PARA Weekly eMagazine Grayscale Version March 6, 2019

PARA WEEKLY eMAGAZINE

I mproving T he Business of H ealthCare Since 1985 M arch 6, 2019 PRICING

CODING

REIM BURSEM ENT

COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - ED Triage - Moderate Sedation - Anesthesia Pre-Surgical Consults - NCD Effectiveness Versus Implementation Dates - LCD For 20610 CY2020 SNF PROVIDERS: WHAT IS PDPM? CODING AND REIMBURSEMENT FOR COLD THERAPY CUBE

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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.

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES 2019 CATEGORY III AMA RELEASE CMS EMERGENCY ET3 MODEL RURAL HOSPITAL PROGRAM GRANTS

PARA COMPANY NEWS

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OPIOID PRESCRIBIN G M AP Where's t he heaviest use? Page 11

Administration: Pages 1-38 HIM /Coding Staff: Pages 1-38 Providers: Pages 2,4,6,8,11,18 Surgical Svcs: Page 4 Anesthesia: Page 5 Cardiology Svcs: Page 6 Skilled Nursing Facility: Page 12

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Finance: Pages 8,18,31,34,36 PDE Users: Pages 8,23,29,37 Pharmacy: Page 11 Compliance: Pages 28,33,35 Therapy Svcs: Page 13 Rural Healthcare: Page 27 Outpatient Svcs: Page 19

© 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 6, 2019

ED TRIAGE

We have reviewed information provided by PARA dated November 2011 on the establishment of Facility ED Levels. Could we define a Level 1 facility E/M level to include the patient that presents to the ED for treatment, is triaged by the RN and subsequently leaves the facility prior to being seen?

We found the following information: CMS states that providers may not bill for triage-only services (King & Spalding LLP Christopher Kenny. USA December 5 2011): ?CM S per sonnel par t icipat ing in t he N ovem ber 22, 2011 H ospit al Open Door For um st at ed t hat a hospit al m ay not bill M edicar e for a low -level em er gency depar t m ent visit in inst ances w her e a pat ient r eceives only t r iage ser vices fr om an ED nur se and elopes befor e being seen by a physician.

Pr ovider s m ay bill M edicar e for any diagnost ic ser vices fur nished t o t he pat ient and also m ay bill t he pat ient for t he t r iage visit as a noncover ed ser vice for w hich t he pat ient is liable. CM S per sonnel m ade clear t hat an ED visit is only billable if t he pat ient is act ually seen by a physician. Tr iage per for m ed pur suant t o a st anding ED physician or der is not billable if t he pat ient does not see a physician. CM S per sonnel also r eject ed a quest ioner 's suggest ion t hat a hospit al could bill for t he visit if t he t r iage nur se confer r ed w it h a physician r egar ding t he pat ient 's condit ion befor e t he pat ient eloped.

The k ey consider at ion, t he par t icipant s st at ed, w as w het her t he pat ient act ually m et w it h t he physician. CM S w ill post an FAQ t o it s Web sit e on t his issue by t he next Open Door For um , scheduled for Januar y 2012."

I have attempted to locate the FAQ but I'm unable to locate. Could you validate that CMS has published this guidance in some format? It seems that hospitals are penalized for following EMTALA regulations with this directive.

I had heard at a seminar that hospitals could charge a level 1 ED facility charge for completing the triage/assessment as mandated by EMTALA. I appreciate your assistance.

Answer: The hospital should not bill for an emergency department triage if the patient never saw an qualified healthcare practitioner (such as an MD, DO, PA, or NP.) The FAQ that was posted subsequent to the 2011 Hospital Open Door Forum has since been taken down, but here's a snapshot:

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PARA Weekly eMagazine: March 6, 2019

ED TRIAGE

In addition, here is a reference within an FAQ document that is still available with a valid CMS link: https://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers/Downloads/FFS-FAQs.pdf

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PARA Weekly eMagazine: March 6, 2019

MODERATE SEDATION

I just want to confirm we are charging this scenario correctly on the technical fee side. If during a surgery performed in the hospital setting conscious sedation is performed, is it appropriate to charge with a 370 revenue code and no CPTÂŽ/HCPCs?

Answer: Yes, we recommend charging for conscious sedation using revenue code 0370 for facility fees, without a HCPCS. A HCPCS is not necessary in revenue code 0370, by omitting a HCPCS, the hospital may avoid CCI edits that might otherwise restrict billing for this service.

We previously published this advice with our 2017 CPTÂŽ Code Update document, at the address here: https://apps.para-hcfs.com/para/Documents/2017%20Moderate %20Sedation%20Coding%20-%20Updated%20Nov%2021%202016.pdf

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PARA Weekly eMagazine: March 6, 2019

ANESTHESIA PRE-SURGICAL CONSULTS

We have CRNAs (Method II CAH hospital) that are looking at doing Pre- Surgical Consults for anesthesia. This would be an outpatient appointment they may order labs/echo/stress echo/cardiac consult.

The goal would be in meeting with these people beforehand they would know more about the case, if they are high risk or not, in hopes of preventing those last minute cancellations because pieces were missed that could have been caught. Our CRNA was under the impression that we couldn't bill but I was reading through the Medicare manual and was unsure if that's true.

Answer: In general, no. A pre-anesthesia exam is not separately reported from the anesthesia service, even if performed on a separate day. The reimbursement for anesthesia services includes all pre-anesthesia evaluation. Attached is an American Association of Anesthesia article which addresses this question fully.

We found a Medicare reference that allows an evaluation to be separately reported if the surgical procedure was canceled as a result of the evaluation.

This would be unusual; here's an excerpt from an Anesthesia Billing Guide published in 2013 by Palmetto, a Medicare Administrative Contractor in the Southeast. It refers to an anesthesia evaluation performed on an inpatient: https://engage.ahima.org/ HigherLogic/System/ DownloadDocumentFile. ashx?DocumentFileKey= 9af2a07d-26e1-4694b1de-a4c59d0dbc30

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PARA Weekly eMagazine: March 6, 2019

NCD EFFECTIVE VERSUS IMPLEMENTATION DATES

Our Cardiac Dept is wanting to know the difference between Effective Date and Implementation Date on this MLN Matters. Also, how is CMS going to know if the shared decision-making encounter is occurring at a separate visit? Are they going to audit every one of these cases?

Answer: The NCD is 20.4 ? applicable to Implantable Automatic Defibrillators. The coverage rules changed in 2018 for this procedure, but Medicare had not yet planned for how providers could indicate on their claims that coverage criteria was met. The original transmittal publishing this NCD was silent as to billing instructions.

Your question of how Medicare will know that the shared decision-making visit requirement was met (unless they audit each claim) is probably being asked all over the country. In this latest transmittal, CMS instructed the MACs to work together to come up with a process to edit claims that ensures the coverage criteria are met, i.e. evidence of the shared decision-making visit.

The ?effective date? of 02/15/18 is still the DOS on which the coverage criteria are applicable ? hospitals must comply with this rule as of 2/15/18. However, in this revised transmittal, CMS instructed that ?A/B MACs shall work together collaboratively from a clinical aspect to ensure consistent national editing across jurisdictions.? Our interpretation is that the MAC contractors must come to agreement and submit their plan to CMS by 2/26/19.

CMS intends to incorporate the final agreed billing rules into the Medicare Claims Processing Manual.

Until then, MACs are instructed to meet and come to consensus on the edits. Here are some excerpts from the revised transmittal: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R209NCD.pdf

?? A subsequent CR will be released at a later date that contains a Pub.100-04 Claims Processing Manual update with accompanying instructions. Until that time, the Medicare Administrative Contractors (MACs) shall be responsible for implementing NCD 20.4.?

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PARA Weekly eMagazine: March 6, 2019

NCD EFFECTIVE VERSUS IMPLEMENTATION DATES

We expect that once the A/B MACs agree on edit criteria by February 26th, there will be another provider education article published to explain how to indicate on the claim whether and when the shared decision-making encounter happened.

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PARA Weekly eMagazine: March 6, 2019

LCD FOR 20610

We asked questions about this injection in October or November of last year and found that the 20610 LCD was retired and there is no longer an LCD. However, I just put in 20610 with diagnosis G56.10 and it is showing the ICD-10 failed per LCD coverage guidelines.

Is something not updated for all codes in the PARA Calculator? I'm just trying to make sure there definitely is no LCD for this code anymore beginning January 01. 2019.

Answer: We understand your frustration. WPS has created a Local Coverage Article instead of a Local Coverage Determination (LCD). Articles typically do not limit coverage (i.e. list only covered or non-covered conditions of coverage such as ICD10 codes), but offer coding and billing information or guidance.

Here?s an explanation from the Medicare website explaining the difference between an LCD and an Article: https://www.cms.gov/Medicare/Coverage/DeterminationProcess/LCDs.html

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PARA Weekly eMagazine: March 6, 2019

LCD FOR 20610

In this case, however, the Local Coverage Article appears to have the effect of limiting coverage to only 8 diagnosis codes. The Article was updated in October and again in November 2018; the current version became effective 12/1/18. The diagnosis you entered, G56.10 is not one of the covered diagnoses.

Articles can be searched in the PARA Data Editor Calculator tab with a few adjustments to the LCD search.

- First, the user must use a word rather than a CPTÂŽ code (many articles do not contain CPTÂŽ codes), - Secondly, the user must select the ?Articles? button on the report line. Here?s an example:

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PARA Weekly eMagazine: March 6, 2019

LCD FOR 20610

The report returns the article ? twice, to report the old and the new versions ? notice the update dates I?ve highlighted on the right:

The most current article informs us that only 8 diagnosis codes are covered for 20610; here?s a link and an excerpt: https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleId=56157&ver =4&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=Indiana&CptHcpcsCode =20610&bc=gAAAACAAAAAA&

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PARA Weekly eMagazine: March 6, 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 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

wh at is t h e Lon g-Ter m Car e / Sk illed Nu r sin g Facilit y Pat ien t -Dr iven Paym en t M odel, or PDPM ?

The PDPM is the CMS designated next iteration of payment reform following the Resident Classification System Version 1 (RCS-1) advance notice of rule-making that was released in CY2017. This new payment reform is set to replace the RUGs IV system of reimbursement. PDPM follows suit from RCS-1 in moving away from a ?therapy minutes driven reimbursement system? to a system that is more focused on the ?clinical characteristics of the resident?.

Good news to providers, under the PDPM reimbursement will be decided on fewer Minimum Data Set (MDS) assessments. With this being said, there are an expected reduction in scheduled PPS assessments from five to one required assessment and only two unscheduled assessments (the IPA and the Discharge PPS assessments). Just with this reduction in administrative tasks Medicare is expecting to save over $2 billion dollars over a 10 - year period.

https://www.cms.gov/ Medicare/Medicare-Feefor-Service-Payment/ SNFPPS/ therapyresearch.html

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PARA Weekly eMagazine: March 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

This payment model is expected to be implemented beginning October 01, 2019.

Overview of Case-Mix Categories: Within the new PDPM, resident characteristics will determine the clinical category for care.

1.Acute infection 2.Acute neurological 3.Cancer 4.Cardiovascular and coagulations 5.Major-joint replacement or spinal surgery 6.Medical management 7.Non-orthopedic surgery 8.Non-surgical orthopedic/musculoskeletal 9.Orthopedic surgery 10. Pulmonary These are further grouped into four categories for Occupational Therapy (OT) and Physical Therapy (PT) calculations: 1.Major joint replacement or spinal surgery 2.Other orthopedic 3.Non-orthopedic and acute neurologic 4.Medical Management PDPM uses five case-mix components and a non-case-mix component to determine the rate of reimbursement for the residents stay, which differs from the RUGs IV calculation which only used therapy and nursing components and was weighted by therapy minutes in the higher categories. In PDPM, therapy minutes will not be used in the case-mix calculation, however, they will be required as part of the discharge assessment process.

The five designated case mix components are: 1.Physical Therapy (PT) 1.Occupational Therapy (OT) 1.Speech/Language Pathology (SLP) 1.Nursing Non-therapy Ancillaries These five components will be combined with a non-case mix amount to calculate daily reimbursement.

SLP will be required to use the presence of comorbidities (i.e.; aphasia, CVA/TIA/stroke, hemiplegia/paralysis, TBI, tracheostomy care, present of ventilator or respiratory, laryngeal cancer, apraxia, dysphagia, ALS, oral cancers and speech /language deficits), cognitive impairment and 13

PARA Weekly eMagazine: March 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

the presence of swallowing disorders or the need for a mechanically altered diet to determine the case mix.

The NTA case mix is determined by the need for extensive service covered through the MDS and the part-c risk adjusted model. Points are associated with the services and a total determined, which would place the resident in a case-mix group for NTA. The table below demonstrates how the daily rate for PDPM is calculated by case-mix component for each resident.

)

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PARA Weekly eMagazine: March 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

It should be noted, PDPM does not completely do away with the RUGS IV methodology. The Nursing Component uses a modified non-therapy RUG calculation that places residents into one of the 25 categories instead of the previous 43 nursing categories that were under the 66 Grouper. The 25 PDPM RUGs reduces the number of end-splits determined by ADL calculations.

An additional change within the PDPM from the previous RUG IV is the ADL score has been updated to include Section GG items. These items are used to calculate LTPAC cross-setting measures as required by the IMPACT Act of CY2014.

In PDPM, the four late loss ADLs used in the calculation for RUGS IV would be replaced with items from section GG; an eating and toileting item, three transfer items and two bed mobility items.

Refer to the table below:

Nursing CMIs will use staffing data to reflect nursing utilization during care. In addition, PDPM is expected to add an 18% increase for the nursing component when the resident is diagnosed with HIV/AIDS. Payments for Nursing and Speech/Language Pathology will remain constant through the resident?s stay however, PT, OT and Non-therapy Ancillaries will see variable rates over the length of stay. PT and OT will see downward adjustments of 2% at day 20 and then a further 2% decrease every 7th day thereafter.

NTA will decrease by two-thirds starting at day 4.

So how is this going to impact Skilled Nursing Organizations?

1.PDPM is designed to push SNFs to take on more clinically complex residents.

2.Homes will need to start evaluating current care and staff resources to determine if they are prepared for this shift or will they need to implement systems and training for staff to meet the criteria for this program 3.Therapy that was previously incentivized in the previous payment model is not included in the case mix calculations but the need for therapy based on care requirements is predicted to be the same. PDPM requires 75% of all therapy delivered be individually provided: - Concurrent and group therapies are capped at 25% of total minutes provided, which is a decrease from 50% in RCS-1 4.CMS is predicting that non-profit organizations should see an increase of 1.9%, while government providers should see increases of approximately 4.2%. Smaller SNF providers should see modest increases, while those providers running homes over 100 certified beds may see declines in revenue.

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PARA Weekly eMagazine: March 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

This table demonstrates the basic differences between RUGs IV and PDPM:

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PARA Weekly eMagazine: March 6, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

Recommendations for preparing for PDPM Implementation: 1.Providers should begin by reviewing current processes from end-to-end. This activity will assist in determining what processes will need to be changed to meet the criteria for PDPM 2.Training staff on the shift in data capture will be a key point to a successful PDPM implementation.

For example, staff need to ensure that all diagnosis and conditions are collected as soon as possible to ensure accurate coding on the MDS 3.Coding staff will need it identify the primary diagnosis that maps to a clinical category where possible 4.Communicating to physicians about the upcoming changes and educating them on the new categories and importance of a correct diagnosis is critical for a successful adoption of PDPM 5.Review of therapy contracts is critical for identifying the business impact from the therapy perspective to avoid any surprises once the facility implements PDPM

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PARA Weekly eMagazine: March 6, 2019

CODING AND REIMBURSEMENT FOR COLD THERAPY CUBE

it durable medical equipment or a retail product? Hospitals often now use this new product in the Operating Suites, but how can hospital bill for its use?

To clarify, we first answer the following questions: 1. Are these considered DME? 2. What is the definition of DME? 3. Is there a L code for this?

4. Do organizations/clients charge for this?

Is

In follow up to the questions regarding the correct reporting process for Cold Therapy Cube, the following applies: 1.The item is not DME, rather it is classified as a Class II Medical Device. It is currently being used in a hospital/clinic setting in Post-Operative, Arthroscopic Procedures, Reconstructive Procedures, Plastic Surgery, General Surgery, Post-Trauma, Chronic Pain and Physical Therapy. However, because the device is utilizing the same basic concept as hot/cold packs, the therapy does not meet medical necessity criteria 2.2. The reporting code is E0218 3.3. The device can be reported using revenue codes 0271 or 0947 This is an inexpensive purchase item that costs between $200.00 to $350.00 depending on where it is purchased. Patients can purchase the item for home use at stores such as Target or WalMart. There is no separate reimbursement for the item.

Here's PARA's recommendation: Complete an analysis on which procedures the device is being used in Post-operative and include the cost of the device in the OR procedure or the Post-Operative Room Rate.

For more information on how it's used, click on the link below. https://www.breg.com/products/cold-therapy/devices/cube-cold-therapy/

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PARA Weekly eMagazine: March 6, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

To determine whether a HCPCS code can be ?split billed? (reported by both the facility and the physician for services performed in the outpatient facility setting) users can refer to Medicare?s payment policy indicators displayed on the PARA Data Editor Professional Fee report on the Calculator tab:

Refer to the PC/TC indicator on the lower left:

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PARA Weekly eMagazine: March 6, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

Here are the definitions of the PC/TC Indicators 0 ? 5 and the split billing instructions for services performed in the outpatient facility setting:

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PARA Weekly eMagazine: March 6, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

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PARA Weekly eMagazine: March 6, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

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PARA Weekly eMagazine: March 6, 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 6, 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 6, 2019

CMS EMERGENCY TRIAGE, TREAT AND TRANSFER (ET3) MODEL

14, 2019, CMS ONFebruary Innovation?launched a payment model with new treatment and transport options to ensure the needs of beneficiaries are met more appropriately in emergency situations.

At this time, the Emergency Triage, Treat and Transport (ET3) Model is a voluntary, five year payment model designed to allow a greater flexibility to ambulance care teams following a 911 call.

Under this model program, CMS will reimburse participating ambulance suppliers and providers to: 1.Transport an individual to a hospital emergency department (ED) or other destination covered under the current regulations 2.Transport to an alternative destination (i.e.; primary care physician office or urgent care clinic) 3.Provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth CMS?intentions with this new innovation model is: - To allow beneficiaries to access the most appropriate emergency services at the right time and place - Encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches, upon successful implementation of the model, by establishing a medical triage line for low-acuity 911 calls - Improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports https://www.cms.gov/newsroom/fact-sheets/ emergency-triage-treat-and-transport-et3-model

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PARA Weekly eMagazine: March 6, 2019

CMS EMERGENCY TRIAGE, TREAT AND TRANSFER (ET3) MODEL

Who can participate in this model program?

Participants that CMS is expecting to select to participate in the model and have an opportunity for cooperative agreement funding are: - Medicare-enrolled ambulance service suppliers - Hospital-owned ambulance providers - Local governments, their designees, or any other entities that operate or have authority over one or more 911 dispatches in geographical areas Ambulance suppliers and providers together, will focus on direct services, while local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches will create a supportive structure to ensure successful and sustainable delivery of services.

How will funding be awarded to model participants?

In Summer CY2019, CMS Innovation Center is expecting to release a Request for Applications (RFA). The RFA process will be solicited to Medicare-enrolled ambulance suppliers and providers.

Participants will be selected from the RFA applications and upon announcement, the Innovation Center will issue a Notice of Funding Opportunity (NOFO) the following Fall CY2019.

The ET3 Model time line is expected to have a five (5) year performance period with an anticipated start date of January CY2020. The performance period for all participants, regardless of their start date in the program, will end at the same time.

For more information on this model program, providers are encouraged to the CMS link below: For more information on the ET3 Model, please visit: https://innovation.cms.gov/initiatives/et3/ If stakeholders have questions on the ET3 Model, they can send an email to ET3Model@cms.hhs.gov

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PARA Weekly eMagazine: March 6, 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 6, 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, February 28, 2019 New s & An n ou n cem en t s

· Interoperability and Patient Access to Health Data: New Proposals · Opioid Prescribing Mapping Tool Improved with Medicaid and Rural Data · Hospice Compare Refresh · Data on Geographic Variation in the Medicare Program · 2017 CMS Program Statistics · Quality Payment Program: Payment Adjustment Resource · Choosing a Primary Clinician in MyMedicare.gov: New Video for Your Patients Pr ovider Com plian ce

· Laboratory Blood Counts: Provider Compliance Tips ? Reminder Upcom in g Even t s

· Interoperability and Patient Access Proposed Rule Listening Session ? March 5 · Dementia Care & Psychotropic Medication Tracking Tool Call ? March 12 · Open Payments: Transparency and You Call ? March 13 · 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 edicar e Lear n in g Net w or k ® Pu blicat ion s & M u lt im edia

· HPTCs Code Set: April 2019 Update MLN Matters Article ? New · DMEPOS Fee Schedule: April 2019 Update MLN Matters Article ? New · NCCI: Modification of MCS Logic for Modifiers Involving PTP MLN Matters Article ? New · Home Health PDGM MLN Matters Article ? Revised · Organ Acquisition Charges Not Included in IPPS Payment MLN Matters Article ? Revised · Medical Documentation: Exchanging the List of eMDR via esMD MLN Matters Article ? Revised · How to Use the Medicare Coverage Database Booklet ? Revised · SNF Billing Reference Booklet ? Revised · Clinical Laboratory Fee Schedule Fact Sheet ? Revised View this edition as a PDF [PDF, 308KB]

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PARA Weekly eMagazine: March 6, 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 1, 2019 Update

Prev ious Updates

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PARA Weekly eMagazine: March 6, 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.

1

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

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PARA Weekly eMagazine: March 6, 2019

The link to this Med Learn MM11066

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PARA Weekly eMagazine: March 6, 2019

There were FOUR new or revised Transmittals released this week.

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

4

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly eMagazine: March 6, 2019

The link to this Transmittal R186SOMA

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PARA Weekly eMagazine: March 6, 2019

The link to this Transmittal R257BP

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PARA Weekly eMagazine: March 6, 2019

The link to this Transmittal R4247CP

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PARA Weekly eMagazine: March 6, 2019

The link to this Transmittal R2266OTN

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PARA Weekly eMagazine: March 6, 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 37

plewis @para-hcfs.com

PARA Weekly eMagazine: March 6, 2019

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