive.

PURPOSE: The purpose of the PARA Patient Share of Cost Estimator Widget is to create a web-based system that allows the Patient to determine their share of cost for healthcare services.

METHOD: PARA will review your current website design structure to create a patient cost estimator widget mirroring the look and structure of your current website. The PARA Patient Share of Cost Estimator Widget provides the patient an easy to use decision tree to select the services required.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

PARA will provide your facility a suggested list of services based on trends of the most recent Medicare Data available including:

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- All Inpatient Medicare DRG Data - Top 25 ICD-10 Diagnoses for ED Level Charges New and Established Patient Level Samples Mammography Charges Top 50 EKG/Stress Test Charges Top 25 Laboratory Procedures Top 25 Radiology Procedures Other Service Lines (as requested by client)

PARA will develop custom procedure categories and subcategories based on the facility-approved list of services and will develop and provide the implementation instructions for facility and designated Employers for immediate deployment. Initial and ongoing training and support for the duration of the agreement for Employers and facility are provided.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

DELIVERABLES: PARA will provide your facility a web-based control panel to allow updates and changes to the estimator on an ongoing basis (e.g. update prices, change benefit plans, add services, etc.)

PARA will provide an optional insurance and benefit plan allowing any patient to enter their own benefit information to calculate their cost.

PARA will provide Medicare and Medicaid terms (where applicable) allowing patients to calculate their cost, and will incorporate the hospital?s self-pay discount to allow self-pay patients to calculate their cost.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

PARA will provide an option for the price estimate to be emailed to the patient or printed and will provide links and referrals to financial counseling, charity care policies, quality ratings, patient satisfaction scores, and other information deemed pertinent by the hospital.

PARA will provide an internal web-based tool to the provider to review all estimates created by Patients.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

The PARA Patient Share of Cost Estimator Widget statistics can be tracked in the PARA Data Editor (PDE) according to general use, visits by date, top estimates by service, and estimates by insurance.

Built in Protection of the Hospital Managed Care Contract Terms The ability to calculate patient estimates on your website will be provided upon the consumer?s ability to input their specific plan details.

PARA has also developed the ability to integrate contracts and in doing so have added additional layers of protection, so the Patient Share of Cost Widget becomes a more accurate tool for providing price estimates.

However, by including this additional functionality, competitors and other malicious users may attempt to take advantage of the tool to shop prices.

PARA is further developing the ability to protect your facility from such attacks by folding in user eligibility checking before proceeding to view the final estimate to ensure proper usage.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

After the consumer has responded to ?Step 1a ? Choose a Specific Service,? the patient would then be able to view only the gross charges for the service(s) they have selected.

Once they have viewed the charges, the patient will be asked to complete an Eligibility Form which asks for their personal insurance information, as shown below:

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

Once the user has input their information and chosen to perform the check, PARA takes this information and communicates via an Electronic Data Interchange (EDI) linkage to the patient?s insurance plan to confirm coverable, copays, and deductibles.

A successful verification response, as shown below, ensures a further level of protection to avoid data mining from outside parties:

Only when PARA hears back that the check has been successful will the user be able to proceed to view their final estimate.

Further functionality will be developed in order to save the results from the eligibility check and the final estimate for the user to review the quote on a later date. This will be accomplished by asking the Patient for their email address and sending a secure link via email to reopen the results.

Links emailed to users will also be used when the eligibility check does not return an immediate result.

The user will be notified once a result has been received and whether they can proceed to open their requested quote.

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PARA Weekly eMagazine: March 20, 2019

FEATURED PRODUCT: PATIENT SHARE OF COST WIDGET

SAMPLES OF PRICE TRANSPARENCY WITH PARA?S PRICE ESTIMATOR DECISION TREE WIDGET:

Pr ice Tr an spar en cy Lin k an d Cost Est im at ion s f or M edicar e an d No In su r an ce:

1 Pr ice Tr an spar en cy Lin k an d Pat ien t Est im at es u sin g PARA?s st an dar d Decision Tr ee f or In su r an ce, M edicar e an d Self -Pay:

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Pr ice Tr an spar en cy Lin k bu ilt in t o PARA?s cu st om lan din g page f or Hospit al Def in ed Ser vices an d pr ovidin g Pat ien t Est im at es w it h PARA?s st an dar d Decision Tr ee f or In su r an ce, M edicar e an d Self -Pay:

4 Pr ice Tr an spar en cy Lin k bu ilt in t o PARA?s cu st om lan din g page f or dir ect Cost Est im at ion s r egar dless of payer :

5 Pr ice Tr an spar en cy Lin k br ok en ou t by locat ion w it h dir ect Cost Est im at ion s also depen den t on locat ion :

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PARA Weekly eMagazine: March 20, 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: March 20, 2019

PARA DATA EDITOR UPGRADE

On April 1, 2019 the Multiple Browser compatible version of the PARA Data Editor (PDE) will go live and the current version will be removed. The new version can be accessed with Internet Explorer or Chrome with no changes to the User?s experience. There will be no need to update your bookmarks or favorites, the transition will be seamless. For those of you already using the Beta version compatible with the Chrome browser, you should notice very little difference.

The look and feel of the PDE will be slightly different, but the layout and functionality remain the same. There will also be some enhancements-in the image below, the market groups are now displayed by tab, rather than a drop-down menu-Projects and Assessments are available for viewing in addition to the Bulletin Board and Documents, and there is a ?Refresh Page? button on each module:

If you have any questions regarding the new and improved PDE, please contact your Account Executive or Technical Support staff listed on the Select tab for your facility.

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PARA Weekly eMagazine: March 20, 2019

CMS RELEASES NEW OPIOID PRESCRIBING MAPPING TOOL

On February 22, CMS released an expanded version of the Opioid Prescribing Mapping Tool, ensuring that you have the most complete and current data to effectively address the opioid epidemic across the country.

This update further demonstrates the agency?s commitment to opioid data transparency and using data to better inform local prevention and treatment efforts, particularly in rural communities hard hit by the opioid crisis. For the first time, the tool includes data for opioid prescribing in the Medicaid program.

Additionally, users can now make geographic comparisons of Medicare Part D opioid prescribing rates over time for urban and rural communities.

The Medicare Part D opioid prescribing mapping tool is an interactive tool that shows geographic comparisons at the state, county, and ZIP code levels of de-identified Medicare Part D opioid prescriptions filled within the United States. The mapping tool presents Medicare Part D opioid prescribing rates for 2016 as well as the change in opioid prescribing rates from 2013 to 2016.

The mapping tool allows the user to see both the number and percentage of opioid claims at the local level in order to better understand how this critical issue impacts communities nationwide. By openly sharing data in a secure, broad, and interactive way, CMS and the U.S. Department of Health and Human Services (HHS) believe that this level of transparency will inform community awareness among providers and local public health officials.

The data reflect Medicare Part D prescription drug claims prescribed by health care providers.

Approximately 70% of Medicare beneficiaries have Medicare prescription drug coverage either from a Part D plan or a Medicare Advantage Plan offering Medicare prescription drug coverage. In 2016, Medicare Part D spending was $146 billion; U.S. retail prescription drug spending was about $329 billion.

The mapping tool does not contain beneficiary information nor does the information presented in this tool indicate the quality or appropriateness of care provided by individual physicians or in a given geographic region.

The map will automatically adjust between state, county, and zip code levels as users zoom in or out.

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PARA Weekly eMagazine: March 20, 2019

CMS EXPANDS PRIVATE PAYOR LAB REIMBURSEMENT REPORTING

M edicar e r equ ir es ?applicable labor at or ies? t o r epor t pr ivat e payor r em it t an ce dat a f or t h e pu r pose of developin g it s paym en t r at es u n der t h e Clin ical Labor at or y Fee Sch edu le (CLFS.) Th is year , t h e def in it ion of ?applicable labor at or ies? w as expan ded t o in clu de cer t ain ph ysician gr ou ps an d h ospit als.

A n u m ber of PARA clien t s h ave r equ est ed in f or m at ion on w h et h er t h ey w ill be r equ ir ed t o r epor t .

Medicare clarified reporting requirements in an MLN article published in late February, 2019: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE19006.pdf For purposes of determining applicable laboratory status under the CLFS, a hospital outreach laboratory is a hospital-based laboratory that furnishes laboratory tests to patients other than admitted inpatients or registered outpatients of the hospital. A hospital outreach laboratory bills for Medicare Part B services it furnishes to non-hospital patients using the Form CMS-1450 14x Type of Bill (TOB).

I. Determination of Applicable Laboratory Status Based on the NPI This section includes information on how independent laboratories and physician office laboratories that bill Medicare Part B under their own NPI and hospital outreach laboratories that bill Medicare Part B under their own NPI (separate from the hospital?s NPI) determine whether they are an applicable laboratory. As discussed later in this article, hospital outreach laboratories that bill Medicare Part B using the hospital?s NPI must determine applicable laboratory status based on its revenues attributed to the Form CMS-1450 14x TOB. There are four steps in determining whether a laboratory meets the requirements to be an applicable laboratory based on the laboratory?s own billing NPI: 21

PARA Weekly eMagazine: March 20, 2019

CMS EXPANDS PRIVATE PAYOR LAB REIMBURSEMENT REPORTING

1. Is the laboratory certified under CLIA? 2. Does the CLIA- certified laboratory bill Medicare Part B under its own NPI? 3. Does the laboratory meet the majority of Medicare revenues threshold?

4. (4) Does the laboratory meet the low expenditure threshold?

The first step hospitals should take is to identify if it reports a separate NPI on the 141 (non-patient services) bill type. If the lab bills under the same NPI as the hospital, the laboratory is not required to report private payor reimbursement rates. If the lab uses a separate NPI, additional financial analysis is required to determine whether the organization is required to report.

Background: Under the Protecting Access to Medicare Act (PAMA) of 2014, Medicare is required to base payment for clinical lab services on a basis equivalent to the amounts that large insurers pay for private payor patients. Medicare is required by law to develop rates in the CLFS to be equal to the weighted median of private payor rates determined for the test.

To meet this obligation, CMS required large independent laboratories to submit the necessary private payor payment rate data. ?Applicable laboratories? are required to collect private payor payment rates during a specified period and report the data to CMS during a specified window.

Prior to 2019, hospital laboratories and physician practices were not required to report data. However, in the 2019 Clinical Fee Schedule Final Rule, Medicare expanded the definition of ?applicable laboratory? to include ?hospital outreach laboratories? which bill for services on a UB04 14X bill type (non-patient services.) The original CMS language defining ?applicable laboratories? included hospital laboratories which: - Are independently enrolled in Medicare with a separate NPI - Submit claims to Medicare for lab services on either the CMS1500/837p, or UB04/837i bill type 14X (non-patient services) - Are reimbursed under the CLFS or the Medicare Physician Fee Schedule for at least 50 percent of its revenues - Received total revenues under the CLFS of at least $12,500 during a data collection period Effective January 1, 2019, the regulatory definition of an applicable laboratory is summarized below. An applicable laboratory means an entity that: - Is a laboratory as defined under the Clinical Laboratory Improvement Amendments (CLIA) regulatory definition of a laboratory (42 CFR Section 493.2); - The laboratory bills Medicare under its own National Provider Identifier (NPI) or a. For hospital outreach laboratories: Bills Medicare Part B on the Form CMS-1450 under TOB 14x - The laboratory must meet a ?majority of Medicare revenues,? threshold, where it receives more than 50 percent of its total Medicare revenues from one combination of the CLFS or the PFS in a data collection period. For purposes of determining whether a laboratory meets the ?majority of Medicare revenues? threshold, total Medicare revenues includes: fee-for-service payments under Medicare Parts A and B, prescription drug payments under Medicare Part D, and any associated Medicare beneficiary deductible or coinsurance. Effective January 1, 2019, total Medicare revenues no longer includes Medicare Advantage payments under Medicare Part C. 22

PARA Weekly eMagazine: March 20, 2019

CMS EXPANDS PRIVATE PAYOR LAB REIMBURSEMENT REPORTING

- The laboratory must meet a ?low expenditure? threshold, where it receives at least $12,500 of its Medicare revenues from the CLFS in a data collection period.

Consequently, hospitals conducting significant ?outreach? laboratory service should verify whether the 141 bill type uses the same NPI as the main facility. If the lab uses a separate NPI, the hospital must evaluate whether it meets the other tests for required reporting. Reporting is due in 2020, and significant penalties apply if reporting is not submitted promptly and accurately.

While Medicare did not intend to include hospitals in the data collection requirement, the expansion to include hospitals with significant lab business responds to criticism that the data used to calculate the current CLFS rates was obtained from too narrow a provider base.

Links and excerpts to Medicare announcements on this topic are provided below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE19006.pdf

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PARA Weekly eMagazine: March 20, 2019

CMS EXPANDS PRIVATE PAYOR LAB REIMBURSEMENT REPORTING

A link and an excerpt from the Medicare website summarizes the changed requirement: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/ PAMA-Regulations.html The Clinical Laboratory Fee Schedule (CLFS) final rule entitled ?Medicare Program: Medicare Clinical Diagnostic Laboratory Tests Payment System? (CMS-1621-F) was published in the Federal Register on June 23, 2016. The final CLFS rule implements section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

Under the final rule, laboratories, including physician office laboratories, are required to report private payor rate and volume data if they: - have more than $12,500 in Medicare revenues from laboratory services on the CLFS and - they receive more than 50 percent of their Medicare revenues from laboratory and physician services during a data collection period Laboratories will collect private payor data from January 1, 2019 through June 30, 2019 and report it to CMS by March 31, 2020.

We will post the new Medicare CLFS rates (based on weighted median private payor rates) in November 2020 that will be effective on January 1, 2021.

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PARA Weekly eMagazine: March 20, 2019

2019 CATEGORY III AMA RELEASE

The American Medical Association (AMA) has released mid-year Category III changes for the 2020 CPTÂŽ production cycle. These codes are effective July 1, 2019. Twenty new Category III codes ranging from 0543T to 0562T have been added. These codes can be found in the PARA Data Editor Calculator.

New Category III Codes include: Transapical Mitral Valve Repair (MVR) ? 0543T ? 0545T

Radiofrequency spectroscopy and Bone-Material quality testing ? 0546T ? 0547T

Transperineal Periurethral Balloon Continence device ? 0548T ? 0551T

Laser Therapy and Percutaneous Transcatheter placement 0552T ? 0553T

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PARA Weekly eMagazine: March 20, 2019

2019 CATEGORY III AMA RELEASE

Bone Strength and Fracture Risk analysis ? 0554T ? 0557T

Anatomic Model 3-D printed image data sets ?0559T -0562T

Category III codes are temporary CPT速 codes identified with five characters (four numerical digits followed by a T). They allow data collection for emerging technologies, services, procedures, and service paradigms, unlike the use of unlisted codes, which does not offer the opportunity for the collection of specific data.

If a Category III code is available, this code must be reported in lieu of a Category I unlisted code.

Category III codes may or may not eventually receive a Category I CPT速 code. New codes or revised codes in this section are released semi-annually via the AMA CPT速 website to expedite dissemination for reporting. Codes approved for deletion are published annually with the full set of temporary codes for emerging technology, services, procedures, and service paradigms in the CPT速 code set.

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PARA Weekly eMagazine: March 20, 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

Medicare Rural Hospital Flexibility Program - Emergency Medical Service Supplement Provides up to $250,000 to build an evidence base for rural EMS activities in the Flex Program by funding the implementation of demonstration projects of sustainable rural EMS models and quality metrics, and by sharing the results of those projects with rural EMS stakeholders. Application Deadline:

April 5, 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: March 20, 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, March 14, 2019 New s & An n ou n cem en t s

· New Medicare Card: 67% of Claims Submitted with MBI · DMEPOS Competitive Bidding: Get Ready for Round 2021 · Protecting the Health and Safety of all Americans · LTCH Compare Refresh · IRF Compare Refresh · March is National Colorectal Cancer Awareness Month Com plian ce

· Hospital Beds and Accessories: Provider Compliance Tips Even t s

· Data Interoperability across the Continuum: CMS Data Element Library Call ? March 19 · SNF Value-Based Purchasing Program: Phase One Review and Corrections Call ? March 20 · Submitting Your Medicare Part A Cost Report Electronically Webcast ? March 28 M LN M at t er s® Ar t icles

· New MBI: Get It, Use It ? Revised · NGACO Model Post Discharge Home Visit HCPCS ? Revised Pu blicat ion s

· PECOS FAQs ? Revised · PECOS Technical Assistance Contact Information ? Revised M u lt im edia

· Quality Payment Program: 2017 MIPS Performance Feedback Web-Based Training Course View this edition as a PDF [PDF, 252KB]

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PARA Weekly eMagazine: March 20, 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

M arch 15, 2019 Update

Prev ious Updates

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PARA Weekly eMagazine: March 20, 2019

There were FIVE 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: March 20, 2019

The link to this Med Learn MM11049

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PARA Weekly eMagazine: March 20, 2019

The link to this Med Learn MM11192

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PARA Weekly eMagazine: March 20, 2019

The link to this Med Learn MM11204

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PARA Weekly eMagazine: March 20, 2019

The link to this Med Learn MM11216

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PARA Weekly eMagazine: March 20, 2019

The link to this Med Learn MM11163

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PARA Weekly eMagazine: March 20, 2019

There were SEVEN new or revised Transmittals released this week.

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

7

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R2270OTN

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4253CP

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4256CP

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4254CP

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4255CP

41

PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4257CP

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PARA Weekly eMagazine: March 20, 2019

The link to this Transmittal R4258CP

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PARA Weekly eMagazine: March 20, 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 44

plewis @para-hcfs.com

PARA Weekly eMagazine: March 20, 2019

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