ParaRev Weekly eJournal June 22, 2022

ej o u r n a l june22, 2022

Navigating Compliance

The Great Resignation

There Are No Surprises W ith Price Transparency

Overcoming Staffing Challenges

Cardiac Device Credits New Reminders From CMS

1

PARA Weekly eJournal: June 22, 2022

CMS ISSUES REMINDER ON CARDIAC DEVICE CREDITS

In May 2022, Medicare released a new MLN which reminds hospitals of the special billing rules for cardiac device charges if the hospital obtains the device at full or partial credit due to a manufacturer warranty or recall. Readers may recall the November 2020 audit report released

by The Health and Human Services Office of Inspector General (OIG), which found Medicare overpaid hospitals for reimbursements for medical devices supplied at a reduced cost for specific patients. The full OIG audit report is available on the PARA Dat a Edit or Advisor tab:

The new MLN reminds hospitals of the proper modifiers, condition codes and value codes that must be used for billing when receiving cardiac devices at no cost or with credits from the device manufacturers for the replacements. Below lists key billing information for reporting cardiac devices at no costs or credits.

2

PARA Weekly eJournal: June 22, 2022

HIMSS, THE GREAT RESIGNATION & OVERCOMING STAFFING CHALLENGES

The first quarter of 2022 was a whirlwind in our industry. There was an influx in national and regional shows (or family reunions, for some who have missed their industry colleagues), consistent conversations about staffing shortages, and the shroud of darkness that is ?The Great Resignation?which continues to cause complications in programs reliant upon staff across the Untied States.

At #HIMSS22, and every week since the national HIMSS show, we have had conversation around staff augmentation assistance, and the use of tech enabled services that allow facilities to breathe and feel confident in their ability to do more with less.

We had the opportunity to visit with 4 different subject matter experts in different segments of the industry about the impact they are feeling from the great resignation and how they are seeing it impact the revenue cycle. It was one of the more insightful episodes of Cof f ee w it h Cor r o, and worth a listen. One segment of the interview is with Grace Vinton (@HITeaWit h Gr ace on Twitter). She specifically discusses the compounding effects of the great resignation, the toll COVID has taken on our industry, physician burnout, and how all of this is happening during a push to remote work environments.

Ch eck it ou t :

3

PARA Weekly eJournal: June 22, 2022

HIMSS, THE GREAT RESIGNATION & OVERCOMING STAFFING CHALLENGES

Also at HIMSS, Greg Goodale (VP of Marketing) and Jason Barnhouse (National Director of Enterprise Solutions) sat down with Colin Hung (HealthcareIT Today) to discuss how AI can help can bring relief to the staffing challenges we are facing.

Specifically, they discuss overcoming shortfalls that are occurring in revenue cycle management.

As I am sitting here writing this blog, I was tagged in a tweet that perfectly encompasses the importance of both rectifying the staffing issue, as well as knowing and trusting the positive impact that AI solutions can have on your workers, programs, facilities, and overall RCM processes.

Joe Desiderio stated here, h t t ps:/ / t w it t er .com / JoeDesider io/ st at u s/ 1529867282016616448, that it is not just ?Or staff ?, or ?Or AI?, but it is #AndNotOr. Like the article and interview states, the solution to the great resignation is not ?just more staff ? or ?just add AI and tech solutions?, but it?s the adaptation of the two and educating teams about the importance of both working well together. Thus, #AndNotOr.

Tak e a look at t h e ar t icle an d give t h e in t er view a list en : h t t ps:/ / w w w.you t u be.com / w at ch ?v=xdIqh ULAVjY

4

PARA Weekly eJournal: June 22, 2022

IS YOUR HOSPITAL LOSING MILLIONS?

5

PARA Weekly eJournal: June 22, 2022

IS YOUR HOSPITAL LOSING MILLIONS?

6

PARA Weekly eJournal: June 22, 2022

IS YOUR HOSPITAL LOSING MILLIONS?

7

PARA Weekly eJournal: June 22, 2022

IS YOUR HOSPITAL LOSING MILLIONS?

8

PARA Weekly eJournal: June 22, 2022

BILLING FOR IRRADIATED BLOOD PRODUCTS

Hospitals should take care to report the appropriate blood product HCPCS code on outpatient claims, particularly when providing irradiated blood. Most irradiated blood products are reported with HCPCS codes that indicate the irradiated status within the blood product code.

Here is a list of the irradiated blood HCPCS codes currently in effect, as displayed in the PARA Dat a Edit or Calculator Tab.

9

PARA Weekly eJournal: June 22, 2022

BILLING FOR IRRADIATED BLOOD PRODUCTS

Since the irradiation procedure may be performed at the facility or by the blood bank supplier, some hospitals have inaccurately reported the HCPCS code for the irradiation procedure, 86945 (Irradiation of blood product, each unit) separately, rather than reporting the single HCPCS which describes the unit of irradiated blood.

For example, P9040 represents a unit of irradiated leukocyte-reduced red blood cells; the same blood product would be reported with P9016 (Red blood cells, leukocyte reduced, each unit) if not irradiated. OPPS hospitals risk losing Medicare reimbursement unless the appropriate irradiated product HCPCS is reported.

Under OPPS payment packaging rules, CPT® 86945 will not be separately reimbursed when billed with another payable code on the same claim ? the hospital will be paid for the un-irradiated blood code.

Here?s an example of a 2022 OPPS claim which reported 86945 separately from the blood product code ? the irradiation procedure, 86945, is packaged to the other payable codes on the same claim:

10

PARA Weekly eJournal: June 22, 2022

BILLING FOR IRRADIATED BLOOD PRODUCTS

When billing for irradiated units of blood, CMS instructs hospitals to report the specific HCPCS P-code for irradiated blood, if one is available. If there are no appropriate HCPCS describing the irradiated blood product, providers may report CPT® code 86945 in conjunction with a non-irradiated HCPCS code.

As always, the use of irradiated blood products must be reasonable and necessary for the treatment of the particular patient?s medical condition. Irradiated blood is typically used to prevent a blood transfusion complication called Transfusion-Associated Graft-Versus-Host Disease (TA-GvHD).

Patients more susceptible to TA-GvHD include, but are not limited to patients: - With Hodgkin?s disease, Leukemia, or Lymphoma - With hereditary immune disorders - With developed immune system disorders due to certain drug treatments or bone marrow/stem cell transplants - Unborn babies or newborns

The Medicare Claims Processing Manual offers the following instruction:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf

231.5 - Billin g f or Ir r adiat ion of Blood Pr odu ct s (Rev. 496, Issued: 03-04-05, Effective: 07-01-05, Implementation: 07-05-05) In situations where a beneficiary receives a medically reasonable and necessary transfusion of an irradiated blood product, an OPPS provider may bill the specific HCPCS code which describes the irradiated product, if a specific code exists, in addition to the CPT® code for the transfusion. If a specific HCPCS code for the irradiated blood product does not exist, then the OPPS provider should bill the appropriate HCPCS code for the blood product, along with CPT® code 86945 (irradiation of blood product, each unit).

EXAM PLE: If an OPPS provider transfuses the product described by P9040 (red blood cells, leukocytes reduced, irradiated, each unit), it would not be appropriate to bill an additional CPT® code for irradiation of the blood product since charges for irradiation should be included in the charge for P9040.

11

PARA Weekly eJournal: June 22, 2022

BILLING FOR IRRADIATED BLOOD PRODUCTS

The American Association of Blood Banks (AABB) offers its Billing Guide for Blood Products and Related Services (July 2020) at the following link: https://www.aabb.org/docs/default-source/default-document-library/resources/ aabb-billingguide-for-blood-products-and-related-services.pdf

12

PARA Weekly eJournal: June 22, 2022

NAVIGATING COMPLIANCE: NO SECRETS IN PRICE TRANSPARENCY

The American Hospital Association said patients should be wary of reports regarding federal hospital price transparency compliance reports from organizations other than CMS. The group said in a June 16, 2022 post on its website that organizations have reached "wildly different conclusions about the status of implementation across the hospital field." It points to two reports as examples. A report from Patient Rights Advocate said 14 percent of hospitals are compliant. Another from Milliman found a 68 percent compliance rate.

The American Hospital Association said these groups are ignoring CMS's guidance on aspects of the rule, such as how to fill in an individual negotiated rate when such a rate does not exist due to patient services being bundled and billed together. In this instance a blank cell is appropriate, but outside reports count any file with blank cells as non-compliant.

"CMS, the only true arbiter, has indicated about 160 hospitals remain out of compliance, a much smaller number than either the Patient Rights Advocate or Milliman reports suggest," the American Hospital Association said in the post.

CMS h an ded dow n the first price transparency violation fines June 7. Atlanta-based Northside Hospital was fined more than $1 million for noncompliance at two of its hospitals.

13

PARA Weekly eJournal: June 22, 2022

2022 PREDICTIONS FOR HEALTHCARE CYBERSECURITY

Heading int o 2022, we asked t he "Heal t hcar e It t oday" communit y t o shar e some pr edict ions f or t he new y ear .

Now, six months into 2022, are those predictions coming true?

There?s no topic in health IT that keeps healthcare CIOs more than security. It?s likely one of the most challenging problems any CIO faces. Plus, if they do a great job at it, no one will know what they did. However, if they fail, everyone will know. That?s a challenging recipe for any leader.

However, the trust of patients depends on the success of CIOs and CISOs to protect patient information. Given this, hopefully we can help you get a peak into what healthcare cybersecurity will look like in 2022.

Here?s a look at some of the 2022 healthcare cybersecurity predictions we received: Dr ex DeFor d, Execu t ive Healt h car e St r at egist at Cr ow dSt r ik e 1. 2022 has more ransomware that previous years ? more activity is the result of success + little risk to adversary.

2. Data exfiltration will get new emphasis this year ? the ?extortion e-crime economy thrives ? privacy regs/laws will ramp up across the board ? the fines/penalties for losing data becomes a new painful motivator to build better security programs.

3. API?s are more exploited that previous years, driving new attention to how they?re written/secured.

4. Data-sharing, AI, & aggressive analytics approaches means more consolidated data, in more places, making the ?crown jewels? even harder to protect using antiquated cybersecurity models.

5. Identity Protection becomes paramount. Adversaries are now ?logging in? vs ?breaking in? because of the availability of credentials on dark-web ?Access-Broker ? sites; protecting flawed Active-Directory becomes critical.

14

PARA Weekly eJournal: June 22, 2022

2022 PREDICTIONS FOR HEALTHCARE CYBERSECURITY

Leon Ler m an , co-f ou n der an d CEO at Cyn er io While cyber attacks on critical infrastructure ? such as the Colonial Pipeline and a Florida water plant ? created a lot of buzz this year, last year we saw a 123% increase in the number of ransomware attacks on the healthcare industry ? a trend that has unfortunately continued to plague the healthcare industry throughout 2021. Worse yet, attacks on hospitals have turned deadly. A recent Ponemon Institute report found that ransomware attacks on healthcare providers can lead to increased mortality, and the first ransomware-related fatality in the U.S. was recently reported at Alabama-based Springhill Medical Center.

As we continue into 2022, it is likely we will see an increase in both the sheer number of attacks on hospitals as well as severity. It will be critical for hospitals to have proactive response strategies in place to prevent attacks and ensure continuity of care in the event of an attack.

Additionally, more government intervention is needed ? as has been the case for cyber attacks like that on Colonial Pipeline ? to ensure hospitals are prepared with the tools they need to address the evolving threat landscape in healthcare. It could be the difference between life or death.

Sam M u n ak l, CEO at Cyt ek A rise in cyber attacks in healthcare Healthcare was a favorite target of hackers in 2021 and will continue to be in 2022. More than 40 million patient records were known to be compromised last year with many more cyber attacks within the sector suspected of being unreported.

Expect attacks on healthcare providers to become more targeted and sophisticated in 2022. Bad actors will use what they have learned during the pandemic attack surge to shift from a mass targeting model to a one-target strategy. With this tactic, there is more up-front profiling and analysis of a hospital?s weaknesses, vulnerabilities, and potential payouts.

Reprinted from Healthcare IT Today January 26, 2022

By John Lynn 15

continued on next page

PARA Weekly eJournal: June 22, 2022

2022 PREDICTIONS FOR HEALTHCARE CYBERSECURITY

Ryan Wit t , Residen t CISO, Healt h car e at Pr oof poin t Ransomware was the overarching theme of 2021. That wasn?t a surprise, as we saw the breadcrumbs throughout 2020 with the huge increase in downloaders that indicated ransomware would explode this year. What wasn?t so clear was the highly-publicized damage inflicted upon organizations large and small, both in terms of cost and reputation.

We also saw high-profile assaults on the supply chain, ranging from SolarWinds to Microsoft Exchange. Although these attacks aren?t new, their impact on critical infrastructure heightened visibility of the supply chain?s vulnerabilities.

Many of the attacks we?ve seen over the past year have been people-centric, requiring human interaction to succeed. This trend, that began with the pandemic and work-from-home employment, escalated in 2021. Social engineering, deep fakes and other impersonations,

misinformation, and sophisticated phishing attacks increased, taking advantage of hybrid workforces and intensified emotions.

These three areas ? ransomware, supply chain attacks, and people-centric security issues ? will continue into 2022, but may impact organizations in different ways.

Supply Chain Security Supply chain security will be vital in 2022, particularly in the need for improving security because of Application Programming Interface (API) compromise.

APIs move data to the cloud and accelerate integration between solutions, the DevOps process, and more powerful applications. So, we?ll see a rise in malicious apps connecting through APIs. They will attack specific APIs in order to compromise the broader supply chain. We haven?t experienced a lot of these API threats yet, but that will likely change in 2022.

Threat actors will also exploit vulnerabilities within the supply chain and use these weaknesses to infiltrate different environments, so we?ll see more attacks like SolarWinds. Organizations always look to innovate. The software supply chain facilitates transformation.

But cyber criminals innovate too. They understand how companies leverage various internal tools, whether they be security tools or IT tools. They seek gaps in the umbrella tools to get closer to corporate data assets. In attacks like SolarWinds, threat actors took this to a new level, allowing them to compromise multiple organizations simultaneously. This will lead to bigger and larger scale data breaches.

The Human Element The human element has always played an important role in cybersecurity. That factor will come into greater focus, but not always in the way one might think.

16

PARA Weekly eJournal: June 22, 2022

2022 PREDICTIONS FOR HEALTHCARE CYBERSECURITY

People have become the perimeter, so the human part of security must take form in distinct shapes: as a shield against an adversary, as defender, and as facilitator.

As an adversary, the insider threat has been around for a long time. With many organizations keeping some level of remote work into the next year, they must improve insider risk monitoring. Threat actors have a growing arsenal of tools to lure users into doing the wrong thing. Remote workers have picked up poor security behaviors, which adds to their employers? risks. And, malicious insiders find it easier to act when using personal devices away from the office.

Organizations have also been impacted by the Great Resignation. While there was already a cybersecurity skills shortage, now, as cybersecurity professionals leave their jobs because of burnout or better offers, the talent gap is widening. There will be a strong competition to find people with the right skills, and so long as jobs go unfilled, there will be fewer people to defend against attacks.

As facilitators, we will start seeing more automation around behavioral analytics. We can?t effectively protect our organizations without honing worker behavior. Adaptive controls can mitigate risks caused by people inside the company and detect potential threats from anywhere.

Ransomware, Data Breaches, and Governance Ransomware will continue to cause significant challenges. Companies will experience data breaches. As more organizations continue the digital transformation journey, and they adopt new cloud solutions more broadly, there will be new ways for threat actors to leverage the cloud to their advantage.

This evolving threat landscape will demand regulatory challenges and changes. They will come in different forms.

There will be new cloud governance constraints. We?ve reached the point where standard breach notification requirements are crucial. Different industries and different states can no longer work under their own special procedures because security teams don?t know whose rules come first. It causes confusion on how to respond. That needs to change. The regulation landscape is too fragmented to enable operational effectiveness and timely notifications.

Cyber liability insurance is the second piece to corporate governance. Third-party coverage focuses on security liability and regulatory fines. But you also need coverage for the costs of breach responses, crisis management, and supply chain damage and restoration, as well as shelter for fourth, fifth, and sixth-party risk. As expenses climb, we?ll also see an increase in self-insurance for cyber security protections, which may cause new strains on general corporate finances.

17

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

This paper summar izes t heJuly 2022 OPPS updat eas conv ey ed in t he CMS t r ansmit t al dat ed May 26, 2022. For a det ail ed l ist ing of t he OPPS codes, st at us indicat or s, and coding updat es, v isit t he OPPS t r ansmit t al at : https://www.cms.gov/files/document/r11435cp.pdf

Readers are advised that the July 2022 update to the OPPS Addendum A and Addendum B files was not available as of the date of this publication. The status indicator and payment information reported herein was derived entirely from the transmittal cited above.

18

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

Su m m ar y of Ch an ges The update includes HCPCS additions, HCPCS changes, and payment policy indicators are generally described below; where the list of included HCPCS codes was lengthy, the list is provided on separate pages at the end of this paper.

- Pr opr iet ar y Lab An alysis Codes ? added 9 new codes for lab tests that are proprietary ? in other words, the test method applicable to that CPT® is owned by the patent holder for the test - Advan ced Diagn ost ic Lab Test - 1 new code was retroactively approved as an Advanced Diagnostic Lab Test (ADLT) to 3/24/2022. The ?TissueCypher Barrett?s Esophagus Assay?, CPT® 0108U, is OPPS Status Indicator A (paid under a fee schedule) - 24 n ew CPT Cat egor y III - codes have been added effective 7/1/2022. The AMA releases new codes in July and January of each year; Category III codes are temporary codes for emerging technology, services, procedures, and service paradigms - Pr ocedu r es assign ed t o New Tech n ology APC?s were updated: - Added CPT® 0721T -- The Optellum Lung Cancer Prediction (LCP) Procedure, which applies an algorithm to a patient?s CT scan to produce a raw risk score for a patient?s pulmonary nodule.Status indicator S, APC 1508 ($600-$700); effective 7/1/2022 - Added CPT® 0723T ? Quantitative Magnetic Resonance Cholangiopancreatography Procedure, which produces a three-dimensional reconstruction of the biliary tree, pancreatic duct, along with volume and duct metrics.Status indicator S, APC 1511 (Level 11, $900-$1,000), effective July 1, 2022 - Excluded the Argus®II Retinal Prosthesis implant codes, as the device is no longer available in the marketplace. The implantation procedure and programming procedures (0100T, 0472T, 0473T, C1841) will be assigned status E2, excluded from coverage, effective July 1, 2022 - Updated the description for HCPCS C9782 (CardiAMP cell therapy IDE study), which was established 4/1/2022.CMS revised the HCPCS description to specify inclusion of the device within the procedure code; assigned Status Indicator T, New Technology Level 39 ($15,001-$20,000.)

19

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

- Sk in Su bst it u t es - Four Skin Substitute codes are newly assigned to the High Cost skin substitute group effective July 1, 2022.Among the four,A2001 (Innovamatrix ac, per square centimeter), will be retroactively payable as High-Cost effective April 1, 2022

- Dr u gs, Biologicals, an d Radioph ar m aceu t icals -Sixteen new drug codes were established effective July 1, 2022 ? of those, nine new codes were assigned pass-thru status, and four existing drugs with prior HCPCS assigned to pass-through status will have HCPCS updates to a new code:

20

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

- J0879 (Injection, Difelikeafalin, 0.1 microgram (for End Stage Renal Disease on dialysis)) will become retroactively payable as status K under OPPS effective April 1, 2022.

- Covid-19 Labor at or y t est s an d ser vices (an d on e ot h er lab code)

- CMS provided a comprehensive list of COVID-19 lab tests and related services and OPPS status indicators. CPT® 87913 is relatively new, having been added in February 2022 - One lab code listed along with the COVID test codes, 0014M, is listed in this section, although it is not a COVID-19 lab test.It had been inadvertently omitted in the April OPPS update - HCPCS K1034 (Over-the-Counter Covid-19 Tests Demonstration) for providers who wish to supply home COVID-19 test kits to Medicare beneficiaries.HCPCS K1034 has been available to report dispensed test kits since April 4, 2022 - New Covid-19 Vaccin e an d Adm in ist r at ion codes - Effective 3/29/2022, CMS will recognize and reimburse the Moderna COVID-19 vaccine booster dose (91309) and its administration (0094A), which coincides with the date this vaccine received an Emergency Use Authorization (EUA) from the FDA - Several other new CPT ® codes were established by the AMA but cannot be billed to Medicare until they receive an Emergency Use Authorization (EUA), including the Sanofi Pasteur booster vaccine for adults 18 years and older, and the Pfizer booster code for pediatric patients 5-11 years old

21

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

22

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

23

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

24

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

25

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

26

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

27

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

28

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

29

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

30

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

31

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

32

PARA Weekly eJournal: June 22, 2022

JULY 2022 OPPS CODING UPDATE

33

PARA Weekly eJournal: June 22, 2022

INTRODUCING: CORROHEALTH ACADEMY

we al l know t hat l ear ning is a j our ney, not a dest inat ion.

Now you can par t ner wit h cor r oheal t h and t he ex per t s at par ar ev enue t o wal k beside you on t hat pat h f or knowl edge.

Introducing, Cor r oh ealt h Academ y. It's a library of on-demand learning sessions that provides insight and knowledge of the coding industry. Cor r oh ealt h Academ y is a series of webinars and learning opportunities designed to dramatically improve the confidence, proficiency and expertise of healthcare providers, revenue cycle professionals and finance executives.

There are literally dozens of topics from which to choose. And, we make the learning easy and on your terms.

Th er e ar e THREE easy st eps on you r pat h t o m ast er y:

Regist er For Upcom in g Webin ar s

Cr eat e A Fr ee Accou n t

Select You r Cou r ses

Let The Learning Begin!

34

PARA Weekly eJournal: June 22, 2022

CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022

CMSissuedadocument reporting HCPCScodingdecisionsinresponseto manufacturer appl ications for newcodeassignment eachquarter. The first quarter 2022report incl udes anumber of HCPCSfor drugsand biol ogics, whichwil l becomeeffectiveJuly 1, 2022. https://www.cms.gov/files/document/2022-hcpcs-application-summary-quarter-1-2022drugs-and-biologicals.pdf

A summary of the decisions is provided below in three sections ? Medicine, Wound Care, and Radiopharmaceuticals.

M edicin e - FYARRO® -- which is currently reported with temporary HCPCS C9091, will be assigned HCPCS J9331 ? ?Injection, sirolimus protein-bound particles, 1 mg.? This drug is used to treat advanced unresectable or metastatic malignant perivascular epithelioid cell tumor (PEComa) - LEQVIO® -- will be assigned HCPCS J1306 ? Injection, inclisiran, 1 mg. LEQVIO® is indicated as an adjunct to diet and maximally tolerated statin therapy for the treatment of adults with heterozygous familial hypercholesterolemia (HeFH)] or clinical atherosclerotic cardiovascular disease (ASCVD), who require additional lowering of low-density lipoprotein cholesterol (LDL-C)

35

PARA Weekly eJournal: June 22, 2022

CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022

- SUSVIM O? , an intraocular injection used to treat patients with age-related macular degeneration, will be assigned two HCPCS, one for the injection, and another for the implant. The recommended dose of SUSVIMO? is 2 mg (0.02 mL of 100mg/mL solution) continuously delivered via the SUSVIMO? ocular implant with refills administered every 24 weeks (approximately 6 months). The new HCPCS are: J2779 ?Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg?, and C9093 ?Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg?

- RYPLAZIM ® , which is indicated for the treatment of patients with plasminogen deficiency type 1 (hypoplaminogenemia), will be assigned HCPCS J2998 ?Injection, plasminogen, human-tvmh, 1 mg?. Apparently this medication is considered a self-administered drug unless delivered by IV infusion; modifier JA ?administered intravenously? must be appended when delivered by IV infusion to qualify for Medicare coverage - XIPERE? (Triamcinolone acetonide) is a synthetic glucocorticoid (glucocorticoids are often referred to as corticosteroids) with immunosuppressive and anti-inflammatory activity.

The newly assigned HCPCS will be J3299 ?Injection, triamcinolone acetonide (xipere), 1 mg?

- VYVGART? , is indicated for the treatment of adult patients with generalized myasthenia gravis who are anti-acetylcholine receptor antibody positive. This drug may have been reported with miscellaneous/unclassified codes previously. The newly assigned HCPCS is J9332 ?Injection, efgartigomod alfa-fcab, 2 mg?

- cu t aqu ig®, which prevents infections of a wide variety of bacterial and viral agents in immunodeficient adults by temporarily restoring IgG levels in circulating plasma, will be assigned HCPCS J1551, ?Injection, immune globulin (cutaquig), 100 mg?

- TEZSPIRE? is an add-on maintenance treatment of adult and pediatric patients aged 12 years and older with uncontrolled asthma while receiving treatment with medium- or high-dose inhaled corticosteroids (ICS) plus at least one additional controller medication with or without oral corticosteroids (OCS). The newly assigned HCPCS will be J2356, ?Injection, tezepelumab-ekko, 1 mg?

- APRETUDE, which reduces the risk of sexually acquired HIV-1 infection, is an intramuscular injection kit that must be administered by a healthcare provider. The new HCPCS assigned by CMS will be J0739, ?Injection, cabotegravir, 1 mg?.

36

PARA Weekly eJournal: June 22, 2022

CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022

Sk in Su bst it u t es an d Wou n d Car e Pr odu ct s - Celer a? Du al M em br an e an d Celer a? Du al Layer skin substitutes will be assigned new HCPCS Q4259 ?Celera dual layer or celera dual membrane, per square centimeter.?

Previously, this product may have been reported with Q4100 ?Skin Substitute, Not Otherwise Specified.?

- Sign at u r e APat ch , a wound protection barrier/cover will be assigned HCPCS Q4260 ?Signature APatch, per square centimeter ?

- TAG, a wound protection barrier/cover, will be assigned HCPCS Q4261, ?Tag, per square centimeter ?.

Radioph ar m aceu t icals - Illu cix ® , a radioactive prostate cancer PET imaging product, will be assigned HCPCS A9596 ?Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie?. Providers using this agent in PET scans are hopeful that the new HCPCS will offer better reimbursement for this expensive radiopharmaceutical. (The payment status will be announced with the next update to the OPPS Addendum B, expected in June, 2022.)

- TAUVID? , a radioactive diagnostic agent used in PET imaging of the brain to evaluate patients for Alzheimer ?s disease will be assigned HCPCS A9601 ?Flortaucipir f 18 injection, diagnostic, 1 millicurie?

37

PARA Weekly eJournal: June 22, 2022

CMS ANNOUNCES NEW HCPCS EFFECTIVE JULY 1, 2022

The CMS document also listed the applications for which it declined to assign a HCPCS for various reasons: - RETHYM IC® - used only in inpatient settings - Lidocidex? - a compounded drug (CMS does not issue HCPCS for compounded drugs) - Cocoon Du al-Layer an d Sin gle-Layer M em br an es ? due to differences in the HCPCS application and information submitted to the FDA - Palin Gen ® Du al Layer M em br an es are dehydrated, human allografts derived from the placenta ? due to differences in the HCPCS application and information submitted to the FDA - Esan o AAA, a triple layer decellularized, dehydrated human amniotic membrane allograft for wound care, due to differences in the HCPCS application and information submitted to the FDA - San opellis are dehydrated, human allografts derived from the placenta for wound care, due to differences in the HCPCS application and information submitted to the FDA - 3L Biovan ce® Tr i-Layer an d 3L Biovan ce ® , a human amniotic membrane allograft for wound care, due to differences in the HCPCS application and information submitted to the FDA - Pem et r exed, a single agent in the treatment of locally advanced and metastatic non-squamous non-small cell lung cancer, due to an incomplete HCPCS application.

38

PARA Weekly eJournal: June 22, 2022

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 .

39

PARA Weekly eJournal: June 22, 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, Ju n e 16, 2022

New s -

Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 Men?s Health: Talk to Your Patients About Preventive Services

Com plian ce -

Implanted Spinal Neurostimulators: Document Medical Records

Claim s, Pr icer s, & Codes -

ICD-10-CM Diagnosis Codes: Fiscal Year 2023 July 2022 Quarterly Average Sales Price [ASP] Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files

M LN M at t er s® Ar t icles -

July 2022 Update of the Ambulatory Surgical Center (ASC) Payment System Mental Health Visits via Telecommunications for Rural Health Clinics & Federally Qualified Health Centers ? Revised

40

t

PARA Weekly eJournal: June 22, 2022

r a n s mi t t a l s

4

Ther e w er e FOUR new or r evised Tr ansmittal s r el eased this w eek .

To go to the ful l Tr ansmittal document simpl y cl ick on the scr een shot or the l ink .

41

PARA Weekly eJournal: June 22, 2022

TRANSMITTAL R206SOMA

42

PARA Weekly eJournal: June 22, 2022

TRANSMITTAL R11460OTN

43

PARA Weekly eJournal: June 22, 2022

TRANSMITTAL R11453OTN

44

PARA Weekly eJournal: June 22, 2022

TRANSMITTAL R11457CP

45

m1

PARA Weekly eJournal: June 22, 2022

ed l ea r n s

Ther e w as ONE new or r evised MedLear n r el eased this w eek .

To go to the ful l Tr ansmittal document simpl y cl ick on the scr een shot or the l ink .

46

PARA Weekly eJournal: June 22, 2022

MEDLEARN MM12761

47

PARA Weekly eJournal: June 22, 2022

FOR YOUR INFORMATION

The preceding materials are for instructional purposes only. The information is presented "as-is" and to the best of ParaRev?s knowledge is accurate at the time of distribution. However, due to the ever changing legal/regulatory landscape this information is subject to modification, as statutes/laws/regulations or other updates become available.

Nothing herein constitutes, is intended to constitute, or should be relied on as, legal advice. ParaRev expressly disclaims any responsibility for any direct or consequential damages related in any way to anything contained in the materials, which are provided on an ?as-is?basis and should be independently verified before being applied.

You expressly accept and agree to this absolute and unqualified disclaimer of liability.The information in this document is confidential and proprietary to ParaRev and is intended only for the named recipient. No part of this document may be reproduced or distributed without express permission. Permission to reproduce or transmit in any form or by any means electronic or mechanical, including presenting, photocopying, recording and broadcasting, or by any information storage and retrieval system must be obtained in writing from ParaRev. Request for permission should be directed to sales@pararevenue.com.

Par aRev is excited to announce we have joined industry leader Cor r oHealt h to enhance the reach of our offerings! Par aRev services lines are additive in nature strengthening Cor r oHealt h?s impact to clients?revenue cycle. In addition, you now have access to a robust set of mid-cycle tools and solutions from Cor r oHealt h that complement Par aRev offerings.

In terms of the impact you?ll see, there will be no change to the management or services we provide. The shared passion, philosophy and cultures of our organizations makes this exciting news for our team and you, our clients.

While you can review the Cor r oHealt h site HERE, we can coordinate a deeper dive into any of these solutions. Simply let us know and we?ll set up a meeting to connect.

As always, we are available to answer any questions you may have regarding this news. We thank you for your continued partnership.

48