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Date

PARA WEEKLY

UPDATE For Users

I mproving T he Business of H ealthCare Since 1985 July 11, 2018

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Coding Videocapsule Placement On Outpatient GI Procedures - Supplies Billable On A Clinic Claim CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS NEW "HOW-TO" VIDEO ON PDE

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UPDATE FOR NEW MEDICARE CARD (MBI) NEW PART B EDIT FOR DUPLICATION OF DIAGNOSIS HARD COPY CLAIMS ALERT: ESRD ADD-ON PAYMENT CLAIMS ALERT: NORIDIAN MASS ADJUSTMENTS FOR QMB BENEFICIARIES NORIDIAN ALERT: CLAIMS PROCESSING ISSUES ALERT: ELECTROCARDIOGRAPHIC CLAIM EDIT FOR NGS JURISDICTION 6 OIG ALERT: REASON CODE 701G2

PARA COMPANY NEWS

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ABOUT PARA

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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.

Administration: Pages 1-34 HIM /Coding Staff: Pages 1-34 GI Services: Page 2 Providers: Pages 2,6,12,14,17,19 Laboratory: Page 6 Senior Services: Pages 12,16,17 Cardiology Svcs: Page 18

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Pharmacy: Pages 15,27 SNF: Pages 26,30 PDE Users: Pages 11,22,24 Rural HealthCare: Page 21 DM E: Pages 3,29 Home Health: Page 23 Business Development: Page 24

© 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: July 11, 2018

CODING VIDEOCAPSULE PLACEMENT ON OUTPATIENT GI PROCEDURES

Can you provide some guidance for coding videocapsule placement procedures on outpatient hospital GI Lab claims?

We offer the following general guidance for these endoscopic procedures. The coding will vary between facility fee reporting and professional fee reporting for videocapsule placement. Professional Fees: Since the physician has supplied the videocapsule, the hospital cannot report the 91110 (Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report) for the videocapsule placement service alone. The physician will report that code with place of service 11 (Office) on the professional fee claim (claiming reimbursement for the ?global? procedure.) If the physician will report 91110 when the study is complete, and the purpose of the hospital scope procedure is exclusively to place the capsule, with no other diagnostic or therapeutic objective, the professional should not report the capsule placement service separately; the ?global? charge for 91110 includes placement of the capsule. If additional services are performed, such as biopsies or esophageal dilation, then the diagnostic/therapeutic service is separately reportable. Facilities, however, may report the appropriate CPTÂŽ for the most appropriate scope procedure that was performed for the capsule placement, either alone, or incidentally as a component of a more comprehensive procedure, or together with another procedure that does not cover the capsule placement. - The insertion of the capsule may be reported separately with the HCPCS that best describes the procedure, 43235, with modifier -52 (reduced service) if the objective was solely placement of the capsule and no other diagnostic or therapeutic service was performed - When capsule placement is performed at the same time another therapeutic or diagnostic EGD procedure is performed, report the code that best describes the other diagnostic/therapeutic procedure. If the code for the other procedure covers the anatomic area at which the capsule was placed, report the diagnostic/therapeutic procedure only, consider the capsule placement incidental and not separately reported - If the code for another endoscopic procedure performed at the same encounter does not extend to the location at which the capsule is placed, report the capsule placement separately with 43235-52. For example, it is appropriate to code 43235-52 and esophageal dilation, 43450, because the capsule placement was below the esophagus. (By the way, we found that modifier 52 was reported with 43235 on only one of the 20 claims.) HCPCS 91110 should not be reported by the facility if it has not supplied the capsule, that code is reported solely by the physician in the office setting.

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PARA Weekly Update: July 11, 2018

SUPPLIES BILLABLE ON A CLINIC CLAIM

Can an orthopedic clinic bill for cast supplies?

Answer: In general, yes, but the precise means of reporting supplies (with or without HCPCS codes) differs depending on whether the clinic is ?provider-based?, meaning it is operated and billed to Medicare as a department of a hospital, and whether the supplies qualify as ?prosthetics and orthotics? under Medicare?s Durable Medical Equipment (DME) Fee Schedule. Independent physician clinics may report HCPCS for casting and splints, as well as Durable Medical Equipment in the category of prosthetics and orthotics. For example, Q4010 - CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS may be reported by an independent physician clinic for Medicare reimbursement. This supply is not considered a prosthetic or an orthotic, but a supply item that is not included in the Medicare Physician Fee Schedule reimbursement for fracture care. However, ?provider-based? clinics, as departments of a hospital, should report non-DME supplies without a HCPCS, typically in revenue code 0270 for non-sterile supplies, or 0272 for sterile supplies. Provider-based clinics may report facility fees for durable medical equipment within the category of ?prosthetics and orthotics? with a HCPCS under revenue code 0274. No special DME enrollment is required of hospitals supplying ?prosthetic and orthotic? DME in conjunction with other medical services, such as L3908 - WRIST HAND ORTHOSIS, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED, PREFABRICATED, OFF-THE-SHELF for outpatients treated in the provider-based clinic setting. The DME report on the PARA Data Editor Calculator tab identifies whether a HCPCS is billable by a hospital in the column labelled ?OPPS Billable?:

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PARA Weekly Update: July 11, 2018

SUPPLIES BILLABLE ON A CLINIC CLAIM

Crutches fall into Medicare?s supplies category of ?Inexpensive and Other Routinely Purchased Items.? This category of supplies may be billed only to Medicare through a claim to the DME MAC by an enrolled DME supplier. Following is an excerpt from the Chapter 20 of the Medicare Claims Processing Manual which defines these items: 130.2 - Billing for Inexpensive or Other Routinely Purchased DME (Rev. 1, 10-01-03) A3-3629, B3-4107.8 This is equipment with a purchase price not exceeding $150, or equipment that the Secretary determines is acquired by purchase at least 75 percent of the time, or equipment that is an accessory used in conjunction with a nebulizer, aspirator, or ventilators that are either continuous airway pressure devices or intermittent assist devices with continuous airway pressure devices. Suppliers and providers other than HHAs bill the DME MAC or, in the case of implanted DME only, the A/B MAC (B). HHAs bill the A/B MAC (HHH) or the DME MAC. Splints and Casts: The following reference from Chapter 20 of the Medicare Claims Processing Manual indicates that many of the DME Q-codes are payable when billed by an independent (non-provider-based) physician clinic: Link to guidance manual.

170 - Billing for Splints and Casts (Rev. 2993, Effective: ASC X12 - 01-01-12, ICD-10 - Upon Implementation of ICD-10; Implementation: ASC X12 - 08-25-14, ICD-10 - Upon Implementation of ICD-10) The cost of supplies used in creating casts are not included in the payment amounts for the CPTÂŽ codes for fracture management and for casts and splints. Thus, for settings in which CPTÂŽ codes are used to pay for services that include the provision of a cast or splint, supplies maybe billed with separate HCPCS codes. The work and practice expenses involved with the creation of the cast or splint are included in the payment for the code for that service. For claims with dates of service on or after July 1, 2001, jurisdiction for processing claims for splints transferred from the DME MACs to the A/B MAC (B). The A/B MACs (B) have jurisdiction for processing claims for splints and casts, which includes codes for splints that may have previously been billed to the DME MACs. Jurisdiction for slings is jointly maintained by the A/B MACs (B) (for physician claims) and the DME MACs (for supplier claims). Notwithstanding the above where the beneficiary receives the service from any of the following providers claims jurisdiction is with the A/B MAC (A). An exception to this is hospital outpatient services and hospital inpatient Part B services, which are included in the OPPS payment and are billed to the A/B MAC (A) using the ASC X12 837 institutional claim format or Form CMS- 1450). Other providers and suppliers that normally bill the A/B MAC (A) for services bill the A/B MAC (B) for splints and casts.

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PARA Weekly Update: July 11, 2018

SUPPLIES BILLABLE ON A CLINIC CLAIM

According to the 2017 CMS DME file, Q40XX codes are in the Supplies and Casts (?SC?) category, and are therefore reimbursed in a independent (non-provider-based) clinic setting on a 1500/837p type claim. Here is a link and an excerpt from the file: Click Here For The Link.

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PARA Weekly Update: July 11, 2018

CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS

CMS recently postponed the implementation and enforcement of the Date of Service exception policy announced in the 2018 OPPS Final Rule. The CMS website recently added two new documents, an FAQ and a notice informing providers that the DOS exceptions, which would have required that in many cases, only the performing laboratory (not the hospital) should bill certain molecular pathology and Advanced Diagnostic Lab Tests (ADLTs). This delay means that the reporting changes are optional until January 1, 2019. The first document, Frequently Asked Questions, was published on the CMS website on June 28, 2018: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/ CLFS-DOS-FAQs.pdf

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PARA Weekly Update: July 11, 2018

CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS

The second document, announcing a delay in enforcement, was published on July 3, 2018: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/ Enforcement-Discretion.zip

This news means that if the reference laboratory is not willing or able to bill Medicare directly, the hospital may continue to report molecular pathology tests and ADLTs on the outpatient hospital claim. Many of the molecular pathology HCPCS also require that the hospital supply a Molecular Pathology Z-code on its claim. PARA has provided guidance on Z-codes at the following link: https://apps.para-hcfs.com/para/Documents/Molecular_Diagnostics_Z_Codes_May_2017 _Update_edited.pdf

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PARA Weekly Update: July 11, 2018

CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS

Until it delayed implementation in its most recent website publications, CMS had indicated that as of January 1 of 2018, hospitals should no longer bill a list of codes representing ?Advanced Diagnostic Laboratory Tests? (ADLTs) and molecular pathology tests when performed on a sample taken during an outpatient encounter but performed by a laboratory other than the hospital. Prior to January 1, 2018, Medicare had required hospitals to include all lab tests on the hospital outpatient claim if the specimen was collected during an outpatient hospital visit, and the test was performed within 14 days of the hospital encounter. CMS has not supplied any information as to how it will enforce the new requirement after January 1, 2019. It is possible that the claims processing system could match the Z-code, which identifies the performing laboratory, against the facility identity. The complete list of HCPCS that may be billed by either the hospital or the performing laboratory (but not both) until January 1, 2019 is available at the following link: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Downloads/ CLFS-Test-Codes-DOS-Exception.zip

Assuming that CMS does not further modify its requirements, after January 1, 2019, hospitals will no longer be permitted to claim certain molecular pathology and ADLTs performed by reference laboratories on specimens collected during an outpatient encounter when the following criteria were met: - The test is performed following a hospital outpatient?s discharge from the hospital outpatient department; - The specimen was collected from a hospital outpatient during an encounter (as both are defined 42 CFR 410.2); - It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter; - The results of the test do not guide treatment provided during the hospital outpatient encounter; and - The test was reasonable and medically necessary for the treatment of an illness

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PARA Weekly Update: July 11, 2018

CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS

Medicare made a change in policy for these outpatient tests for a variety of reasons. Under the previous DOS policy, the reference laboratory was prohibited from billing Medicare directly for ADLTs performed within 14 days of the date a specimen collected during an outpatient hospital encounter. That DOS rule applied whether the hospital was an OPPS hospital or whether it was a Critical Access Hospital (CAH). Note that the criteria above do not apply to specimens collected during an inpatient stay. The hospital must continue to include the cost of testing performed on specimens collected during an inpatient stay on the hospital?s inpatient claim. Medicare may consider changes to inpatient billing rules at a later date; for now, hospitals should continue as before in regard to ADLT tests performed on specimens collected during an inpatient stay. Medicare determined that the administrative complexity of its previous laboratory DOS policy frequently led hospitals to delay ordering of ADLTs. Some of the problems Medicare heard regarding the old policy included that: - Because ADLTs are performed by only a single laboratory and molecular pathology tests are often performed by only a few laboratories, and most hospitals do not have the technical ability to perform these complex tests, the hospital may be reluctant to bill Medicare for a test it would not typically (or never) perform. As a result, the hospital might delay ordering the test until at least 14 days after the patient is discharged from the hospital outpatient department or even cancel the order to avoid the DOS policy, which may restrict a patient?s timely access to these tests. (We note that this concern does not apply to Critical Access Hospitals.) - The previous laboratory DOS policy may have disproportionately limited access for Medicare beneficiaries under original Medicare fee-for-service (that is, Medicare Part A and Part B) because Medicare Advantage plans under Medicare Part C and other private payors allowed laboratories to bill directly for tests they perform. The 2018 OPPS Final Rule (Federal Register / Vol. 82, No. 239 / Thursday, December 14, 2017 / Rules and Regulations, Pages 59398) explained that hospitals would not have the option to continue to bill for ADLTs when the 5 criteria above are met: https://www.gpo.gov/fdsys/pkg/FR-2017-12-14/pdf/R1-2017-23932.pdf Comment: One commenter requested clarification as to whether an exception to the laboratory DOS policy would allow a hospital to continue billing for ADLTs or molecular pathology tests excluded from the OPPS packaging policy or whether the policy change would require a laboratory to bill Medicare directly for these tests. ? Response: If a test meets all requirements for the new exception to the DOS policy in ยง 414.510(b)(5), the DOS of the test must be the date the test was performed, which means the laboratory performing the test must bill Medicare for the test. The hospital would no longer be permitted to bill for these tests unless the hospital laboratory actually performed the test. That is, if the hospital laboratory performed the ADLT or molecular pathology test, the hospital laboratory would bill Medicare for the test. ? 9


PARA Weekly Update: July 11, 2018

CMS DELAYS ENFORCEMENT OF LAB TEST DOS EXCEPTIONS

Under OPPS, Medicare requires a hospital to include all charges for services rendered ?under arrangements? on the hospital claim, but services rendered after the encounter, such as the analysis of send-out laboratory specimens, were sometimes billed by hospitals, and sometimes billed by the reference laboratory independent of the facility claim. This change in policy standardizes Medicare?s expectation that ADLTs must always be billed by the performing laboratory provider. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/ Clinical-Lab-DOS-Policy.html

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PARA Weekly Update: July 11, 2018

NEW "HOW-TO" VIDEOS LOADED ON PARA DATA EDITOR

Learning Has Never Been So Easy! PARA is developing a series of online training videos that will be accessible to PARA Data Editor (PDE) users at their convenience. These training videos will provide step-by-step instructions on a variety of topics. Our first video, "The PARA PDE Overview," has been posted to the PDE and we invite you to try it out! The training videos are available for any user with a seat on the PDE. Depending on the size of the video, it may take a few minutes to download. But once downloaded, you can easily view the entire video, advance the video or repeat a section, if you like. Our first video is in beta mode right now, so you won't be able to see it on your PDE log in just yet. But here's a preview! Click here to see the video!

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PARA Weekly Update: July 11, 2018

UPDATE FOR NEW MEDICARE CARD (MBI)

CMS is busy mailing out the new Medicare Beneficiary Identifier (MBI) cards. As of June 2018, Wave 1 is ending and Wave 3 is beginning. States in Wave 1 are: Delaware, District of Columbia, Maryland, Pennsylvania, Virginia and West Virginia. This category is ending. States in Wave 3 are: Arkansas, Illinois, Indiana, Iowa, Kansas, Minnesota, Nebraska, North Dakota, Oklahoma, South Dakota and Wisconsin. This category is just beginning. States in Wave 2 are: Alaska, American Samoa, California, Guam, Hawaii, Northern Mariana Islands, Oregon, all Medicare beneficiaries nationwide that are new to Medicare. This category is on-going. If a Medicare beneficiary presents for treatment and indicates they did not get their new card, providers are requested to do the following: - Print and give them the ?Still Waiting for Your New Card?? hand-out (available in English and Spanish) or - Give them the phone number for Medicare (1-800-633-4227). There may be a reason why the card was not received such as, an incorrect mailing address https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/ Tear-Off-for-After-Card-Mailing-Ends.pdf

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PARA Weekly Update: July 11, 2018

UPDATE FOR NEW MEDICARE CARD (MBI)

Further, all Medicare Administrative Contractor (MAC) secure portal MBI look-up tools are ready to use for providers. Providers are required to ?sign-up? for access to use the tool, unless they already have access established. Once the MBI card is mailed to the patient, providers are able to use the look-up tool to verify entitlement and coverage. To ensure no interruption in care for Medicare Beneficiaries, providers are requested to continue using the Medicare Health Insurance Claim Number (HIC) through December 31, 2019, unless the beneficiary presents with the new card. For further updates and information concerning the new Medicare Card conversion process, providers can visit the CMS website link provided below: https://www.cms.gov/medicare/new-medicare-card/nmc-home.html

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PARA Weekly Update: July 11, 2018

NEW PART B EDIT FOR DUPLICATION OF DIAGNOSIS HARD COPY CLAIMS

All Part B providers should be aware that Medicare is implementing changes for Part B 837 formats beginning July 02, 2018. The changes will ensure there is a coordination of benefits/Medicare crossover claim. Providers that submit CMS-1500 claims hard-copy should review the claims and ensure they do not list the same diagnosis code twice within field 21. Medicare has instructed MACs to return these claims to the provider as un-processable. The claim adjustment reason code (CARC) = 16 and the Remittance Advice Remark Code (RARC) = M76 with additional RARC =N211. https://www.palmettogba.com/palmetto/providers.nsf/ls/JJ%20Part%20B~AZYGLM4070?opendocument

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PARA Weekly Update: July 11, 2018

ALERT: ESRD ADD-ON PAYMENT CLAIMS

CMS has published an alert to ESRD providers regarding a system error for claims reporting the new Transitional Drug Adjustment Add-On Payment Adjustment. Currently, claims reporting these services are incorrectly reimbursed if they: - Are eligible for Transitional Drug Adjustment Add-On Payment Adjustment and - Contain non-covered charges CMS is not expecting to have a fix in place prior to January 01, 2019, when CMS will do a mass adjustment on all claims for providers. Providers are not required to take any action. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ESRDpayment/ ESRD-Transitional-Drug.html

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PARA Weekly Update: July 11, 2018

ALERT: NORIDIAN MASS ADJUSTMENTS FOR QMB BENEFICIARIES

Beginning on June 05, 2018, Noridian is adjusting claims that are identified as Qualified Medicare Beneficiaries (QMB). In the Medicare system, QMBs are beneficiaries that have a zero cost-sharing liability. As a result of CMS CR9911, Noridian will begin adjustments for QMB claims with the dates of service prior to December 7, 2017 that received the QMB messages implemented on 10/01/2017. https://med.noridianmedicare.com/web/jeb/topics/ra/qualified-medicare-beneficiary-qmb-program

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PARA Weekly Update: July 11, 2018

NORIDIAN ALERT: CLAIMS PROCESSING ISSUES

On June 29, 2018, Noridian Medicare reported an issue with the claim processing system that is causing therapy claims to process incorrectly. The issue is due to the signing of the Bipartisan Budget Act of 2018. Following the signing of the Act, CMS revised the Medicare Physician Fee Schedule (MPFS) effective for dates of service beginning January 01, 2018. Claims are re-processing at the new allowed amounts beginning on 05/09/2018. However, if the patient is at their therapy cap and the therapy claim is re-processed without the KX modifier, the claim will deny and a recoupment request is being issued to the provider. Provider Action Required: Providers are asked to follow the recoupment process, return the funds, and re-bill or re-open the claim with a KX modifier, if appropriate. Proposed Resolution: Providers must re-bill the denied claim with a KX modifier or add the KX modifier via a Self-Service Re-opening in the portal, if appropriate. https://med.noridianmedicare.com/web/jfb/fees-news/alerts-details/-/view/10534/claims-reprocessing -causing-therapy-claim-recoupments

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PARA Weekly Update: July 11, 2018

ALERT: ELECTROCARDIOGRAPHIC CLAIM EDIT FOR NGS JURISDICTION 6

National Government Services (NGS) for Jurisdiction 6 Part B has issued a claim edit alert for providers. This edit caused rejection and denied claims for certain electrocardiographic services beginning on/after July 31, 2017 through June 14, 2018. No action is required by providers in this jurisdiction at this time. Claims will be reprocessed by the MAC. If providers have any questions regarding this alert, they are asked to contact the MAC provider center. This alert was posted by NGS on July 02, 2018. https://ngsmedicare.com/ngs/portal/ngsmedicare/newngs/home-lob/!ut/p/z1/04_ Sj9CPykssy0xPLMnMz0vMAfIjo8ziTRw9XQ0NnQ28_Z1dHQ0cTVz8zPwc3Qz9DUz1w 9EUGPtbABW4Obm4BAYYuzsZ6UcRo98AB3A0IE4_HgVR-I0P149CswLTB4TMKMgNDY0 wyHQEAHrpc1k!/dz/d5/L2dBISEvZ0FBIS9nQSEh/?LOB=Part%20B&LOC=Minnesota&ngsLOC =Minnesota&ngsLOB=Part%20B&jurisdiction=Jurisdiction%206

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PARA Weekly Update: July 11, 2018

OIG ALERT: REASON CODE 70IG2: BILL TYPES 013X,014X AND 085X

Per a recent article published by WPS GHA, as a result of an OIG audit a mass adjustment is underway that began on May 07, 2018, on certain outpatient claims type of bill 013X, 014X and 85X with the paid dates beginning May 01, 2014 and ending April 01, 2017. The OIG identified these claims as being paid in error when they overlapped inpatient claims bill type 011X. Remittance advice remark code for this mass adjustment is 7OIG2. Providers that are seeing this remark code on a remittance will receive a demand letter after the claim has been adjusted. https://www.wpsgha.com/wps/portal/mac/site/claims/news-and-updates/reason-code-7OIG2-current -oig--audit-information/!ut/p/z0/fY7LCsIwEEW_aJi2Qu1WRY3SUHEhbTYyNGkN6qTkob9v6Qe4vHDO4a LCFhXTx44UrWN6zbtT5f0iRCnyKqubQmbZRh5uq31Vb6trjmdU_4G5UHi5kyOqieIDLA8OWzbfAMQa0q QpmoCtNxQcQ--0gXVzOhbQJ-8NR3B2BKCkbVxk_17O4fRU3Q9G-x5N/

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PARA Weekly Update: July 11, 2018

PARA SERVICES AT A GLANCE

Here is a simple, easy-to-follow presentation PARA experts recently made to the Idaho Hospital Association. We invite you to review the presentation by clicking either of the icons below.

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PARA Weekly Update: July 11, 2018

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.

Healthy Eating Research: Building Evidence To Promote Health And Well-Being Among Children - Provides approximately 8 small scale grants of up to $200,000 and 2 large scale grants of up to $500,000 to fund research on policy, systems and environmental strategies to promote the health and well-being of children. - Letter of Intent, July 18, 2018; Application Deadline: September 26, 2018

Rural Opioid Response Program - Provide funding for a single entity to provide technical assistance services to HRSA's Rural Communities Opioid Response Program - Award recipient will provide resources and expertise in support of the execution of the following focus areas: 1) Prevention; 2)Treatment; and 3) Recovery - Application Deadline: August 10,2018

Service Area Funding For Health Center Programs - Provides grants to health centers that offer comprehensive primary healthcare services to an underserved area or population. - Estimated funding is $409,300,000 for 86 awards. - Project period is up to three years - Application Deadline: August 6, 2018

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PARA Weekly Update: July 11, 2018

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 or the PDF!

Thursday, July 5, 2018 News & Announcements - New Medicare Card: MBI Changes - MIPS Payment Adjustment Targeted Review: Request by September 30 - Open Payments Program 2017 Financial Data - Laboratory Date of Service Exception - Qualified Medicare Beneficiary Information on RAs and MSNs Provider Compliance - Hospice Election Statements Lack Required Information or Have Other Vulnerabilities ? Reminder Claims, Pricers & Codes - Rejected Claims for Medicare Diabetes Prevention Program Services - ESRD Claims Error: Transitional Drug Adjustment Add-On Payment Adjustment Upcoming Event s - CMS Data Element Library Webinar ? July 11 - Public Reporting on Physician Compare Webinar ? July 24 or 26 Medicare Learning NetworkÂŽ Publications & Multimedia - NCCI PTP Edits, Version 24.3: Quarterly Update MLN Matters Article ? New - Medicare Diabetes Prevention Program Call: Audio Recording and Transcript ? New - IMPACT Act Call: Audio Recording and Transcript ? New - Prohibition Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article ? Revised - Global Surgical Days for CAH Method II MLN Matters Article ? Revised - HCPCS Drug/Biological Code Changes: July 2018 Quarterly Update MLN Matters Article ? Revised - Comprehensive ESRD Care Model Telehealth: Implementation MLN Matters Article ? Revised - ASC Payment System: July 2018 Update MLN Matters Article ? Revised View this edition as a PDF [PDF, 240KB]

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PARA Weekly Update: July 11, 2018

MLN CONNECTS

Date 2018-07-02 Subject CMS Takes Action to Modernize Medicare Home Health SPECIAL EDITION Monday, July 2, 2018 CMS Takes Action to Modernize Medicare Home Health On July 2, CMS proposed significant changes to the Home Health Prospective Payment System (PPS) to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care. ?Today?s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,? said CMS Administrator Seema Verma. ?The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.? CMS?s proposed changes promote innovation to modernize home health by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form. This is expected to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared among patients, their caregivers, and their providers. Supporting patients in sharing this data will advance the Administration?s MyHealthEData initiative. As required by the Bipartisan Budget Act of 2018, this proposed rule would also implement a new Patient-Driven Groupings Model (PDGM) for home health payments. The proposed rule also includes information on the implementation of home infusion therapy temporary transitional payments as required by the Bipartisan Budget Act of 2018. In addition, the proposed rule solicits comments on elements of the new home infusion therapy benefit category and proposes standards for home infusion therapy suppliers and accrediting organizations of these suppliers as required by the 21st Century Cures Act. Physicians who order home health services for their patients would also see administrative burden reduced under this rule. CMS is proposing to eliminate the requirement that the certifying physician estimate how much longer skilled services would be needed when recertifying the need for continuing home health care, as this information is already gathered on a patient?s plan of care. The proposed rule helps advance the Trump Administration?s Meaningful Measures Initiative. CMS is proposing changes to the Home Health Quality Reporting Program (HH QRP). The cost impact related to updated data collection processes as a result of the proposed implementation of the PDGM and proposed changes to the HH QRP are estimated to result in a net $60 million in annualized cost savings to Home Health Agencies (HHAs), or $5,150 in annualized cost savings per HHA, beginning in CY 2020. In the proposed rule CMS is releasing a Request for Information to welcome continued feedback on the Medicare program and interoperability. CMS is gathering stakeholder feedback on revising the CMS patient health and safety standards that are required for providers and suppliers participating in the Medicare and Medicaid programs to further advance electronic exchange of information that supports safe, effective transitions of care between hospitals and community providers. For More Information: -

Proposed Rule Fact Sheet Home Health PPS website HHA Center website Home Health Value-Based Purchasing Model webpage Home Health Quality Reporting Requirements webpage

See the full text of this excerpted CMS Press Release (issued July 2). 23


PARA Weekly Update: July 11, 2018

PARA INTRODUCES NEW OUTPATIENT OUTMIGRATION REPORTS In their continuing expansion of product lines critical to streamlining hospital data collection and improving decision support tools for Chief Executive Officers, Chief Financial Officers and Business Development executives, PARA Analytics introduces the new Outpatient Migration Report. Among other items, PARA customers using this vital report will be able determine where patients in their primary and secondary service areas are going for outpatient services, total volumes of selected outpatient services and the value of these services. The Outpatient Migration Report provides information on Medicare Outpatient Visits and the patient?s county of residence. The source of this information is the Medicare Outpatient Limited Data Set. For the selected hospital, the top ten counties are identified based on the number of outpatient visits from those counties of residence. These counties are listed horizontally across an easy-to-read report. All facilities that had an outpatient visit from the selected hospital?s home county are listed vertically on the report and it then details how many outpatient visits to each facility originated from each of the ten corresponding counties. The Outpatient Migration Report includes ten tabs with this same format. The first tab includes statistics on all outpatient visits. The subsequent nine tabs include the visit counts that have been identified as specific visit types. These include: - Emergency, Mammography - CT - MRI - Therapy - GI - Diagnostic Radiology - Lab, and - Wound Care The final tab provides reference information on how outpatient visits are assigned to the preceding categories. If any of the listed codes appear on the claim, then the visit is assigned the corresponding label. PARA Analytics is the first national healthcare financial firm to develop such valuable reports in a more timely manner than data typically available from public sources. Using PARA?s proprietary algorithms in the PARA Data Editor, PARA can rapidly produce relevant and functional reports. For more information and a demonstration of these new reports, please contact PARA Account Executives: Violet Archuleta-Chiu, Senior Account Executive varchuleta@para-hcfs.com (800) 999-3332, ext. 219 Sandra LaPlace, Account Executive slaplace@para-hcfs.com (800) 999-3332, ext. 225 24


PARA Weekly Update: July 11, 2018

There were TWO new or revised Med Learn (MLN Matters) article released this week. To go to the full Med Learn document simply click on the screen shot or the link.

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

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PARA Weekly Update: July 11, 2018

The link to this Med Learn: MM10825

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PARA Weekly Update: July 11, 2018

The link to this Med Learn: MM10624

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PARA Weekly Update: July 11, 2018

There were FIVE new or revised Transmittals released this week. To go to the full Transmittal document simply click on the screen shot or the link.

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

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PARA Weekly Update: July 11, 2018

The link to this Transmittal R806PI

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PARA Weekly Update: July 11, 2018

The link to this Transmittal R4084CP

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PARA Weekly Update: July 11, 2018

The link to this Transmittal R4085CP

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PARA Weekly Update: July 11, 2018

The link to this Transmittal R4083CP

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PARA Weekly Update: July 11, 2018

The link to this Transmittal R179SOMA

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PARA Weekly Update: July 11, 2018

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PARA Weekly Update For Users July 11 2018  

PARA Weekly Update For Users July 11 2018

PARA Weekly Update For Users July 11 2018  

PARA Weekly Update For Users July 11 2018