PARA Weekly Update For Users December 8 2017 by CorroHealth

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 December 8, 2017 NEWS FOR HEALTHCARE DECISION MAKERS IN THIS ISSUE QUESTIONS & ANSWERS - Non Pressure Skin Ulcer - Breast Lump Lower Inner Quadrant - Apligraf & Puraply Reporting With JC Modifier - Wound Care Supplies - Flu A and Flu B PCR CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA

2018 CODING UPDATE DOCUMENTS

New For 2018!

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CMS CLINICAL LAB FEE SCHEDULE RATES FOR 2018

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

The number of new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type "Med Learn", in the Advisor tab of the PARA Dat a Edit or . Click here.

The number of new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type "Transmittals" in the Advisor tab of the PARA Dat a Edit or . Click here.

FAST LINKS: Click on the link for special areas of interest: - Administration: Pages 1-30 - HIM/Coding Staff: Pages 5,8,11,13,16,18, 27-28 - Providers: Pages 2,4-6, 8, 16 - Finance Dept: Pages 16,24-27 Page

Imaging Departments: Page 4 Outpatient Services: Page 6 Telehealth: Page 23 Clinical Laboratories: Page 16 Revenue Cycle: Pages 24-25

PARA Weekly Update: December 8, 2017

NON PRESSURE SKIN ULCER

Question: What is the appropriate ICD-10 CM code(s) to report chronic trophic non-pressure ulcer of right thigh with bone involvement with necrosis? Answer: Report ICD-10 CM L97.116, Chronic non-pressure ulcer of right thigh. ICD-10 CM code L97.116 includes ?without necrosis? within the code description.Effective October 1, 2017, ICD-10 code series L97.- (Non-pressure ulcer of lower limb), has been expanded to further specify the severity of the ulcer. The expansion includes, sixty-three new codes that have been created to category L97.These new codes identify "muscle involvement without evidence of necrosis," "bone involvement without evidence of necrosis" and "other specified severity." All codes from category L97 include the specified severity by ulcer location.This advice is supported by Coding Clinic for ICD-10 CM 4th Qtr 2017 provided below.The new codes are identified in the 2018 ICD-10 CM Code book with a solid red circle in front of the code. The ICD-10 CM tabular index for ICD-10 CM code series L97,has an instructional note that includes terms such as chronic ulcer of skin lower limb NOS, non-healing ulcer of skin, tropical and trophic ulcer NOS.?Includes notes and terminology? in ICD-10 CM indicate the terminology following the main term in the tabular index aresynonyms with the main condition description. Please refer to the 2017/ 18 Official Coding Guidelines Section I.A.10 and 11 which defines includes notes and inclusion terms and how to identify they them in the code set. Please refer to the PARA Data Editor code descriptions and Coding Clinic for ICD-10 CM 4th Qtr, 2017 provided below. Please refer to the 2017/ 18 Official Coding Guidelines Section I.A.7, 11 located in the PARA Data Editor calculator..

Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 17 Sixty-three new codes have been created at categoryL97, Non-pressure chronic ulcer of lower limb, not elsewhere classified, to provide additional information regarding the severity of the ulcer. The new codes identify "muscle involvement without evidence of necrosis," "bone involvement without evidence of necrosis" and "other specified severity." Similarly, nine new codes have been created at subcategory L98.4, Non-pressure chronic ulcer of buttock, for the same descriptions of severity.

PARA Weekly Update: December 8, 2017

NON PRESSURE SKIN ULCER

PARA Weekly Update: December 8, 2017

BREAST LUMP LOWER INNER QUADRANT

Question: What is the appropriate ICD-10 CM code(s) to report left breast lump lower inner quadrant? Answer: Report ICD-10 CM N63.24,lump in the left breast, lower inner quadrant.The location of an unspecified breast lump (N63) can now be described by laterality and quadrant or in the axillary tail and/ or subareolar by laterality (N63.0-N63.42). Effective October 1, 2017, ICD-10 code series N63.(Unspecified breast lump) has been expanded to provide greater specificity in code selection. The expansion identifies laterality, quadrant and whether the lump is in the axillary tail and/ or subareolar by laterality .Laterality is identified in the fourth character of ICD-10 CM code series N63 and quadrant is identified in the fifth character of ICD-10 CM code series N63. This advice is supported by Coding Clinic for ICD-10 CM 4thQtr 2017 provided below.The new codes are identified in the 2018 ICD-10 CM Code book with a solid red circle in front of the code. Please refer to the PARA Data Editor code descriptions and Coding Clinic for ICD-10 CM 4th Qtr, 2017 provided below:

ICD-10-CM New/Revised Codes: Lump in Breast Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 19 CodeN63, Unspecified lump in the breast, has been expanded with new codes to provide additional specificity regarding laterality (right, left, unspecified), as well as the quadrant (upper outer, upper inner, lower outer, lower inner, and unspecified). New codes have also been created for unspecified lump in the axillary tail and subareolar areas of the right and left breasts. Facilities may choose to develop a facility-specific coding guideline addressing the correlation of clock positions and breast quadrants, which would allow code selection to be based on documentation of clock position rather than requiring the provider to document the quadrant. These facility guidelines must not conflict with the ICD-10-CMOfficial Guidelines for Coding and Reporting developed by the Cooperating Parties. Additionally, they should not be developed to replace physician documentation needed to support code assignment. 4

PARA Weekly Update: December 8, 2017

APLIGRAF & PURAPLY REPORTING WITH JC MODIFIER

Question: Should Apligraf and Puraply be reported with the JC modifier (skin substitute used as a graft)? Answer: PARA has not seen any provider claims reporting the JC modifier on the skin substitute when billed together with one of the application codes 1527X or C527X. To see if other providers are reporting it, we asked our IT team dig into our Medicare data for the first quarter of 2017, and found that that nationwide, this modifier was reported to Medicare on outpatient claims only 628 times by 103 different providers. In other words, not many of providers report the JC modifier. The JC modifier was created in 2011, when it may have solved a problem that no longer exists. The AMA created unique CPT® ?s for skin substitute applications (15271-15278) in 2012, making the JC modifier duplicative. The skin substitute application procedure code should be billed on the same claim as the apligraf or puraply HCPCS. That being said, it is not improper to append the JC modifier, although it would have no effect on reimbursement. Here is an old article from NGS that offers coding guidelines from 2011. Perhaps the JC modifier was needed then because the application codes were not yet available: https://apps.ngsmedicare.com/SIA/ARTICLE_A46092.htm Coding Guidelines: Payable places of service for the application of Apligraf® (CPT® codes 15340 and 15341 for dates of service prior to January 1, 2011 and HCPCS codes G0440 and G0441 for dates of service on or after January 1, 2011): office (11), urgent care facility (20), inpatient hospital (21), outpatient hospital (22), hospital emergency room (23), ambulatory surgical center (24), skilled nursing facility (31), nursing facility (32) and independent clinic (49). Payable places of service for Apligraf® (HCPCS code Q4101) if billed by the facility: outpatient hospital, (22), emergency room (23), ambulatory surgical center (24) and skilled nursing facility (31). Payable places of service for Apligraf® (HCPCS code Q4101) if billed by the physician or non-physician practitioner: office (11), urgent care facility (20), nursing facility (32) and independent clinic (49). The following modifiers were effective for dates of service on or after 01/01/2009: - JC ? Skin substitute used as a graft - JD ? Skin substitute not used as a graft The JC and JD modifiers should be used when billing for skin substitutes. The difference between them is whether the skin substitute is used as a graft or as a skin covering. The definition of a skin graft for this purpose is whether the skin substitute is implanted into the wound to be incorporated in the healing of the wound. If the skin substitute is used to cover a wound, to protect it from contamination or fluid loss, then it is not a graft, but a dressing. In summary, JC is still a valid modifier, but it isn?t required. It does not have any impact on reimbursement. 5

PARA Weekly Update: December 8, 2017

WOUND CARE SUPPLIES

Question: About 9 months ago, our general surgeon and nurses began a wound care clinic - it is not provider based. We have not been able to get any of the supplies paid - some of the wound supplies can be costly and we'd like to receive reimbursement if we can. We talked about this on our monthly RWHC call and Monica suggested that we send some examples including EOBs - I have attached 3 examples with different A codes that have been denied. Answer: The claims report A6441, A6443, A6021, and A6209 on a CMS1500/ 837p claim form; according to Medicare?s 2017 DME Jurisdiction list, these codes may be reported on a physician claim but they are not separately reimbursed.

PARA Weekly Update: December 8, 2017

WOULD CARE SUPPLIES

An enrolled DME provider may bill the DME MAC for these supplies when they are provided to a patient for personal use. While we have heard of physicians providing a script to patients to fill at a DME supplier, and then asking the patient to bring the dressing to the clinic visit, PARA deems this to be non-compliant. CMS considers its payment for the office visit or wound care procedure to be inclusive of the dressings supplied during the physician visit. It is therefore inappropriate to have the patient provide the dressing to be used during the visit. However, a patient may obtain the dressing from a DME supplier and apply it on the instructions of the physician in the private/ home setting.

PARA Weekly Update: December 8, 2017

FLU A AND FLU B PCR

Question: Our Lab Director has two edits built in the chargemaster - one for Flu A PCR and one for Flu B PCR. The MUE states that two can't be charged on the same day. The description is Flu A or B. Are we approaching this correctly? An sw er : If multiplex testing is initially performed for multiple respiratory viral targets including one or more influenza viral targets (87631-87633) and based on those results, it is medically reasonable and necessary that additional testing for different influenza types or subtypes is performed, then multiple units of 87502 may be billed. To bill additional units, append modifier GD to the second unit of 87502 on a separate line and add information on the claim remark line to summarize the scenario. Otherwise, we recommend combining the dollar charge of both units to report on only one unit of 87502 to bypass the MUE edit. 87502 is set up on two lines of the chargemaster:

The MUE quantity for 87502 is 1, but the MAI is 3.

PARA Weekly Update: December 8, 2017

FLU A AND FLU B PCR

The 2017 CMS NCCI Edit Manual explains the MUE?s related to these codes in a couple of sections, a link and excerpts provided below: https:/ / apps.para-hcfs.com/ para/ documents/ CHAP10-CPTcodes80000-89999_FINAL111516.pdf 14. The CPT Manual instructions preceding CPT codes87260-87660(infectious agent antigen detection) state that separate results for different species or strain of organism should be coded separately with modifier 59. (This instruction is clarified in the paragraph following this one.) Based on this instruction the MUE value for each of these codes, except CPT code 87400, was one (1) when these edits were claim line edits. For these codes each claim line was adjudicated separately against the MUE value for the code on that claim line. When these MUEs were converted to date of service edits, the MUE values were based on data reflecting the total number of units of service of each code paid on a single date of service. If a single infectious agent antigen detection test procedure produces results for more than one species or strain of organism, report only one Download the (1) code with one (1) unit of service (UOS) for the procedure. Based on the methodology utilized and the strains or species tested by that entire paper. procedure, the physician may report one UOS of a CPT code describing Click the the testing for a specific infectious agent or one UOS of a CPT code document describing testing for multiple organisms (e.g., 87300, 87451, 87800, 87801). A physician may report more than one UOS for testing different strains or species of an organism if and only if different test procedures are performed for the different strains or species. A physician should never report more UOS than the number of independent test procedures performed. For example, if a test kit contains a card with five different spots each testing for a different species of an infectious agent, only one UOS for that test procedure may be reported. However, if a physician tests for three different species of that infectious agent by using three different test kits each containing a card testing for one species, the physician may report three UOS of the appropriate CPT code. 3. CPT codes 87631-87633 describe infectious agent detection by nucleic acid for respiratory viruses for multiple types or subtypes of viral targets at one time. The codes differ based on the number of viral targets tested. CPT codes87501-87503describe infectious agent detection by nucleic acid for influenza viruses. If multiplex testing is performed for multiple respiratory viral targets including influenza viral targets, this testing would be reported with CPT codes 87631-87633.CPT codes 87501-87503 should not be reported separately for the influenza viral target testing. If multiplex testing is initially performed for multiple respiratory viral targets including one or more influenza viral targets and based on those results it is medically reasonable and necessary that additional testing for different influenza types or subtypes is performed, CPT codes 87501-87503 may be reported for the additional influenza virus testing. 9

PARA Weekly Update: December 8, 2017

FLU A AND FLU B PCR

The MAI indicator of 3 tells us that additional quantities may be reimbursed upon MAC review/ approval if billed with modifier GD and a note in the remarks field on the claim that explains why additional units were considered necessary in the treatment of this individual patient. Our paper on resolving MUE edits, which explains the significance of the MUE Adjudication Indicator (MAI), is attached.

Download the entire paper. Click the document

PARA Weekly Update: December 8, 2017

CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA In the Medicare Physician Fee Schedule Final Rule for 2018, CMS has delayed the requirement that physicians report their use of Appropriate Use Criteria when ordering advanced diagnostic imaging tests for an additional year, until January 1, 2020, and CMS has also backed away from the notion of using G-codes with modifiers to convey the information. Following is a link and excerpts from the 2018 Medicare Physician Fee Schedule Final Rule: https:/ / www.gpo.gov/ fdsys/ pkg/ FR-2017-11-15/ html/ 2017-23953.htm In response to public comments we are further delaying the effective date for the AUC consultation and reporting requirements for this program from January 1, 2019 as proposed to January 1, 2020. We are also finalizing a voluntary period during which early can begin reporting limited consultation information on Medicare claims from July 2018 through December 2019. During the voluntary period there is no requirement for ordering profadoptersessionals to consult AUC or furnishing professionals to report information related to the consultation. On January 1, 2020, the program will begin with an educational and operations testing period and during this time we will continue to pay claims whether or not they correctly include such information. Ordering professionals must consult specified applicable AUC through qualified CDSMs for applicable imaging services furnished in an applicable setting, paid for under an applicable payment system and ordered on or after January 1, 2020, and furnishing professionals must report the AUC consultation information on the Medicare claim for these services ordered on or after January 1, 2020. ? In response to the public comments, we are not moving forward with requiring reporting of AUC consultation information on Medicare claims using a combination of G-codes and modifiers. Rather, we will evaluate a simplified method of reporting during the voluntary reporting period using a single modifier while we work with stakeholders to explore using a standardized unique AUC consultation identifier.

Download the entire paper. Click the document

PARA Weekly Update: December 8, 2017

CMS DELAYS, CLARIFICATION APPROPRIATE USE CRITERIA Elsewhere in the rule, Medicare clarified that the AUC reporting requirements would not apply to testing performed in a Critical Access Hospital: Any advanced imaging service furnished within a CAH wouldnot be furnished in an applicable setting. Applicable settingscurrently include physician offices, hospital outpatient departments and ambulatory surgical centers. CAH patients who are furnished an advanced diagnostic imaging service in an applicable setting but the claim for that imaging service is not paid under one of the applicable payment systems would not require consultation and reporting of the AUC consultation. This may apply in situations when a CAH has elected Method II billing. Earlier this year, CMS had proposed that hospitals (without an exception for Critical Access Hospitals) and interpreting radiologists to report new G-codes on certain claims for advanced diagnostic imaging services ordered after 1/ 1/ 2019.That reporting requirement would have conveyed the ordering physicians?consultation of Clinical Decision Support Mechanisms (CDSM) for advanced diagnostic imaging services within eight high-priority clinical areas.Claims for applicable services without the AUC data were to be rejected. As new reporting mechanisms are announced, PARA will continue to keep clients and readers of the PARA Weekly Update apprised.

PARA Weekly Update: December 8, 2017

2018 CODING UPDATE DOCUMENTS

Reprinted!

In preparation for the year-end CPTÂŽ / HCPCS update, PARA is preparing a number of short, one to two- page ?coding update? documents listing deleted codes and added codes within a particular clinical area or procedure group.The coding topics addressed are those which are most likely to be ?hard-coded? to a line item in a facility chargemaster.Users are advised that topics are divided into immediately related areas, and more than one paper may contain information useful to a service line manager. Due to CPTÂŽ licensing restrictions, these documents cannot be published within the PARA Weekly Update, however, PARA Data Editor users may access the information on the Advisor tab; search ?Coding Update? in the type field, and 2018 in the subject field, as illustrated below:

Following the release of the OPPS Final Rule in November, coding update papers may be revised to indicate whether Medicare will accept/ cover new HCPCS.PARA Data Editor Users can identify updated papers by the word ?Revised? in the title and the date issued will be updated. Download these FREE papers from the PDE

PARA Weekly Update: December 8, 2017

For PD E Users PARA YEAR-END HCPCS UPDATE PROCESS In keeping our commitment to outstanding customer service, PARA clients will be fully supported with information and assistance on the annual CPTÂŽ HCPCS coding updates. The PARA Data Editor (PDE) contains a copy of each client chargemaster; we use the powerful features of the PDE to identify any line item in the chargemaster which has a HCPCS code assigned that will be deleted as of January 1, 2018. For this reason, it is important that clients check to ensure that a recent copy of the chargemaster has been supplied to PARA for use in the year-end update. PARA will produce excel spreadsheets of each CDM line item, as well as our recommendation for alternate codes, in three waves as information is released from the following sources: 1. The American Medical Association?s publication of new, changed, and deleted CPTÂŽ codes; this information is released in September of each year.PARA will produce the first spreadsheet of CPT updates for client review in October, 2017. 2. Medicare?s 2018 OPPS Final Rule, typically published the first week of November; PARA will perform analysis and produce the second spreadsheet to include both the CPT information previously supplied, as well as alpha-numeric HCPCS updates (J-codes, G-codes, C-codes, etc.) from the Final Rule. 3. Medicare?s 2018 Clinical Lab Fee Schedule (CLFS) ? typically published in late November, the CLFS will reveal whether Medicare will accept new CPT?s generated by the AMA, or whether Medicare will require another reporting method (i.e. G0480 ? G0483 for definitive drug testing in 2016 and 2017.)

Clients will be notified by email as spreadsheets are produced and recorded on the PARA Data Editor ?Admin? tab, under the ?Docs? subtab.

In addition, PARA consultants will publish concise papers on coding update topics in order to ensure that topical information is available in a manner that is organized and easy to understand. PARA clients may rest assured that they will have full support for year-end HCPCS coding updates to the chargemaster.

PARA Weekly Update: December 8, 2017

Reprinted

JANUARY 1, 2018 CMS UPDATES

The following Transmittals have been published for the January 1 update. This list will continue to expand in the coming weeks, and links to all documents can be found in the PDE Advisor tab. Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018

January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing

Files and Revisions to Prior Quarterly Pricing Files

Quarterly Influenza Virus Vaccine Code Update - January 2018

Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018

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

PARA Weekly Update: December 8, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018

In 2018, Medicare reimbursement rates will change significantly under the Clinical Laboratory Fee Schedule; Medicare payment for the most commonly ordered lab tests will be reduced by up to 10% per HCPCS (amounts vary by HCPCS.)The new clinical lab fee schedule payment rates will be based on rates paid by private payors, as reported by laboratories nationwide.Here is a link and an excerpt from a Medicare publication explaining the payment methodology:

https:/ / www.cms.gov/ Outreach-and-Education/ Medicare-Learning-Network-MLN/ MLNProducts/ Downloads/ Clinical-Laboratory-Fee-Schedule-Fact-Sheet-ICN006818.pdf Payment Amounts for Services Furnished on and After January 1, 2018 Based on private payor rates from ?applicable laboratories? reported to the Centers for Medicare & Medicaid Services (CMS) by ?reporting entities,? the payment amount for a test on the new CLFS will be equal to the weighted median private payor rate for each test. ? under the new CLFS, there will be no geographic adjustments to the payment amount. ? As an example, the following excerpt from Medicare?s final payment rate national file displays the reduction in payment for several very common lab tests:

PARA is developing an analysis of the impact to lab reimbursement for each of its clients; we expect the analysis to be provided in late December 2017. PARA will base its analysis on claims data drawn from the OPPS data set purchased from CMS and loaded into the PARA Data Editor RAC tab.An example of a single code analysis using the Medicare claims data as displayed on the PARA Data Editor RAC tab is provided below:

PARA Weekly Update: December 8, 2017

CMS CLINICAL LAB FEE SCHEDULE RATES TO CHANGE IN 2018

The spreadsheet report can estimate the impact of reduced reimbursement on a single code as follows:

Use the HCPCS filter to limit the display on HCPCS 80053 only:

Sum the payments column, and approximate reduced reimbursement for 80053 by 10%; this represents the approximate quarterly impact to Medicare reimbursement for this one code.

PARA Weekly Update: December 8, 2017

JANUARY 1,2018 CMS UPDATES

Instructions for Downloading the Medicare ZIP Code File for January 2018

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018

Affordable Care Act Bundled Payments for Care Improvement Initiative - Recurring File Updates Models 2 and 4 January 2018 Updates

Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) Front End Updates for January 2018 This link leads to a ZIP file containing several files with several documents.

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

PARA Weekly Update: December 8, 2017

Updated!

JANUARY 1, 2018 CMS UPDATES

The COMPLETE List! Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3872CP.pdf January 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3878CP.pdf Quarterly Influenza Virus Vaccine Code Update - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3827CP.pdf Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.0, Effective January 1, 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3869CP.pdf Instructions for Downloading the Medicare ZIP Code File for January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3860CP.pdf Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3861CP.pdf Fiscal Year (FY) 2018 Inpatient Prospective Payment System (IPPS) and Long Term Care Hospital (LTCH) PPS Changes https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3885CP.pdf Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified, or Unlisted Service or Procedure Code Data Collection https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3881CP.pdf Payment for Services Furnished by Qualified Nonphysician Anesthetists https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3883CP.pdf Place of Service Codes https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3873CP.pdf 2018 Annual Update for the Health Professional Shortage Area (HPSA) Bonus Payments https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3870CP.pdf Accepting Hospice Notices of Election via Electronic Data Interchange https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3866CP.pdf Instructions for Retrieving the 2018 Pricing and HCPCS Data Files through CMS' Mainframe Telecommunications Systems https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3865CP.pdf Medicare Payment Rates for routine SNF-type services by swing-bed hospitals during calendar year 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R475PR1.pdf

PARA Weekly Update: December 8, 2017

Updated!

JANUARY 1,2018 CMS UPDATES

More of The COMPLETE List! Annual Clotting Factor Furnishing Fee Update 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3862CP.pdf Updated Editing of Always Therapy Services ? MCS https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3863CP.pdf Correcting Payment of Inpatient Prospective Payment System (IPPS) Transfer Claims Assigned to Medicare Severity-Diagnosis Related Group (MS DRG) 385 and Allowing Part A Deductible on Medicare Secondary Payer (MSP) Same Day Transfer Inpatient Claims Https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1918OTN.pdf 2018 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB) Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3857CP.pdf Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3849CP.pdf Healthcare Provider Taxonomy Codes (HPTCs) October 2017 Code Set Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3842CP.pdf Influenza Vaccine Payment Allowances - Annual Update for 2017-2018 Season https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3837CP.pdf Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3828CP.pdf Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS) Fiscal Year (FY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3826CP.pdf Implementation of the Transitional Drug Add-On Payment Adjustment https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1889OTN.pdf ICD-10 Coding Revisions to National Coverage Determinations (NCDs) https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1875OTN.pdf Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as valid Provider Number https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1877OTN.pdf New Specialty Code for Pharmacy https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R290FM.pdf Screening for Hepatitis B Virus (HBV) Infection https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R198NCD.pdf Medicare Part A Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Pricer Update FY 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3796CP.pdf

PARA Weekly Update: December 8, 2017

Updated!

JANUARY 1,2018 CMS UPDATES

More of The COMPLETE List! 2017-2018 Influenza (Flu) Resources for Health Care Professionals https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNMattersArticles/Downloads/SE17026.pdf New Waived Tests https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3902CP.pdf Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R237BP.pdf Annual Medicare Physician Fee Schedule (MPFS) Files Delivery and Implementation and Medicare Physician Fee Schedule Database (MPFSDB) 2018 File Layout Manual https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3903CP.pdf Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program (CBP) - January 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3909CP.pdf Off-Cycle Update to the Long Term Care Hospital (LTCH) Prospective Payment System (PPS) Fiscal Year (FY) 2018 Pricer https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3912CP.pdf Update to Rural Health Clinic (RHC) All Inclusive Rate (AIR) Payment Limit for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3919CP.pdf Therapy Cap Values for Calendar Year (CY) 2018 https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3918CP.pdf Common Working File (CWF) to Modify CWF Provider Queries to Only Accept National Provider Identifier (NPI) as valid Provider Number https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R1976OTN.pdf Update to the Federally Qualified Health Center (FQHC) Prospective Payment System (PPS) for Calendar Year (CY) 2018 - Recurring File Update https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3922CP.pdf 2018 Annual Update to the Therapy Code List https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3924CP.pdf Replacement of Mammography HCPCS Codes, Waiver of Coinsurance and Deductible for Preventive and Other Services, and Addition of Anesthesia and Prolonged Preventive Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3844CP.pdf

PARA Weekly Update: December 8, 2017

There were THREE new or revised Med Learn (MLN Matters) articles released this week. All new and previous Med Learn articles can be viewed under the type ?Med Learn? in the Advisor tab of the PARA Data Editor (see example below.) To go to the full Med Learn document simply click on the screen shot or the link.

PARA Weekly Update: December 8, 2017

The link to this Med Learn: MM10152

PARA Weekly Update: December 8, 2017

The link to this Med Learn: MM10378

PARA Weekly Update: December 8, 2017

The link to this Med Learn: SE17033

PARA Weekly Update: December 8, 2017

There were TWO new or revised Transmittals released this week. All new and previous Transmittals can be viewed under the type Transmittals in the Advisor tab of the PARA Data Editor. To go to the full Transmittal document simply click on the screen shot or the link.

PARA Weekly Update: December 8, 2017

The link to this Transmittal #R1983OTN

PARA Weekly Update: December 8, 2017

The link to this Transmittal #R174SOMA

PARA Weekly Update: December 8, 2017

The PDE Editor Bulletin Board Tablet lists all articles added to the Bulletin Board

PARA Weekly Update: December 8, 2017