PARAREV Weekly eJournal February 2, 2022

ej o u r n a l february 2, 2022

Unpacking The No Surprises Act Understanding The Complex Pieces

DS MTBilling POC COVID Detailed Billing Test And Coding

Billing Guidance For Other Professionals

New Codes For Laboratory Tests 1

W ebinar Catch Up Did You Miss Them?

PARA Weekly eJournal: February 2, 2022

POC COVID TEST

Q.

Is it appropriate for a physician practice to bill for POC administration of the COVID-19 iTest

antigen lab test? The practice is looking to use this POC test due to PCR kit availability and costs.

The nursing staff would do the swabbing in the practice. Our HIM team states that having the patient swab and call with results would not be an ideal method since it would be the patient reporting the results. Our thinking is that CPT® 86811 would be the appropriate code to use if this is, indeed a billable service.

We are aware of the scope of the Emergency Use Authorization under which this test was approved: for non-prescription home use with self-collected specimens. Do these indications of the EUA mean that it would be absolutely inappropriate for the practice to perform and bill for this test?

A

. We suspect you

meant to type CPT® 87811, not 86811. We found the Point of Care COVID test CPT® 87811 on the Novitas JL website list of payable codes at the link below: https://www.cms.gov/ files/document/ mac-covid-19test-pricing.pdf

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PARA Weekly eJournal: February 2, 2022

CASIRIVIMAB/IMDEVIMAB INFUSIONS

Q. A

Can you verify if Z23 should be primary for Casirivimab and Imdevimab infusions?

. ICD10 CM code Z23, Encounter for immunization, would not be appropriate for Casirivimab

and Imdevimab infusions. The appropriate ICD-10-CM code would depend on why the patient is being given the treatment. The FDA has approved the use of Casirivimab and Imdevimab as both a treatment for COVID19 infection or for post-exposure prophylaxis in individuals who are at high risk of developing a severe response should they become infected. Monoclonal antibodies are not an immunization or vaccine, but rather a treatment and is recommended to be given as an infusion. For someone receiving these infusions due to COVID19 infection, assign the appropriate COVID19 ICD-10-CM code. For someone exposed to COVID assign Z20.822.

Please refer to the PARA Dat a Edit or code descriptions and the fda.gov link provided below.

https://www.fda.gov/media/143894/download

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PARA Weekly eJournal: February 2, 2022

DSMT PROGRAM ENROLLMENT AND BILLING

Q.

We have added a registered dietitian with certification from the American Diabetes

Association in Diabetes Self-Management Education and Support (DSMES) to our freestanding clinic staff. Can we have other personnel, such as an RN and a pharmacist, perform DSMT services at that location, and if so, which NPI should we list as the rendering provider on the claim?

A

. While qualified individuals may earn a Certified Diabetes Care and Education Specialist

(CDCES) credential, the certified individual alone does not qualify a provider to bill and be reimbursed for DSMT services.

The billing provider organization (i.e. hospital or medical practice) must obtain DSMT program accreditation from a Medicare-approved DSMT accreditation entity. Registered dietitians are eligible to bill on behalf of an entire DSMT program, as long as the RD has obtained a Medicare provider number.

Currently, CMS recognizes the American Diabetes Association (ADA), American Association of Diabetes Educators (AADE), and the Indian Health Service as approved national accreditation organizations. An approved DSMT program requires a program coordinator, which would be an individual who is a fully qualified/certified DSMT professional.

Part of the program accreditation process includes compiling a list of DSMES ?Team? members with at least 15 hours of training ? although the additional team members are not necessarily fully certified in DSMES. Once the program is accredited, qualified individuals on the DSMES team may provide DSMT services ? including RNs and pharmacists, provided that they meet the program?s quality standards.

When reporting DSMT services on the CMS-1500/837p claim form which were performed by DSMES team members, list the NPI of the enrolled Registered Dietitian as the rendering provider.

An enrolled Part B provider entity (such as a medical group or a hospital) must submit DSMT program accreditation to the A/B Medicare Administrative Contractor (MAC) prior to billing for DSMT services.

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PARA Weekly eJournal: February 2, 2022

DSMT PROGRAM ENROLLMENT AND BILLING

Once the program obtains accreditation, the billing organization submits the certification to its Medicare Administrative Contractor (MAC). The MAC verifies that the DSMT program is accredited by a CMS-approved national accreditation organization, and adds that information into the provider profile in the claims payment system to enable claims for DSMT services to be reimbursed to the billing entity.

Medicare allows the following types of enrolled provider entities which have an accredited DSMT Program to claim reimbursement for Diabetes Self-Management Training (DSMT): - Hospitals - Physician medical practice/clinics - Durable Medical Equipment/Prosthetic Orthotic Suppliers (DMEPOS) - Rural Health Clinics (although not separately reimbursed, payment is included in the All-Inclusive Rate paid on other RHC qualifying visit claims) - Federally Qualified Health Clinic

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PARA Weekly eJournal: February 2, 2022

DSMT PROGRAM ENROLLMENT AND BILLING

To be listed as the rendering provider on a clinic claim, the Registered Dietitian/Nutrition Professional (RD/NP) must be enrolled with Medicare as an individual, as well as under the billing organization?s enrolled list of providers, and must reassign his/her benefits to the billing organization.

That process starts with obtaining an NPI for the RD/NP, then submitting the Medicare 855I form (or the electronic equivalent on PECOS) for enrollment as an individual.The clinic must add the RD/NP to its list of clinic providers on the clinic?s organizational enrollment as well.

Contact the local MAC Part B enrollment office for additional information or assistance on this process.

A link and an excerpt from the CMS individual practitioner enrollment form (855I - MEDICARE ENROLLMENT APPLICATION -- PHYSICIANS AND NON-PHYSICIAN PRACTITIONERS) is provided below: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms855i.pdf

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PARA Weekly eJournal: February 2, 2022

DSMT PROGRAM ENROLLMENT AND BILLING

A link and an excerpt to the Medicare Benefits Policy Manual regarding certified DSMT providers is provided below: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf# 300.2 - Cer t if ied Pr ovider s (Rev. 109; Issued: 08-07-09; Effective Date: 03-30-09; Implementation Date: 09-08-09) A designated certified provider bills for DSMT provided by an accredited DSMT program.

Certified providers must submit a copy of their accreditation certificate to the contractor. The statute states that a ?certified provider ? is a physician or other individual or entity designated by the Secretary that, in addition to providing outpatient self management training services, provides other items and services for which payment may be made under title XVIII, and meets certain quality standards. The CMS is designating all providers and suppliers that bill Medicare for other individual services such as hospital outpatient departments, renal dialysis facilities, physicians and durable medical equipment suppliers as certified. All suppliers/providers who may bill for other Medicare services or items and who represent a DSMT program that is accredited as meeting quality standards can bill and receive payment for the entire DSMT program. Registered dietitians are eligible to bill on behalf of an entire DSMT program on or after January 1, 2002, as long as the provider has obtained a Medicare provider number. A dietitian may not be the sole provider of the DSMT service. There is an exception for rural areas. In a rural area, an individual who is qualified as a registered dietitian and as a certified diabetic educator who is currently certified by an organization approved by CMS may furnish training and is deemed to meet the multidisciplinary team requirement.

The CMS will not reimburse services on a fee-for-service basis rendered to a beneficiary under Part A. NOTE: While separate payment is not made for this service to Rural Health Clinics (RHCs), the service is covered but is considered included in the all-inclusive encounter rate. Effective January 1, 2006, payment for DSMT provided in a Federally Qualified Health Clinic (FQHC) that meets all of the requirements identified in Pub. 100-04, chapter 18, section 120 may be made in addition to one other visit the beneficiary had during the same day.All DSMT programs must be accredited as meeting quality standards by a CMS approved national accreditation organization. Currently, CMS recognizes the American Diabetes Association, American Association of Diabetes Educators and the Indian Health Service as approved national accreditation organizations. Programs without accreditation by a CMS-approved national accreditation organization are not covered. Certified providers may be asked to submit updated accreditation documents at any time or to submit outcome data to an organization designated by CMS.

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PARA Weekly eJournal: February 2, 2022

DSMT PROGRAM ENROLLMENT AND BILLING

The CDC offers useful information for new DSMT providers at the following link: https://www.cdc.gov/diabetes/dsmes-toolkit/reimbursement/medicare.html

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PARA Weekly eJournal: February 2, 2022

Up d at ed 1/ 12 / 2 2

2022 c o mp r eh en s i v e COV ID-19 Gu ide

Click an yw h er e on t h is page t o be t ak en t o t h e f u ll on lin e docu m en t .

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PARA Weekly eJournal: February 2, 2022

TUESDAY WEBINARS: COMPLYING WITH THE NO SURPRISES ACT

t ime is r unning out .

PARA exper t s ar e pr ovidin g a f r ee w ebin ar each Tu esday design ed t o h elp h ospit als u n der st an d an d com ply w it h t h e r equ ir em en t s u n der t h e No Su r pr ises Act .

Ever y Tu esday 11:30 am PST

Sign Up By Click in g HERE, Or Scan Th e QR Code

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PARA Weekly eJournal: February 2, 2022

DID YOU MISS IT? NO SURPRISES ACT WEBINARS? CATCH UP HERE! Did you miss t hev er y impor t ant "No Sur pr ises aCt " Webinar s and Q&A's? If you did you still have a chance to participate in the live versions (see previous page for links). And if you can't participate live, here are the links for the NSA Tool Demo Video , Webinars, Q&A sheets, and the Specific NSA Forms.

Our PARAREV team is always available to help.

Please reach out on our website.

DEM O -

NSA No Surprises Act Tool Demonstration Video

WEBINARS -

NSA No NSA No NSA No NSA No

Surprises Act Surprises Act Surprises Act Surprises Act

Update Webinar- 12/21/21 Update Webinar- 12/28/21 Update Webinar- 1/04/22 Update Webinar- 1/11/22

Q&A -

NSA No Surprises Act Update Q & A? 12/21/21 NSA No Surprises Act Update Q & A? 12/28/21 NSA No Surprises Act Update Q & A? 1/11/22

-

PARA - NSA Update Q&A 1.18.22.pdf (para-hcfs.com) PARA - NSA Q&A 2022.2.1.pdf (para-hcfs.com)

FORM S -

PARA - NSA Template for Convening Facility or Provider Good Faith Estimate - updated 12.28.21 PARA - NSA Template for Right to Receive a Good Faith Estimate of Expected Charges - updated 12.28.21 PARA - NSA Template for Disclosure Notice - updated 12.28.21

LOGINS - If you already have a PDE login ? you have access to the NSA Tool by logging into the PDE and clicking on the PTT/NSA Tab and NSA Link Tab - Please make sure we have an updated email address for you ? Fill out this FORM to confirm your email and to be added/updated onto the Distribution List.

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PARA Weekly eJournal: February 2, 2022

STATE-LEVEL ENFORCEMENT OF NO SURPRISES ACT

The No Surprises Act (NSA) is a set of laws within the Consolidated Appropriations Act of 2021, which offers certain protections for patients against ?surprise? medical bills. The law prohibits facilities and other providers from ?balance billing? patients in certain situations, and the regulations require facilities to offer uninsured (or self-pay) patients a ?Good Faith Estimate? of charges in advance of services.In addition, facilities and certain providers are required to provide patients with a standard Disclosure notice which informs the patient about these protections under state and federal law.

State agencies are partially responsible for enforcement of provider compliance with the NSA rules.Since the regulations became effective on 1/1/2022, CMS surveyed states to determine the state?s authority and intention to enforce new provisions of the NSA. CMS has published state-specific letters which provide details on NSA enforcement at the state level and how the federal dispute resolution processes compare with existing state processes.The state-specific letter can be found on the CMS website at the link below: Consolidated Appropriations Act, 2021 (CAA) | CMS

Information in the state letters may be useful in preparing the NSA Disclosure notice, particularly as it pertains to state enforcement authorities.Providers are encouraged to check back frequently if your state is not yet listed ? state letters will continue to be added as the information is gathered

by CMS.

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PARA Weekly eJournal: February 2, 2022

STATE ACCREDITATION SURVEYORS ASK FOR NSA DISCLOSURE NOTICES

The Washington State Department of Health paid a surprise accreditation survey visit to the hospital operated by East Adams Rural Healthcare on January 4, 2022.As part of their survey, the auditors asked to see the hospital?s disclosure of patient rights (?Your Rights and Protections Against Surprise Medical Bills?), which is a new requirement effective January 1, 2022 under Medicare regulations.

East Adams was prepared for that request, and had the NSA disclosure notice process printed and staff trained to provide it to patients at registration.According to Kelly Wiggins, Interim Revenue Cycle Director at East Adams, ?The resources PARAREV provided boosted us along to ensure that we were ready on January 1 for the new requirement.?

PARAREV offers its clients a suite of services including price transparency, No Surprises Act (NSA) compliance, pricing, billing, coding, chargemaster reviews, and general consulting services.

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PARA Weekly eJournal: February 2, 2022

UPCOMING "ASK THE CONTRACTOR" TELECONFERENCES Q1, 2022

Most Part A and B Medicare Administrative Contractors offer ?Ask the Contractor ? (ATC) teleconferences to provide hospitals and other providers an opportunity to ask questions about Medicare policies and procedures.

Some MACs permit providers to submit questions to their Medicare Administrative Contractor in advance.

Each MAC may hold separate ATC teleconferences for Part A, Part B, and DME suppliers; furthermore, each MAC mayfocus on certain topics during each ATC webinar.Not all MACs follow the same format.

Her e ar e dat es an d lin k s f or u pcom in g ATC con f er en ces f or Par t A M ACs: WPS Ju r isdict ion 5 - Iowa, Kansas, Missouri, and Nebraska - Next ATC 1/25/2022 - Topic:Outpatient Rehabilitation Updates http://wpsghalearningcenter.com/confirm-course?courseid=AM2awu6Lzvg1 NGS Ju r isdict ion 6 an d K - J6: Illinois, Minnesota, and Wisconsin; - JK: Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island, and Vermont - Last meeting held 12/16/2021 https://www.ngsmedicare.com/web/ngs/-/ af_ask-the-contractor-teleconference_091421?lob=93617&state=97206&region=93624 - 2022 ATC conferences have not yet been announced WPS - Ju r isdict ion 8 - Indiana and Michigan - Past ATC conference recordings are available, but 2022 session schedule not yet announced WPS J8 Part A Training Guides and Resources Nor idian Ju r isdict ion E - M edicar e Par t A - California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands - Next ATC March 23, 2022 https://med.noridianmedicare.com/web/jea/education/act 14

PARA Weekly eJournal: February 2, 2022

UPCOMING "ASK THE CONTRACTOR" TELECONFERENCES Q1, 2022

Nor idian Ju r isdict ion F - Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming - Next ATC March 23, 2022 https://med.noridianmedicare.com/web/jfa/education/act Novit as Ju r isdict ion H - Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas, Indian Health & Veteran Affairs - Next ATC scheduled for February 23, 2022 - Topics will include Novitas Initiatives, Acute Hospital Provider Liable Billing, and Acute Hospital Outpatient Billing https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00008196 Palm et t o - Ju r isdict ion J - Alabama, Georgia, and Tennessee - January 12, 2022; April 13, 2022 https://palmettogba.com/palmetto/jja.nsf/DID/AU9QTU8307 Novit as Ju r isdicat ion L - Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania - Next ATC February 23, 2022 - Topics will include Novitas Initiatives, Acute Hospital Provider Liable Billing, and Acute Hospital Outpatient Billing https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00008196 Palm et t o - Ju r isdict ion M - North Carolina, South Carolina, Virginia, and West Virginia - Next ATC January 12, 2022; April 13, 2022 https://palmettogba.com/palmetto/jma.nsf/DID/89BJAR3017 Fir st Coast Ser vice Opt ion s - Ju r isdict ion N - Search for ?Ask the Contractor ? found no results https://medicare.fcso.com/FAQs/0453634.asp

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PARA Weekly eJournal: February 2, 2022

OIG WILL AUDIT COVID-19 OUT OF NETWORK BILLING

Heal t h and Human Ser v ices (HHS) Of f iceof t heInspect or Gener al (OIG) announced t hey wil l conduct a nat ionwideaudit t o r ev iew how pr ov ider s cal cul at ed out - of - net wor k bil l s f or pat ient s admit t ed f or Cov id- 19 t r eat ment .

The Provider Relief Fund (PRF), distributed through HHS and the Health Resources and Services Administration (HRSA) provides funding to health care providers for expenses and lost reimbursement because of COVID-19. As a condition for receiving the payments, a provider cannot collect more from an out-of-network patient treated for COVID-19 than the patient would have owed if the care was provided in-network.In their audit, the OIG will review the documentation on presumptive or actual COVID-19 positive patients to ensure providers who received PRF funds complied with the requirements of the program and did not incorrectly balance bill the patient.

https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000647.asp

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

unpacking t he"no sur pr ises act ".

The No Surprises Act (NSA) is a federal law which went into effect on January 1, 2022. The law bans surprise medical bills for emergency services and elective care when the patient does not have a choice of ancillary service providers in an in-network facility.

The Department of Health and Human Services (HHS) has realized that not all aspects of the NSA will be able to be implemented by providers and facilities by January 1, 2022, so they have elected to exercise ?enforcement discretion? on portions of the act in 2022. To be in compliance in 2022, healthcare providers and health care facilities must be prepared to: 1. Publicize and disseminate a ?Disclosure Notice? which informs beneficiaries of group health plans of their rights under the No Surprises Act; and 2. Publicize and disseminate a ?Right to Receive a Good Faith Estimate? to uninsured or self-pay patients; and 3. Provide uninsured or self-pay patients with a good faith estimate (within a $400 threshold) of services that will be billed by the ?convening? provider or facility.

4. Present a Notice and Consent form, with an estimate of charges, to a beneficiary of a group health plan who chooses to receive services from an out-of-network facility or provider and submit a claim to the health plan.

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

DISCLOSURE NOTICE As of January 1, 2022, the disclosure notice must be prominently displayed on websites, in public areas of an office or facility, and on a one-page (double-sided) notice provided in-person or through mail or e-mail, as chosen by the patient. The disclosure notice must be provided to all commercially insured patients after January 1, 2022, or before that date if the elective service will be provided after January 1, 2022. The notice must be provided before requesting a payment from the insured or before a claim is submitted on behalf insured. eCFR :: 45 CFR Part 149 ? Surprise Billing and Transparency Requirements

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

In states where there are state laws that protect patients against surprise billing, providers and facilities can use a state disclosure notice if it meets or exceeds the federal guidelines. If a provider or facility drafts their own disclosure notice it must include these three points: 1. Restrictions on providers and facilities regarding balance billing in certain circumstances 2. Any applicable state laws protecting against balance billing 3. Contact information for appropriate state and federal agencies if the individual their rights have been violated

believes

RIGHT TO RECEIVE A GOOD FAITH ESTIM ATE NOTICE All uninsured or self-pay individuals must be made aware, both orally and in writing, of their right to receive a good faith estimate for any services that will be rendered beginning January 1, 2022. The form must be prominently displayed on websites, in offices, and where scheduling or questions about the cost of health care may occur.

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

GOOD FAITH ESTIM ATES TO UNINSURED/ SELF PAY When discussing the good faith estimate it is important to know a few terms: - A h ealt h car e pr ovider (pr ovider ) is defined as a physician or other health care provider who is acting within the scope of practice of that provider ?s license or certification under applicable State law.

- A h ealt h car e f acilit y (f acilit y) is defined as a hospital or hospital outpatient department, critical access hospital, ambulatory surgical center, rural health center, federally qualified health center, laboratory, or imaging center that is licensed as an institution pursuant to State laws or is approved by the agency of such State or locality responsible for licensing such institution as meeting the standards established for such licensing.

- The con ven in g pr ovider or f acilit y is the one who receives the initial request for a good faith estimate from an uninsured or self-pay individual and who is or, in the case of a request, would be responsible for scheduling the primary item or service.

- A co-pr ovider or co-f acilit y furnishes items or services that are customarily provided in conjunction with the convening provider.

An uninsured patient is an individual who does not have benefits for an item or service under a group health plan; whereas a self-pay patient is an individual who has benefits under a group health plan but chooses not to have a claim submitted to their plan. The good faith estimate presented to an uninsured or self-pay patient must include services reasonably expected to be provided by the convening provider or facility.

At t h is t im e, est im at es f or ser vices pr ovided by co-pr ovider s an d co-f acilit ies do n ot h ave t o be pr ovided by t h e con ven in g pr ovider or f acilit y.

The following list was provided in the interim final rule published in the Code of Federal Regulations. CMS followed up with a Fact Sheet that clarifies HHS will not be enforcing the requirement of including services provided by co-providers or co-facilities.

A good faith estimate must include: - Patient name and date of birth - Description of the primary item or service - Itemized list of items or services reasonably expected to be furnished - Items or services reasonably expected to be furnished by the convening provider or convening facility for the period of care; and - Items or services reasonably expected to be furnished by co-providers or co-facilities 20

PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

- Applicable diagnosis codes, expected service codes, and expected charges associated with each listed item or service - Name, National Provider Identifier, and Tax Identification Number of each provider or facility represented in the good faith estimate, and the State(s) and office or facility location(s) where the items or services are expected to be furnished by such provider or facility - List of items or services that the convening provider or convening facility anticipates will require separate scheduling eCFR :: 45 CFR Part 149 ? Surprise Billing and Transparency Requirements

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

Requirements Related to Surprise Billing; Part II Interim Final Rule with Comment Period | CMS The Good Faith Estimate process that requires facilities and providers to transmit estimates to health plans, is still on hold.

NOTICE AND CONSENT The Notice and Consent is being enforced for those rare instances when the patient has a choice of providers and chooses to receive services from an out-of-network facility or provider.

Situations when a patient does not have a choice of providers and cannot be requested to sign a consent waiving their balance billing protections in an in-network facility are: - When receiving services that are considered ancillary services: - Items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology - Items and services provided by assistant surgeons, hospitalists, and intensivists - Diagnostic services, including radiology and laboratory services - Items and services provided by a nonparticipating provider if there is no participating provider who can furnish such item or service at such facility Balance billing is prohibited in all emergency situations, even those that arise during a service that is being provided under a written consent. Any charges related to that emergency cannot be balance billed until the patient is deemed stable, as defined in the NSA ? able to transport to another facility by non-medical transportation.

In the event the patient requires a higher level of care that requires transport, the EMTALA guidelines take precedence. A patient admitted to an out-of-network facility from an emergency department who is then considered stable, must be presented with a notice and consent if they choose to continue treatment in the out-of- network facility. If the consent is signed, the out-of-network facility can balance bill for charges incurred after the provider documents that patient is stable, as defined in the NSA ? able to transport to another facility by non-medical transportation. Ancillary services cannot balance bill even after the patient is considered stable.

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PARA Weekly eJournal: February 2, 2022

2022 REQUIREMENTS -- UPDATED

eCFR :: 45 CFR Part 149 Subpart E ? Health Care Provider, Health Care Facility, and AirAmbulance Service Provider Requirements

The Notice and Consent form, with an estimate of all charges, must be presented to the patient for a signature.

- This form must be available in the 15 most common languages in the geographical area. If the individual?s preferred language is not among those 15, a qualified interpreter must be made available to assist the patient with understanding their rights.

- The form must be provided at least 72 hours prior to scheduled services, when they are scheduled at least 72 hours out. When services are scheduled and performed on the same day, the document is required to be presented at least 3 hours before the services are rendered.

- The patient must be provided with a signed copy and a signed copy must be maintained in the medical record in the same manner as all other required documented.

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PARA Weekly eJournal: February 2, 2022

CMS ENHANCES RHC MENTAL HEALTH TELEMEDICINE PAYMENT

Effective January 1, 2022, Medicare will reimburse RHC?s their ?All Inclusive Rate? for certain mental health services delivered over telemedicine.Up until this change, Medicare reimbursement for RHC telehealth services was restricted to mainly HCPCS G2025 (payment for a telehealth distant site service furnished by a RHC or FQHC only), which was reimbursed at less than $100.00. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/RuralHlthClinfctsht.pdf

Beginning January 1, 2022, Medicare will reimburse RHCs for mental health visits furnished via real-time telecommunication technology in the same way they currently do when visits take place in-person, including audio-only visits when the patient isn?t capable of, or doesn?t consent to, using video technology. An in-person, non-telehealth visit must be furnished at least every 12 months for these services; however, Medicare may make exceptions to the in-person visit requirement based on patient circumstances (with the reason documented in the patient?s medical record) and also allow more frequent visits as driven by clinical needs on a case-by-case basis.

The list of ?qualifying visits? for mental health services is provided below: https://www.cms.gov/Medicare/MedicareFee-for-Service-Payment/FQHCPPS/ Downloads/RHC-Qualifying-Visit-List.pdf

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

For hospit al s and heal t h syst ems, ext er nal f or ces ar e conv er ging t o make it incr easingly dif f icul t t o consist ent ly opt imize r ev enue cycl e management and sust ain pr edict abl e cash f l ow.

On the front-end, transparency regulations and consumer-driven healthcare are imposing new realities on traditional hospital business models, making accurate, market-appropriate, and publicly available pricing essential.

Separately, the COVID-19 pandemic has transformed the labor landscape? perhaps permanently? by accelerating both the need and desire of employees to work from home.

Employee burnout, vaccine mandates and an historic shift in employment priorities are further complicating the task of finding top-quality revenue cycle personnel.

Kaufman Hall?s 2021 Healthcare Performance Improvement Report found that 92% of responding healthcare organizations said they were struggling to recruit staff, and all reported they were facing issues with staff burnout, vacancies, wage inflation and high turnover.1 The growing challenges of recruiting and retaining experienced claims analysts can have a major impact on claims and denial management, given the exponential growth in the complexity and volume of payer rules and policies.

By some estimates, a claims analyst must access or address upward of 1,200 separate pieces of information daily. Unfortunately, many analysts simply aren?t equipped with either the skills or tools required to manage this data and complete their work effectively. It?s no wonder that even though 90% of denials are preventable, 65% are never corrected and resubmitted for reimbursement.2

75% of r espon den t s said labor pr oblem s h ave im pact ed

In the Kauffman Hall survey, 75% of respondents said labor problems have resulted in poor revenue cycle impacts, with the most common r even u e being ?an increased percentage of Medicaid patients, followed closely by an increased rate of denials, a lower percentage of commercially insured patients, and an increase in bad debt and uncompensated care.?3 25

cycle .

PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

HARNESSINGTHEPOWEROFAUTOMATION In today?s environment, hospital and health system leaders can no longer expect traditional revenue cycle processes to produce the desired outcomes. To maximize cash flow, hospitals must instead harness automation and advanced analytics to augment their existing approaches at each step of the revenue cycle.

That means developing an end-to-end action plan? from pricing through closed-claims audits? that can transform revenue cycle operations and help personnel quickly and consistently make the right decisions.

PRICEOPTIMIZATIONANDTRANSPARENCY That plan begins with pricing. In the face of rising consumer expectations surrounding healthcare price transparency, hospitals that make their prices easily available online will have a competitive edge over those that do not. Equally important, they?ll mitigate the potentially severe financial consequences of non-compliance with Centers for Medicare and Medicaid Services?

(CMS) transparency regulations.

Before prices can be posted, however, organizations must be certain that the numbers they?re releasing make economic sense and are justifiable and competitive when compared to peer pricing. To accomplish this, hospitals should work with pricing experts equipped with advanced analytics to create consistent, rational pricing models assembled around cost, reimbursement, and peer pricing data.

This process begins with a joint review of existing pricing information across all hospital revenue streams, including room rates, emergency visits, diagnostic and therapeutic procedures, operating room, anesthesia, PACU, pharmacy and medical supplies. Detailed comparisons should then be made to peer prices using ubiquitous, publicly available data sources.

Price-setting should also take into account contractual reimbursement rates to ensure all new rates are consistent with payer policies.

Finally, timelines should be established for the implementation of any price adjustments designed to align with market conditions. Refined pricing models? carefully calculated by experts equipped with analytic applications and developed in close partnership with hospital finance personnel? can help organizations improve revenue capture and strengthen margins while remaining competitive in local markets and compliant with the CMS rules.

Additional intelligent automation processes capable of providing programmed revenue integrity audits can help mitigate revenue leakage to increase collections and improve margins

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

AUTOMATEDDENIALMANAGEMENTANDPROCESSFLOW Once pricing has been refined, the next step in optimizing the revenue cycle is strengthening denial management. Most hospital leaders understand the financial damage denied claims can produce. Yet organizations continue to fight a losing battle when it comes to eliminating new denials and resolving existing ones.

The complexity of revenue cycle management, coupled with frequent changes in payer policies and rules, can make it extremely difficult for providers to consistently identify and mitigate denial root causes. As a result, the problem of denials is becoming substantially worse, with the average denial rate jumping by 23% in 2020 compared to four years earlier.4 A recent American Hospital Association report found that nearly 90% of hospitals and health systems had experienced an increase in denials over the past three years, and more than half said the increase was significant.5 And even with the administrative costs of resolving denials estimated at nearly $9 billion a year, only about one-third of denials are actually reworked.6 As a result, operating cash flow margins for not-for-profit hospitals fell to a median of 7% in 2020, down from 8.3% in the three prior years, according to Moody?s.7

Aver age den ial r at e ju m ped 23% in 2020 vs f ou r year s ear lier .

Effective denial management requires an entirely new approach that utilizes intelligent automation-driven decision trees to help staffers quickly make good decisions when working a denied claim. New guidance platforms accessible to analysts via the web provide a systematic and consistent approach for working claims, regardless of where the employee is located.

With these platforms, denial inventory can be organized by department, carrier, complexity, or dollar size. Once categorized, coded data indicating why a specific claim was denied is extracted from the payer electronic remittance advice (ERA) 835 files and assigned to the claim interface. When the claims analyst opens the denial, they?re presented with a click-through decision tree that includes brief descriptions of the steps required and presents progressive, ?if-then-else? questions to isolate details about the issue.

The decision tree can lead the analyst through the correct protocol to mitigate the problem and resubmit the claim, regardless of whether the core issue involves coding and billing, coverage, utilization, contractual issues, submission/re-billing, cash posting, or process delays. This level of automated decision support is a game-changer when it comes to denial management, both in terms of reducing the burden on staff and in enforcing quality control.

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

Instead of searching manually through multiple documents to find specific payer guidance? likely located in a three-ring binder or computer folder? the analyst is presented with all payer-specific information within the application and simply clicks through to the appropriate next step.

Importantly, these solutions also automatically generate detailed, clearly constructed notes that immediately populate an adjacent note field as the analyst works through the steps to resolve a claim. This concurrent documentation not only ensures an accurate record of the actions taken, it also saves an enormous amount of time. It?s estimated that each denial management note can take from one-to-11 minutes to complete.

root causeanalysis As critical as it is to address denials quickly and accurately, it is arguably even more important to consistently identify where, when, and why they?re occurring. Root causes ranging from flawed internal processes and technology errors to insurance and clearinghouse mistakes must be uncovered and resolved.

Scrutiny therefore must be brought to bear in a wide array of areas, including front-end processes and payer issues. In addition, system edits and automation opportunities should be explored to ensure denial triggers are permanently eliminated. From this process, hospital revenue management staff can develop a comprehensive knowledge base around the issues that trigger payment delays, either independently or in partnership with an AR follow-up vendor.

Going forward, the hospital will then be positioned to systematically address the full spectrum of shortcomings that contribute to payment delays and write-offs.

For truly effective denial remediation and prevention, it is important for hospitals to align with a qualified AR follow-up management vendor; one that utilizes intelligent automation to automatically categorize and prioritize claims by root cause and identify relevant deadlines associated with each claim.

Combining this level of intelligent automation with staff specialization will help streamline and accelerate the resolution process. However, an effective process also requires ongoing collaboration and communication between the parties. That means essentially treating the vendor as an extension of the hospital?s internal business office.

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

DIVISIONOFLABOR Best practice AR management strategies likewise should incorporate a division of labor between billing teams, with separate groups focused on different tasks before and after the claim has dropped.

Pre-submission team responsibilities can include: - Analyzing the chargemaster to identify and correct chargemaster errors, compliance issues and missing charges. Conducted by Health Information Management (HIM) coding staff, this is essentially an audit designed to map as many claim data points as possible back to their originating source before claims submission - Analyzing current pricing methodology and comparing it locally and with similar-sized facilities to identify opportunities to be more competitive - Assessing the efficiency of current clearinghouse and coding edits in place prior to claims submission.

Post-submission teams should take responsibility for claims from the point of submission out to 30-60 days. At 60-180 days, another team can pick up the claim to free the initial billing staff to focus on younger claims.

At 180-210 days, it is useful for a secondary team to step in to target remaining aging claims.

Finally, once any account is at zero, deploying another secondary team to handle zero-balance and bad debt forensic analysis is an effective strategy.

Creating dedicated teams for each phase of AR management helps establish a competitive yet cooperative environment, with each team striving to perform at the highest level when they?re ?up to bat.? The approach also helps create checks and balances at various stages of the revenue cycle. That said, staffing challenges may compel organizations to incorporate external partners for assistance with some or all these AR-related tasks.

ARSTRATEGIESFORAGEDACCOUNTS: EXTERNALPARTNERS A growing number of hospitals are partnering with third parties to implement end-to-end AR management strategies that can help ensure facilities collect every dollar they?re entitled to on every denial. These hybrid approaches typically see hospital billing staff focusing exclusively on the newest claims, then turning over unpaid balances to specialists at specific aging intervals.

Relying on external experts to pursue low-dollar, high-volume claims is often the most cost-effective way to optimize collections and minimize write-offs, since it frees up staff to concentrate on fresher, higher-dollar claims.

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

Pre-write-off insurance collection experts well-versed in health plan policies can provide an additional safeguard to help prevent legitimate claims, regardless of age or size, from going uncollected. A comprehensive approach will help organizations obtain hard collectible dollars from the full spectrum of aged accounts, including pre-write-off claims and even closed balance accounts.

ZERO-BALANCEREVIEWSOFCLOSEDBALANCEACCOUNTS The final, critical element in a comprehensive AR management strategy is a zero-balance claims review. Zero-balance reviews are essentially forensic audits of written-off claims that also serve to validate claims integrity and maximize contractual revenue from all payers. They are designed to assess whether the factors that initially caused a payer ?s denial can be mitigated to secure retroactive reimbursement.

While some may assume that pursuing old write-offs isn?t likely to be productive, experts skilled at identifying common mistakes that frequently result in denials can recover up to one percent of a hospital total net patient revenue. For large hospitals and health systems that may generate hundreds of millions of dollars annually, this can translate into a significant amount of found revenue. Issues that can cause claims to be written off include underpaid commercial and government insurance dollars, complex reimbursement methodologies, ambiguous contract language causing underpayments, and lack of time to reprocess claims.

Another area of vulnerability that can cost hospitals millions in revenue is when Medicare and Medicare Advantage patients?discharge status codes don?t reflect the post-acute care received.

While these services are outside the hospital?s control, the use of customized intelligent automation can greatly improve the reconciliation of post-acute care discharge status codes.

OPTIMIZEREVENUEANDREDUCELEAKAGEWITHPARAREVSERVICESANDSOFTWARE Hospitals are projected to lose $54 billion in net income through 2021, according to recent analysis by the American Hospital Association.8 The reduced income reflects the ongoing effects of the COVID-19 pandemic, including fewer outpatient visits, greater patient acuity, and higher costs for supplies, labor, and medications. Hospitals and health systems consequently must evolve rapidly to ensure long-term financial health and sustainability.

For many, that means adopting new approaches to administrative staffing, revenue cycle management, reimbursement, and pricing to control labor costs and replace lost revenue.

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PARA Weekly eJournal: February 2, 2022

REVENUE CYCLE EXECUTIVE GAME PLAN

Many understand that integrating intelligent automation into the revenue cycle can help optimize the process. However, taking these steps can be challenging due to lack of IT resources and funding.

Par aRev offers a full spectrum of healthcare revenue cycle management services, from front-end charge master analysis and contract management to end-of-cycle zero-balance denial recovery. The Par a prefix, which means alongside or parallel, reflects the company?s commitment to working seamlessly with hospital financial and billing staff to minimize denials and bad debt, improve collections and boost revenues.

Par aRev has three operational divisions focusing on the core pillars of the healthcare revenue cycle. RevCap, the revenue capture services division, supports primary and secondary AR recovery resolution, targeted denial resolution and zero-balance underpayment recovery.

RevTeg, revenue integrity services division, provides contract analysis, coding and compliance services and market-based pricing analysis.

RevTek , the revenue technology services group, offers Par aPat h, our revolutionary denial decision software, and Par aRev Dat a Edit or , a robust web-based single source solution for pricing, coding, reimbursement, and compliance, along with price transparency, contract management and payer scorecard tools. Par aRev ?s comprehensive capabilities, when aligned with hospital internal teams, can help hospitals improve operating margins and collect additional revenue.

1

2021 State of Healthcare Performance Improvement Report: COVID Creates a Challenging Environment, KaufmanHall, October 18, 2021 2

Glen Reiner, ?Success in Proactive Denials Management and Prevention,? HFMA, May 18, 2021

3

2021 State of Healthcare Performance Improvement Report: COVID Creates a Challenging Environment, KaufmanHall, October 18, 2021 4

Jacqueline LaPointe, Hospital Claim Denials Steadily Rising, Increasing 23% in 2020, RevCycle Intelligence. Feb. 4, 2021.

5

Jacqueline LaPointe, Hospital Claim Denials Up for Most, Driven by Prior Authorizations, RevCycle Intelligence, Dec. 8, 2020

6

Chris Wyatt, ?Optimizing the Revenue Cycle Requires a Financially Integrated Network,? HFMA Resource Library, July 7, 2015

7 Susan Moore, Moody?s: Rising costs will slow hospitals rebuilding margins to pre-COVID-19 levels, Healthcare Finance, Oct. 26,

2021 8

Report projects U.S. hospitals will lose at least $54B in net income this year, American Hospital Association, Sept. 21, 2021

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PARA Weekly eJournal: February 2, 2022

NEW CMS PUBLICATION ON RURAL HEALTH CLINICS

CM S h as pu blish ed a n ew book let det ailin g n ew ch an ges f or 2022 f or Ru r al Healt h Clin ics.

You can dow n load t h e book let h er e by click in g an yw h er e on t h e gr aph ic.

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PARA Weekly eJournal: February 2, 2022

MEDICARE TO PRIORITIZE RURAL EMERGENCY HOSPITAL RULES

Sect ion 125 of t heConsol idat ed Appr opr iat ions Act of 2021(CAA) cr eat ed t he Rur al Emer gency Hospit al (REH) model as a new Medicar epr ov ider t y pe.

This new provider type will be eligible for enhanced Medicare fee-for-service rates at 5% above OPPS rates, plus an ?Additional Facility Payment? (AFP) designed to bolster the financial viability of providing emergency care in rural areas.The designation is effective as of January 1, 2023.

Current Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals with fewer than 50 beds may convert to REH status to furnish certain outpatient hospital services in rural areas, including emergency department and observation services, but an REH may not offer acute care inpatient services. An REH may offer non-emergency outpatient services and subacute skilled nursing care, however.

New requirements for ?Rural Emergency Hospitals? are among the priorities discussed in the Department of Health and Human Services (HHS) Regulatory Plan for Fiscal Year 2022.A link and an excerpt are provided below: https://www.reginfo.gov/public/jsp/eAgenda/StaticContent/202110/Statement_0900_HHS.pdf The Department also plans to issue a proposed rule on Requirements for Rural Emergency Hospitals. This rule would establish health and safety requirements as Conditions of Participation (CoPs) for Rural Emergency Hospitals (REHs) participating in Medicare or Medicaid, in accordance with Section 125 of the Consolidated Appropriations Act, 2021, and will establish payment policies and payment rates for REHs. This rule will aim to address barriers to health care, unmet social needs, and other health challenges and risks faced by rural communities.

Excerpts from the Consolidated Appropriations Act are provided below: https://www.congress.gov/116/bills/hr133/BILLS-116hr133enr.pdf? Beginning on page 1779 ?(2) RURAL EMERGENCY HOSPITAL.? The term ?rural emergency hospital?means a facility described in paragraph (3) that?

(A) is enrolled under section 1866(j), submits the additional information described in paragraph (4)(A) for purposes of such enrollment, and makes the detailed transition plan described in clause (i) of such paragraph available to the public, in a form and manner determined appropriate by the Secretary;(B) does not provide any acute care inpatient services, other than those described in paragraph (6)(A); 33

PARA Weekly eJournal: February 2, 2022

MEDICARE TO PRIORITIZE RURAL EMERGENCY HOSPITAL RULES

?

(6) DISCRETIONARY AUTHORITY.? A rural emergency hospital may?

(A) include a unit of the facility that is a distinct part licensed as a skilled nursing facility to furnish post-hospital extended care services; and (B) be considered a hospital with less than 50 beds for purposes of the exception to the payment limit for rural health clinics under section 1833(f).

Interested readers may wish to review a summary of the new provider type prepared by the National Rural Health Association at the following link: https://www.ruralhealth.us/NRHA/media/Emerge_NRHA/Advocacy/ Government%20affairs/2021/04-15-21-NRHA-Rural-Emergency-Hospital-overview.pdf

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PARA Weekly eJournal: February 2, 2022

DEBT LIMIT BILL BRINGS RELIEF FOR MEDICARE PROVIDERS

The United States Congress passed a bill on December 9, 2021 which enables the Senate to use special expedited procedures to increase the debt limit.

Additional provisions of the bill make changes to several important issues for Medicare providers.

The text of the bill is available at the link below: https://www.congress.gov/bill/117th-congress/senate-bill/610/actions

The new law enacts the following changes for Medicare providers: - Ext en ds t h e m or at or iu m of t h e u su al 2% sequ est r at ion discou n t applied to Medicare payments until March 31, 2022, and reduces the discount on Medicare payments from 2% to 1% for three months, until June 30, 2022 - Ext en ds a M edicar e Ph ysician Fee Sch edu le paym en t in cr ease through calendar 2022; 35

PARA Weekly eJournal: February 2, 2022

DEBT LIMIT BILL BRINGS RELIEF FOR MEDICARE PROVIDERS

- St ops f u r t h er r edu ct ion s t o t h e Clin ical Lab Fee Sch edu le in 2022 through 2025; - Avoids a 15% Cu t t o CLFS paym en t r at es f or m an y com m on lab t est s which was to become effective 1/1/2022, as part of the phase-in of rates developed from data collected in 2016 - Delays t h e Pr ivat e Payer lab r at e r epor t in g deadlin e for the January-June 2019 period another year to be due the first quarter of 2023; - Delays t h e im plem en t at ion of M edicar e?s Radiat ion On cology M odel until 2023 Salient excerpts of the changes to Medicare laws and regulations pertaining are provided on the following pages.New language is provided in highlighted italics.

Sequ est r at ion?changes to 2 USC 901a Enforcement of budget goal: (6) Implementing direct spending reductions ?

(B) On the dates OMB issues its sequestration preview reports for each of fiscal years 2022 through 2030, pursuant to section 904(c) of this title, the President shall order a sequestration, effective upon issuance such that(C) Notwithstanding the 2 percent limit specified in subparagraph (A) for payments for the Medicare programs specified in section 256(d), the sequestration order of the President under such subparagraph for fiscal year 2022 shall be applied to such payments so that with respect to the period beginning on April 1, 2022, and ending on June 30, 2022, the payment reduction shall be 1.0 percent. ?(D) Notwithstanding the 2 percent limit specified in subparagraph (A) for payments for the Medicare programs specified in section 256(d), the sequestration order of the President under such subparagraph for fiscal year 2030 shall be applied to such payments so that? ?(i) with respect to the first 6 months in which such order is effective for such fiscal year, the payment reduction shall be 2.25 percent; and?(ii) with respect to the second 6 months in which such order is so effective for such fiscal year, the payment reduction shall be 3 percent.

Th e M edicar e Ph ysician Fee Sch edu le- (Changes to TITLE 42 / CHAPTER 7 / SUBCHAPTER XVIII / Part B / § 1395w-4) (t) Supporting physicians and other professionals in adjusting to Medicare payment changes during 2021 2021 or 2022

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PARA Weekly eJournal: February 2, 2022

DEBT LIMIT BILL BRINGS RELIEF FOR MEDICARE PROVIDERS

(1) In general In order to support physicians and other professionals in adjusting to changes in payment for physicians' services during 2021 during 2021 and 2022, the Secretary shall increase fee schedules under subsection (b) that establish payment amounts for such services furnished on or after January 1, 2021, and before January 1, 2022, by 3.75 percent for (A) such services furnished on or after January 1, 2021, and before January 1, 2022, by 3.75 percent; and (B) such services furnished on or after January 1, 2022, and before January 1, 2023, by 3.0 percent.

Clin ical Lab Fee Sch edu le? changes to TITLE 42 / CHAPTER 7 / SUBCHAPTER XVIII / Part B / § 1395m-1 revising the phase-in of reductions that would have reduced CLFS rates on many codes by as much as 15% in 2022: - (b) Payment rates for clinical diagnostic laboratory tests - ?

(3) Phase-in of reductions from private payer rate implementation (A) In general Payment amounts determined under this subsection for a clinical diagnostic laboratory test for each of 2017 through 2024 through 2025 shall not result in a reduction in payments for a clinical diagnostic laboratory test for the year of greater than the applicable percent (as defined in subparagraph (B)) of the amount of payment for the test for the preceding year.

(B) Applicable percent defined In this paragraph, the term "applicable percent" means(i) for each of 2017 through 2020, 10 percent; (ii) for2021 for each of 2021 and 2022, 0 percent; and (iii) for each of 2022 through 2024 2023 through 2025, 15 percent.

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PARA Weekly eJournal: February 2, 2022

DEBT LIMIT BILL BRINGS RELIEF FOR MEDICARE PROVIDERS

Lab PAM A r epor t in g-(Changes to 42USC 1395m-1(a)(1)(B) Improving policies for clinical diagnostic laboratory tests) (B) Revised r epor t in g per iod ·In the case of reporting with respect to clinical diagnostic laboratory tests that are not advanced diagnostic laboratory tests, the Secretary shall revise the reporting period under subparagraph (A) such that(i) no reporting is required during the period beginning January 1, 2020, and ending December 31, 2021 December 31, 2022; (ii) reporting is required during the period beginning January 1, 2022 January 31, 2023, and ending March 31, 2022 March 31, 2023; and (iii) reporting is required every three years after the period described in clause (ii).

Th e Radiat ion On cology pr ogr am -(Changes to the December 27, 2020 Consolidated Appropriations Act, Public Law 116-26): SEC. 133. DELAY TO THE IM PLEM ENTATION OF THE RADIATION ONCOLOGY M ODEL UNDER THE M EDICARE PROGRAM . Notwithstanding any provision of section 1115A of the Social Security Act

(42 U.S.C. 1315a), the Secretary of Health and Human Services may not implement the radiation oncology model described in the rule entitled ??Medicare Program; Specialty Care Models To Improve Quality of Care and Reduce Expenditures??(85 Fed. Reg. 61114 et seq.), or any substantially similar model, pursuant to such section before January 1, 2022 January 1, 2023.

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PARA Weekly eJournal: February 2, 2022

MLN CONNECTS

PARA in vit es you t o ch eck ou t t h e m ln con n ect s page available f r om t h e Cen t er s For M edicar e an d M edicaid (CM S). It 's ch ock f u ll of n ew s an d in f or m at ion , t r ain in g oppor t u n it ies, even t s an d m or e!

Each w eek PARA w ill br in g you t h e lat est n ew s an d lin k s t o available r esou r ces. Click each lin k f or t h e PDF!

Th u r sday, Jan u ar y 27, 2022

New s -

COVID-19: Tools to Determine if Vaccine Requirements Apply COVID-19 Vaccine Codes: Pfizer Pre-Diluted Vaccine for Patients Ages 12+ & Third Dose for Immunocompromised Patients Ages 5?11 COVID-19: Vaccine Access in Long-term Care Settings Medicare Diabetes Prevention Program: New for Calendar Year 2022

Claim s, Pr icer s, & Codes -

Acute Hospital Care at Home: New Occurrence Span Code and Revenue Code

M LN M at t er s® Ar t icles -

-

April 2022 Update to the Medicare Severity - Diagnosis Related Group (MS-DRG) Grouper and Medicare Code Editor (MCE) Version 39.1 for the International Classification of Diseases, Tenth Revision (ICD-10) Diagnosis Codes for 2019 Novel Coronavirus (COVID-19) Vaccination Status and ICD-10 Procedure Coding System (PCS) Codes for Introduction or Infusion of Therapeutics and Vaccines for COVID-19 Treatment Clinical Laboratory Fee Schedule ? Medicare Travel Allowance Fees for Collection of Specimens CY2022 Telehealth Update Medicare Physician Fee Schedule Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits Internet-Only Manual Updates (IOM) for Critical Care, Split/Shared Evaluation and Management Services, Teaching Physicians, & Physician Assistants New Waived Tests

Pu blicat ion s -

Home Infusion Therapy Services Monitoring Report

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PARA Weekly eJournal: February 2, 2022

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