PARA Weekly Update For Users February 6, 2019

PARA WEEKLY

UPDATE For Users

I mproving T he Business of H ealthCare Since 1985 February 6, 2019 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Screening Physical Therapy Evals - Cause Of Injury Codes - Elastography - CPT 10022 - Same Day, Two EMs - Floseal CMS ISSUES APPROPRIATE USE 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.

MEDICARE 2019 FINAL RULES --MPFS & OPPS CAH METHOD II CLAIMS FOR TELEHEALTH APPLYING CDC GUIDELINES FOR PRESCRIBING OPIOIDS

WHAT WE DO PRICING CODING REIMBURSEMENT COMPLIANCE

FAST LINKS

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Hom e Heal t h an d Hospi ce: New Billing Requirement s

Administration: Pages 1-46 HIM /Coding Staff: Pages 1-46 Providers: Pages 2,4,6,7,21 Urgent Care: Page 4 Imaging Services: Pages 5,15,37 Social Services: Page 7 Home Health: Pages 10,26,34

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Hospice: Pages 10,23 Telehealth: Page 15 CAH: Page 18 Pharmacy: Page 21 CAHs: Page 21 Laboratory: Pages 23,27,34 Cardiac Rehab: Page 30

© 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 Update: February 6, 2019

SCREENING PHYSICAL THERAPY EVALS

Can CPTÂŽ 97799 be used for PT/OT screening? The screening is to determine whether or not the patient needs further evaluation and therapy.

Answer: No, we would not recommend reporting 97799 as a screening code. In general, we advise clients to avoid using the ?unlisted service? XXX99 codes, as they are frequently misused.

There are several choices within the existing PT and OT evaluation codes ? low, moderate, and high complexity, and re-evaluations. We?d recommend reporting the simple evaluation code if the service is an initial evaluation, or the re-evaluation, as appropriate. The service must meet the requirements within the description of the CPTÂŽ.

Here are those codes:

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PARA Weekly Update: February 6, 2019

SCREENING PHYSICAL THERAPY EVALS

Re-evaluations:

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PARA Weekly Update: February 6, 2019

CAUSE OF INJURY CODES

We recently went through an Epic update and a question has come to light. Are cause of injury codes on CMS1500 claim forms required? How does everyone handle cause of injury codes on 1500s? We're hitting some claim edits for not having them, but they're not CMS claim edits- they're internal. Just looking for some feedback on what others are doing.

Answer: Yes, the ICD10 codes that explain the external cause of injury should be reported on 1500 claims when appropriate. Payers check these codes to determine whether a third party should be liable for coverage of the injury, such as might be the case in a motor vehicle accident. In addition, the data is used to aggregate healthcare information that may illuminate trends in accidents and injuries to both insurers and government healthcare agencies.

Each line on the CMS1500/837p claim form should indicate which diagnoses were addressed by each line of professional services. It is appropriate to include the external cause of injury code along with the other ICD10 codes that pertain to the service rendered.

Here is a link and excerpts from the Medicare Claims Processing Manual, Chapter 26 - Completing and Processing Form CMS-1500 Data Set: https://www.cms.gov/Regulations-and-Guidance/Guidance/ Manuals/downloads/clm104c26.pdf Enter up to 12 diagnosis codes. Note that this information appears opposite lines with letters A-L. Relate lines A- L to the lines of service in 24E by the letter of the line. Use the highest level of specificity. Do not provide narrative description in this field.

Here?s an excerpt from the paper CMS1500 claim form indicating the fields that allow up to 12 diagnoses and the diagnosis pointer field on each line item:

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PARA Weekly Update: February 6, 2019

ELASTOGRAPHY

Can CPT® code 0346T - ultrasound, elastography be charged as both a professional and technical fee when coded with CPT® code 76705?

Answer: Effective 1/1/2019, CPT® 0346T has been replaced with 76981, 76982, and 76983; both a professional fee and a technical fee for those codes may be charged.

There is a CCI edit on both the physician claim and the facility claim for 76705 when billed with the elastography code ? the edit requires that the abdominal US 76705 is ?separate and distinct? from the elastography when billed together ? if the studies are separate and distinct, append a modifier (XU -UNUSUAL NON-OVERLAPPING SERVICE = SERVICES ARE DISTINCT BECAUSE SERVICES DO NOT OVERLAP THE USUAL COMPONENTS OF THE MAIN SERVICE ) to the elastography code.

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PARA Weekly Update: February 6, 2019

CPT 10022 CPT速 code 10022 must be charged with a primary code of 76942, 77002, 77012, or 77021, is that correct? Also, when looking in PARA Data Editor under the calculator tab for the professional fee it states that CPT速 code 10022 is a valid code however cannot be found with a professional fee. Can you confirm that this message means CPT速 code 10022 must be billed as a technical fee only?

Answer: Effective 1/1/2019, CPT速 10022 was deleted and replaced with a number of new codes which report by modality FNA with imaging; there are code pairs for the 1st lesion and each additional lesion.

The list of codes in the attached is the PARA paper. Physician reimbursement is provided in the list below:

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PARA Weekly Update: February 6, 2019

SAME DAY, TWO EM S (SOCIAL WORKER AND PHYSICIAN)

One of my physician offices that employs a social worker is asking this question. This Social Worker is enrolled in the Medicare program as a provider. Is the 96150 code limited if the patient has a physician visit on the same day? For example, can a patient see the doctor and the doctor refers the patient to the social worker, and the social worker sees the patient on that same day? Can the E&M for the provider and the 96150 for the social worker be billed on the same day?" The doctor and the social worker in this question are enrolled in Medicare as part of the same provider group and location.

Answer: There is a CCI edit between an EM code, such as 99214, and a 96150 when performed for the same patient on the same DOS by the same physician/practitioner.

The question is whether a different practitioner within the same medical group would be able to report 96150 on the same day.

Here?s the CCI edit:

Medicare?s Group Practice rule allows for separate visits on the same DOS by providers of different specialties according to Medicare?s specialty group assignment. Social Workers are in specialty group 80; if the other practitioner is in a separate specialty group, then both providers should be able to report an E/M on the same date of service for the same Medicare beneficiary.

The Specialty Group crosswalk used to be published in a printable PDF document that was easy to peruse. Attached is the November 2017 version. However, it is now an electronic look-up at the website below, which is a little more challenging to navigate: https://apps.para-hcfs.com/para/Documents/CROSSWALK_MEDICARE_PROVIDER_SUPPLIER_ to_HEALTHCARE_PROVIDER_TAXONOMY%20(1).pdf

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PARA Weekly Update: February 6, 2019

SAME DAY, TWO EM S (SOCIAL WORKER AND PHYSICIAN)

Incidentally, in the 2019 Medicare Physician Fee Schedule Proposed Rule, Medicare had proposed relaxing the group practice limitation on E/M codes; however, in the Final Rule, CMS postponed changes until further information is assembled.

Here?s a link and an excerpt from the Final Rule: https://www.govinfo.gov/content/pkg/FR-2018-11-23/html/2018-24170.htm b) Public Comment Solicitation on Eliminating Prohibition on Billing Same-Day Visits by Practitioners of the Same Group and Specialty The Medicare Claims Processing Manual states, ``As for all other E/ M services except where specifically noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician documents that the visits were for unrelated problems in the office, off campus-outpatient hospital, or on campus-outpatient hospital setting which could not be provided during the same encounter'' (Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.7.B., available on the CMS website at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/ Downloads/clm104c12.pdf).

This instruction was intended to reflect the idea that multiple visits with the same practitioner, or by practitioners in the same or very similar specialties within a group practice, on the same day as another E/M service would not be medically necessary. However, stakeholders have provided a few examples where this policy does not make sense with respect to the current practice of medicine as the Medicare enrollment specialty does not always coincide with all areas of medical expertise possessed by a practitioner--for example, a practitioner with the Medicare enrollment specialty of geriatrics may also be an endocrinologist. If such a practitioner was one of many geriatricians in the same group practice, they would not be able to bill separately for an E/M visit focused on a patient's endocrinological issue if that patient had another more generalized 8

PARA Weekly Update: February 6, 2019

SAME DAY, TWO EM S (SOCIAL WORKER AND PHYSICIAN)

E/M visit by another geriatrician on the same day. Stakeholders have pointed out that in these circumstances, practitioners often respond to this instruction by scheduling the E/M visits on two separate days, which could unnecessarily inconvenience the patient. Given that the number and granularity of practitioner specialties recognized for purposes of Medicare enrollment continue to increase over time (consistent with the medical community's requests), the value to the Medicare program of the prohibition on same-day E/M visits billed by physicians in the same group and medical specialty may be diminishing, especially as we believe it is becoming more common for practitioners to have multiple specialty affiliations, but would have only one primary Medicare enrollment specialty.

We believe that eliminating this policy may better recognize the changing practice of medicine while reducing administrative burden. The impact of this proposal on program expenditures and beneficiary cost sharing is unclear. To the extent that many of these services are currently merely scheduled and furnished on different days in response to the instruction, eliminating this manual provision may not significantly increase utilization, Medicare spending and beneficiary cost sharing.

We solicited public comment on whether we should eliminate the manual provision given the changes in the practice of medicine or whether there is concern that eliminating it might have unintended consequences for practitioners and beneficiaries. We recognize that this instruction may be appropriate only in certain clinical situations, so we also solicited public comments on whether and how we should consider creating exceptions to, or modify this manual provision rather than eliminating it entirely. We also requested that the public provide additional examples and situations in [[Page 59631]] which the current instruction is not clinically appropriate. Comment: We received many comments in response to this solicitation.

Response: We thank the commenters for all of the information submitted, and will review the many public comments we received on this topic and consider this issue further for potential future rulemaking

FLOSEAL We have a physician that used Floseal 5ml vial on a patient with epistaxis. Should this be in the chargemaster as a supply or drug? If a drug, what J code should be used or should it be under 250 revenue code with no hcpcs? Thanks

Answer: According to the manufacturer?s website, FLOSEAL Hemostatic Matrix consists of patented bovine-derived gelatin granules coated in human-derived thrombin that work in combination to form a stable clot at the bleeding site. FLOSEAL is resorbed by the body within 6-8 weeks. There is no appropriate HCPCS assigned to this product.

It is reasonable to report the charge under revenue code 0250, pharmacy, but since it?s action seems more mechanical (forming a clot) than pharmaceutical, it is also reasonable to report it under revenue code 0272, sterile supply. Either way, it is not separately reimbursed under OPPS.

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PARA Weekly Update: February 6, 2019

CY 2019 HOME HEALTH AND HOSPICE CLAIM REQUIREMENTS

With the effective date of January 01, 2019, CMS is implementing the following changes for Home Health claims effective January 07, 2019.

As stipulated in section 50208 of the Bipartisan Budget Act (BBA) of CY2018, Congress amended Section 421 of the Medicare Modernization Act (MMA) to increase the payment amount for Home Health services furnished in a rural area. The defined percentage of the increase will vary based on the county within the rural area.

The county-based increase will apply to Home Health episodes and Home Health visits ending on or after January 01, 2019 and will continue, at changing percentage levels for calendar years 2020, 2021 and 2022. https://www.cms.gov/Regulations-and-Guidance/Guidance/ Transmittals/2018Downloads/R4106CP.pdf To meet the requirements providers are now required to add an additional value code (field 40) on the UB claim form. The new value code is 85. Currently, all providers are required to have value code 61 (field 39) on the UB claim form.

Example: Claims that are missing the correct value code and FIPS code, will be returned to provider (RTP) with reason code 37257.

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PARA Weekly Update: February 6, 2019

CY 2019 HOME HEALTH AND HOSPICE CLAIM REQUIREMENTS

To access the FIPS State and County Code Crosswalk, the link has been inserted below: http://www.nber.org/data/ssa-fips-state-county-crosswalk.html

It is recommended by PARA that Home Health providers contact their software vendors to ensure these changes have been updated within the claims system.

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PARA Weekly Update: February 6, 2019

CMS ISSUES APPROPRIATE USE FACT SHEET

its first volley of provider education efforts toward meeting its legal obligation under the Protecting Access to Medicare Act (PAMA), Medicare has started outreach efforts to educate providers in the new requirements to use of Appropriate Use Criteria (AUC) in ordering ?advanced diagnostic imaging? studies.

The requirement is voluntary until January 1, 2020, when the use of AUC is scheduled to become mandatory.

A link and an excerpt of the fact sheet is provided below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/AUCDiagnosticImaging-909377.pdf

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While appropriate use criteria requirements do not apply to Critical Access Hospitals, all OPPS hospitals should initiate their own efforts to educate ordering providers and offer access to AUC ?Clinical Decision Support Mechanisms? when accepting orders for advanced diagnostic imaging.

For additional information, see the PARA Data Editor resources on the Advisor tab ? search on ?Appropriate Use?:

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PARA Weekly Update: February 6, 2019

MEDICARE 2019 FINAL RULES - MPFS AND OPPS

Reprinted By Request

On Thursday, November 1, Medicare released the 2019 Physician Fee Schedule Final Rule, and on Friday, November 2, 2019, Medicare released the 2019 OPPS Final Rule. Medicare?s ?Fact Sheets? summarize changes to the rules at the following links: https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changesmedicare-physician-fee-schedule-calendar-year

https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-medicare-hospital-outpatient-p rospective-payment-system-and-ambulatory-surgical-center

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PARA Weekly Update: February 6, 2019

MEDICARE 2019 FINAL RULES - MPFS AND OPPS

OPPS Final Rule Highlights - The OPPS payment rates were increased by 1.35 percent in 2019 - Reductions for Off-Campus Provider-Based Departments: Hospitals with off-campus locations that have enjoyed OPPS reimbursement at the full on-campus rate will find reimbursement significantly reduced in 2019. The rate reductions applicable to ?non-excepted? off-campus provider-based departments (PBD) will apply to ?excepted? (grandfathered) provider-based departments, causing the facility fee reimbursement for outpatient visits (G0463 and certain related services) to be reduced to 70% of the OPPS rate in 2019 and to 40% in 2020.

Until this change, off-campus PBDs which were established and reimbursed under OPPS as of November 2, 2015, were deemed ?excepted? (grandfathered), and were insulated from rate reductions. That protection will disappear in 2019.

For example, if the allowable OPPS reimbursement for G0463 (Hospital Outpatient Clinic Visit) is $115, when the same code is reported at an off-campus provider-based location, Medicare?s allowable will be reduced by 30% to $80.50 in 2019, and reduced an additional 30% in 2020 to $46.00 - Additional cuts to reimbursement of drugs purchased through the 340B program will be applied to ?non-excepted? (established after 11/2/2015) provider-based departments, which are paid under the Medicare Physician Fee Schedule (not OPPS.) CMS began paying hospitals 22.5 percent less than the average sales price for drugs purchased through the 340B program in calendar year 2018. The previous payment rate was average sales price plus six percent.

Under the final OPPS rule for 2019, CMS will extend the average sales price minus 22.5 percent rate to 340B drugs provided at nonexcepted off-campus provider-based departments.

- CMS removed one measure from the Hospital Outpatient Quality Reporting Program beginning with the 2020 payment determination, and seven other measures beginning with the 2021 payment determination. CMS strives to use a smaller set of more meaningful measures and to focus on patient-centered outcome measures, while taking into account opportunities to reduce paperwork and reporting burden on providers.

2019 Medicare Physician Fee Schedule Final Rule Highlights - The functional limitation G-codes will no longer be required when reporting therapy services after 1/1/2019 - Medicare has postponed its proposal to simplify E/M payment and coding requirements until 2021; however, some relief on detailed documentation standards was provided - CMS will pay separately for two HCPCS for physicians?services furnished using communication technology: - G2012 -- Brief communication technology-based service, e.g. virtual check-in; and - G2010 -- Remote evaluation of recorded video and/or images submitted by an established patient 14

PARA Weekly Update: February 6, 2019

MEDICARE 2019 FINAL RULES - MPFS AND OPPS

- CMS is also finalizing policies to pay separately for new codes describing chronic care remote physiologic monitoring (CPTÂŽ codes 99453, 99454, and 99457) and interprofessional internet consultation (CPTÂŽ codes 99451, 99452, 99446, 99447, 99448, and 99449) - CMS relaxed the physician supervision requirements for radiology assistants in the physician clinic setting. Diagnostic tests performed by a Radiologist Assistant (RA) that required a ?personal? level of physician supervision in 2018 may be furnished under a ?direct? level of physician supervision in 2019, to the extent permitted by state law and state scope of practice regulations - CMS established two new payment modifiers for services rendered by Therapy Assistants ? one for Physical Therapy Assistants (PTA) and another for Occupational Therapy Assistants (OTA) ? for providers to indicate when services are furnished in whole, or in part by a PTA or OTA. The new modifiers will be used alongside of the current PT and OT modifiers; reduction in reimbursement for services provided by a PTA or an OTA will begin in 2022.

- Modifier CQ: Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant - Modifier CO: Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant The new modifiers will be required to be reported on claims for outpatient PT and OT services with dates of service on and after January 1, 2020, when the service is furnished in whole or in part by a therapy assistant. However, the required payment reductions do not apply for these services until January 1, 2022, as required by section 1834(v)(1) of the Act. - Telehealth will be expanded in several provisions: - To advance care for opioid addiction, the home of an individual as a permissible originating site for telehealth services furnished for purposes of treatment of a substance use disorder or a co-occurring mental health disorder for services furnished on or after July 1, 2019 - A new Medicare benefit category for opioid use disorder treatment services furnished by opioid treatment programs (OTP) will be established under Medicare Part B, beginning on or after January 1, 2020. CMS is accepting comments - Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) will be eligible for additional reimbursement when reporting a G0071 (RHC/FQHC Virtual Communication Service). G0071 will be separately reimbursed for certain telehealth services that are furnished by an RHC or FQHC practitioner when there is no associated billable visit, if the services are unrelated to another service provided within the previous 7 days or within the next 24 hours or at the soonest available appointment - HCPCS codes G0513 and G0514 (Prolonged preventive service(s)) will be eligible for reimbursement as a telehealth service in 2019

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PARA Weekly Update: February 6, 2019

MEDICARE 2019 FINAL RULES - MPFS AND OPPS

- ESRD and Stroke Patient Telehealth services will be expanded. CMS will permit renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites, and will not apply originating site geographic requirements for hospital-based or critical access hospital-based renal dialysis centers, renal dialysis facilities, and beneficiary homes, for purposes of furnishing the home dialysis monthly ESRD-related clinical assessments.

- 2019 will serve as a year-long educational and operations testing period for Medicare?s Appropriate Use Criteria program, during which time AUC consultation information is expected to be reported on claims for advanced diagnostic imaging, but claims will not be denied for failure to include AUC consultation information. Reporting requirements for Medicare?s Appropriate Use Criteria Program continue to be debated and developed.

The 2019 final rule provided additional information on ?extreme hardship? exceptions which may be claimed by some ordering providers to be excused from the reporting requirements. Sometime in 2019, Medicare will finalize procedures for furnishing providers to report informational G-codes on outpatient Medicare claims for ?advanced diagnostic imaging? (eg. CT, MRI/MRA, nuclear medicine) in 2020.

In the meantime, furnishing providers (clinics, IDTFs, and hospitals which are not Critical Access Hospitals) and interpreting providers (radiologists) are expected to report modifier QQ (Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional) when AUC was consulted.

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PARA Weekly Update: February 6, 2019

2019 UPDATE: CHANGES TO THE MEDICARE "INPATIENT ONLY" LIST

Medicare updated the ?inpatient only? list published annually in the OPPS Final Rule, Addendum E. The complete addendum is available on the CMS website at the link below: https://www.cms.gov/apps/ama/license.asp?file=/Medicare/Medicare-Fee-for-ServicePayment/ HospitalOutpatientPPS/Downloads/CMS-1695-FC-2019-OPPS-FR-Addenda.zip HCPCS which were deleted from Medicare?s 2019 ?Inpatient Only? list include codes that are no longer valid (indicated by strike through) and valid codes which are now payable in outpatient status:

In addition, there are 2 HCPCS which are new to Medicare?s 2019 ?Inpatient Only? list in 2019:

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PARA Weekly Update: February 6, 2019

CAH METHOD II CLAIMS FOR TELEHEALTH PRO FEES

In order to ensure appropriate payment, a Method II Critical Access Hospital (CAH) should report telehealth professional fees on the correct claim form ? not all telehealth professional fees billed by a CAH belong on the facility fee claim form.

If the practitioner is properly enrolled with Medicare and has reassigned benefits to the Method II CAH, Method II CAHs should report telehealth professional fees on: - The CAH Method II UB04/837i claim form if the provider was physically located within the CAH when providing telehealth services; for example, an employed physician working at the CAH providing telehealth care to a patient at a distant RHC site - CMS1500/837p professional fee claim form for telehealth services provided to a patient located at the CAH rendered by a distant physician should be reported on a CMS1500/837p claim if that physician is not located within the Method II CAH. The CAH should report the originating site fee, Q3014, on an institutional UB04/837i claim form

A facility should not report, under any circumstance, both the originating site telemedicine fee, Q3014, for the patient end of the telehealth services and a professional fee for the distant site practitioner.

The 2018 Medicare Physician Fee Schedule Final Rule explains that the remote provider professional fee must be billed to Medicare indicating the service location where the distant site is located. The address of the remote provider?s physical location should be indicated in Box 32 of the CMS1500/837p claim. In requiring providers abide by this requirement, CMS ensures its professional fee reimbursement is appropriately calculated to the remote physician?s locality.

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PARA Weekly Update: February 6, 2019

CAH METHOD II CLAIMS FOR TELEHEALTH PRO FEES

https://www.federalregister.gov/documents/2017/11/15/2017-23953/medicare-program-revisions -to-payment-policies-under-the-physician-fee-schedule-and-other-revisions Practitioners furnishing Medicare telehealth services submit claims for telehealth services to the Medicare Administrative Contractors (MACs) that process claims for the service area where their distant site is located.

Section 1834(m)(2)(A) of the Act requires that a practitioner who furnishes a telehealth service to an eligible telehealth individual be paid an amount equal to the amount that the practitioner would have been paid if the service had been furnished without the use of a telecommunications system.

Since Medicare pays professional fees appropriate to the locality in which the physician renders services, Method II CAHs whom employ or contract with remote providers to perform telehealth services for CAH patients should not claim the remote provider?s outpatient professional fees on the CAH outpatient facility claim if the provider was not physically located at the CAH when rendering telemedicine care.

If the CAH serves as the originating site (the patient end), it may report HCPCS Q3014 on the UB04, but the distant site professional fee can be accurately reported on only a CMS1500/837p claim form, which identifies the service location. There is no way to indicate that the physician is at another location on a facility fee claim form.

CAHs may report the professional fee of a distant site practitioner who has reassigned benefits to the CAH by submitting a professional fee claim, CMS1500/837p, and reporting place of service code 02, Telehealth. The actual physical address of the practitioner must appear in box 32 to enable Medicare to pay the allowable rate of 80% of the Medicare Physician Fee Schedule for the locality in which the physician is working. Prior to billing, hospitals should verify that the physician?s Medicare enrollment (855I form) list the address at which the physician provides telemedicine care as one of his/her practice locations.

Modifier GT ? ?Via interactive audio and video telecommunications system? ? was discontinued in 2018 for all providers except CAH Method II, as explained in the MedLearn Matters Article below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/downloads/MM10152.pdf

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PARA Weekly Update: February 6, 2019

CAH METHOD II CLAIMS FOR TELEHEALTH PRO FEES

Modifier GT should be reported on a CAH Method II UB04/837i if the distant site practitioner is located at the CAH, which means the patient receiving telemedicine care is at an originating site which is not the Method II CAH. If the patient is not at the CAH, but professional fees are generated within the CAH, the facility claim would report only the professional fees with modifier GT appended to the HCPCS. Below are two examples to illustrate the different billing scenarios for a Method II CAH billing professional fees for a physician which has reassigned benefits to the CAH: Example 1: The distant site practitioner is located at a Method II CAH and provides telemedicine care to a patient at an originating site outside the CAH, such as a distant Rural Health Clinic, physician clinic, or another CAH. Billing: The Method II CAH should report professional fees on a UB04/837i claim to Medicare, with modifier GT appended to the HCPCS/CPTÂŽ code.

Example 2: The Method II CAH serves as the originating site for the patient receiving telemedicine services, and the distant site practitioner is not within the CAH but at a distant location.

Billing: The Method II CAH may claim reimbursement for the professional telemedicine services by submitting a separate CMS1500/837p claim, reporting Place of Service code 02 and the physical address of the remote physician providing the telemedicine care in box 32.

In summary, when billing for an employed or contracted remote provider?s professional fees, CAHs should report professional fees on a separate CMS1500/837p claim form; they should not report remote provider services on the UB04/837i unless the practitioner renders telemedicine services while physically located within the CAH. An excerpt of the bottom portion of a CMS 1500 claim form illustrates the appropriate reporting of telehealth professional fees by a remote provider ? distant from the CAH:

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PARA Weekly Update: February 6, 2019

APPLYING CDC'S GUIDELINES FOR PRESCRIBING OPIOIDS

In 2017, almost 57 million American patients had at least one prescription for opioids filled or refilled. The

average number of opioid prescriptions per patient was 3.4, and the average days of supply per prescription was 18 days. Taking opioids for longer periods of time or in higher doses increases the risk of addiction, overdose, and death.

The CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for safer and more effective prescribing of opioids for chronic pain in patients 18 and older in outpatient settings outside of active cancer treatment, palliative care, and end-of-life care. This interactive online training series aims to help healthcare providers apply CDC?s recommendations in clinical settings through patient scenarios, videos, knowledge checks, tips, and resources. Providers can gain a better understanding of the recommendations, the risks and benefits of prescription opioids, non-opioid treatment options, patient communication, and risk mitigation. Each stand-alone module is self-paced and offers free continuing education credit.

The list below contains information about the trainings currently available, as well as those planned for release for the remainder of this year.

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PARA Weekly Update: February 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

Healthy Food Financing Initiative Targeted Small Grants Program Provides Financial assistance to support projects that improve access to healthy foods in underserved areas, create and preserve quality jobs, and revitalize low income communities. In general, grants are expected to fall in the range of $25,000 - $250,000 Application Deadline: February 14, 2019

Juvenile Tribal Healing to Wellness Courts: Coordinated Tribal Assistance Solicitation (CTAS) Juvenile Healing to Wellness Courts grants offers up to $350,000 in funding to federally-recognized tribes to develop and implement new healing to wellness court programs that focus on responding to alcohol and substance use issues of tribal juveniles and young adults under 21 .

- Application Deadline: February 26, 2019

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PARA Weekly Update: February 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, January 31, 2019 New s & An n ou n cem en t s

· New App Displays What Original Medicare Covers · Physicians and Non-Physician Practitioners: New Medicare Enrollment Application · QPP Videos: Create an Account in HARP · QPP Videos: MIPS Data Submission · eCQM Resources · Hospice Quality Reporting Program: FY 2021 Data Collection Began January 1 · Hospice Training: Updates to Public Reporting in FY 2019 · Prevent Legionnaires' Disease: Water Management Program Training Pr ovider Com plian ce

· Cochlear Devices Replaced Without Cost: Bill Correctly ? Reminder Claim s, Pr icer s & Codes

· Physician Anesthesia Claims for SNF Patients Upcom in g Even t s

· New Electronic System for Provider Reimbursement Review Board Appeals Call ? February 5 · New Medicare Card Open Door Forum ? February 6 · Home Health Patient-Driven Groupings Model Call ? February 12 · New Part D Opioid Overutilization Policies Call ? February 14 · MIPS Data Submission Office Hours Sessions ? February 26 and March 19 M edicar e Lear n in g Net w or k ® Pu blicat ion s & M u lt im edia

· RHCs/FQHCs: Communication Technology Based Services and Payment MLN Matters Article ? New · Quality Payment Program in 2018: Transitioning to an Advanced APM Web-Based Training ? New · Hospital Based Hospice Provider Compliance Tips Fact Sheet ? New · Lab Tests: Urinalysis Provider Compliance Tips Fact Sheet ? New · Lab Tests: Routine Venipuncture Provider Compliance Tips Fact Sheet ? New · Lenses Provider Compliance Tips Fact Sheet ? New · Parenteral Nutrition Provider Compliance Tips Fact Sheet ? New · Patient Lifts Provider Compliance Tips Fact Sheet ? New

23

PARA Weekly Update: February 6, 2019

There were FOUR 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.

4

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

24

PARA Weekly Update: February 6, 2019

The link to this Med Learn MM11112

25

PARA Weekly Update: February 6, 2019

The link to this Med Learn MM11081

26

PARA Weekly Update: February 6, 2019

The link to this Med Learn MM11061

27

PARA Weekly Update: February 6, 2019

The link to this Med Learn MM11003

28

PARA Weekly Update: February 6, 2019

There were SIXTEEN new or revised Transmittals released this week.

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

16

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

29

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4222CP

30

PARA Weekly Update: February 6, 2019

The link to this Transmittal R256BP

31

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2243OTN

32

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4229CP

33

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4228CP

34

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4230CP

35

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4227CP

36

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4225CP

37

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2247OTN

38

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2248OTN

39

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2249OTN

40

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2250OTN

41

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2244OTN

42

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2245OTN

43

PARA Weekly Update: February 6, 2019

The link to this Transmittal R2246OTN

44

PARA Weekly Update: February 6, 2019

The link to this Transmittal R4223CP

45

PARA Weekly Update: February 6, 2019

46