PARA Weekly Update For Users Grayscale Version 2-27-19 by CorroHealth

PARA WEEKLY

UPDATE For Users

I mproving T he Business of H ealthCare Since 1985 February 27, 2019 PRICING

CODING

REIM BURSEM ENT

COM PLIANCE

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - ALS2 Procedure - 93668 PAD Rehabilitation - Platelet Charge - Acapella Device - Gastric Intubation - 36589 APC And Physician Fee CY2020 SNF PROVIDERS: WHAT IS PDPM? CMS ISSUES APPROPRIATE USE FACT SHEET IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

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

CY202 Sk i l l ed N u r si n g Faci l i t i es: What Is The PDPM? Page 10

2019 CATEGORY III AMA RELEASE CMS EMERGENCY ET3 MODEL

PARA COMPANY NEWS

SERVICES

ABOUT PARA

FAST LINKS

Administration: Pages 1-48 HIM /Coding Staff: Pages 1-48 Providers: Pages 2,5,21 Cardiology: Pages 5,21 Laboratory: Pages 6,31,41 Gastroenterology: Page 9 Skilled Nursing: Pages 10,26

Finance: Page 10 Outpatient Svcs: Page 21 Emergency Svcs: Page 17 Compliance: Pages 16,21 Emergency Svcs: Page 23 Rural Healthcare: Page 25 Rural Healthcare: Page 29

PARA Weekly Update: February 27, 2019

ALS2 PROCEDURE

A question has come to light about an ambulance patient whose airway was protected using a King Airway -- and as to whether or not this constitutes a level 2 ALS call. A King Airway is a blind airway insertion device which we use now in place of a Combi-Tube.

Answer: Medicare does not describe which brand of airway constitutes an ALS procedure, but Medicare specifically identifies endotracheal intubation as an ALS2 procedure. According to our research, the King airway is not inserted into the trachea, therefore it?s use is not considered endotracheal intubation. Consequently, it is not an ALS2 procedure. The King Airway manufacturer?s website describes an airway which seals the esophagus and oropharynx; it does not enter the trachea: https://www.narescue.com/media/custom/upload/File-1443546141.pdf

PARA Weekly Update: February 27, 2019

ALS2 PROCEDURE

According to the Merck Manual, endotracheal intubation means that a tube is inserted directly into the trachea: https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-arrest/ airway-and-respiratory-devices An endotracheal tube is inserted directly into the trachea via the mouth or, less commonly, the nose. Another class of rescue ventilation devices is laryngeal tube or twin-lumen airways (eg, CombitubeÂŽ, King LTÂŽ). These devices use 2 balloons to create a seal above and below the larynx and have ventilation ports overlying the laryngeal inlet (which is between the balloons). The Medicare Benefits Policy Manual defines the list of ALS2 procedures, which includes endotracheal intubation: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c10.pdf

Advanced Life Suppor t , Level 1 (ALS1) Definition: Advanced life support, level 1 (ALS1) is the transportation by ground ambulance vehicle (as defined in section 10.1, above) and the provision of medically necessary supplies and services (as defined in section 10.2, above) including the provision of an ALS assessment by ALS personnel or at least one ALS intervention. Advanced Life Suppor t Assessment Definition: An ALS assessment is an assessment performed by an ALS crew as part of an emergency response (as defined below) that was necessary because the patient's reported condition at the time of dispatch was such that only an ALS crew was qualified to perform the assessment. An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service. In the case of an appropriately dispatched ALS Emergency service, as defined below, if the 3

PARA Weekly Update: February 27, 2019

ALS2 PROCEDURE

ALS crew completes an ALS Assessment, the services provided by the ambulance transportation service provider or supplier shall be covered at the ALS emergency level, regardless of whether the patient required ALS intervention services during the transport, provided that ambulance transportation itself was medically reasonable and necessary, as defined in section 10.2, above and all other coverage requirements are met. Advanced Life Suppor t Inter vention Definition: An ALS intervention is a procedure that is in accordance with state and local laws, required to be done by an emergency medical technician-intermediate (EMT-Intermediate) or EMT-Paramedic. Application: An ALS intervention must be medically necessary to qualify as an intervention for payment for an ALS level of service. An ALS intervention applies only to ground transports. Advanced Life Suppor t , Level 1 (ALS1) - Emer gency Definition: When medically necessary, the provision of ALS1 services, as specified above, in the context of an emergency response, as defined below. Advanced Life Suppor t , Level 2 (ALS2) Definition: Advanced life support, level 2 (ALS2) is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including (1) at least three separ ate administr ations of one or more medications by intravenous (IV) push/ bolus or by continuous infusion (excluding crystalloid fluids) or (2) ground ambulance transport, medically necessary supplies and services, and the provision of at least one of the ALS2 procedures listed below: a. Manual defibrillation/ cardioversion; b. Endotracheal intubation; c. Central venous line; d. Cardiac pacing; e. Chest decompression; f. Surgical airway; or g. Intraosseous line. ? Endotracheal (ET) intubation (which includes intubating and/ or monitoring/ maintaining an ET tube inserted prior to transport) is a service that qualifies for the ALS2 level of payment. Therefore, it is not necessary to consider medications administered by ET tube to determine whether the ALS2 rate is payable.

PARA Weekly Update: February 27, 2019

93668 PAD REHABILITATION

Do you have any information you can share on the appropriate use and coverage for CPTÂŽ 93668 PAD rehab? Answer: NCD 20.35 explains the coverage requirements for Supervised Exercise Therapy, which is reported with 93668 - PERIPHERAL ARTERIAL DISEASE (PAD) REHABILITATION, PER SESSION: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx? NCDId=371&ncdver=1&CoverageSelection=Both&ArticleType=All&PolicyType =Final&s=Indiana&KeyWord=Peripheral&KeyWordLookUp=Title& KeyWordSearchType=And&bc=gAAAACAAAAAA&

Benefit Category - Incident to a Physician's Professional Service - Outpatient Hospital Services Incident to a Physician's Service - Physicians' Services - Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service. - Item/Service Description A. General Research has shown supervised exercise therapy (SET) to be an effective, minimally invasive method to alleviate the most common symptom associated with peripheral artery disease (PAD) ? intermittent claudication (IC). SET has been shown to be significantly more effective than unsupervised exercise, and could prevent the progression of PAD and lower the risk of cardiovascular events that are prevalent in these patients. SET has also been shown to perform at least as well as more invasive revascularization treatments that are covered by Medicare. Indications and Limitations of Coverage B. Nationally Covered Indications Effective for services performed on or after May 25, 2017, the Centers for Medicare & Medicaid Services has determined that the evidence is sufficient to cover SET for beneficiaries with IC for the treatment of symptomatic PAD. Up to 36 sessions over a 12-week period are covered if all of the following components of a SET program are met. The SET program must: - consist of sessions lasting 30-60 minutes comprising a therapeutic exercise-training program for PAD in patients with claudication; - be conducted in a hospital outpatient setting, or a physician?s office; - be delivered by qualified auxiliary personnel necessary to ensure benefits exceed harms, and who are trained in exercise therapy for PAD; and - be under the direct supervision of a physician (as defined in 1861(r)(1)), physician assistant, or nurse practitioner/clinical nurse specialist (as identified in 1861(aa)(5)) who must be trained in both basic and advanced life support techniques. Beneficiaries must have a face-to-face visit with the physician responsible for PAD treatment to obtain the referral for SET. At this visit, the beneficiary must receive information regarding cardiovascular 5

PARA Weekly Update: February 27, 2019

93668

disease and PAD risk factor reduction, which could include education, counseling, behavioral interventions, and outcome assessments. C. Nationally Non-Covered Indications SET is non-covered for beneficiaries with absolute contraindications to exercise as determined by their primary physician. D. Other Medicare Administrative Contractors (MACs) have the discretion to cover SET beyond the nationally covered 36 sessions over a 12-week period. MACs may cover an additional 36 sessions over an extended period of time. A second referral is required for these additional sessions (This NCD last reviewed May 2017.)

PLATELET CHARGE A physician ordered pheresis platelet unit on newborn & the bag contained 226 ml but the physician only gave 31 ml out of the bag & the rest was disposed. There is no pediatric bag for this type of product. So, do we charge for the entire bag or just the portion that was used?

Answer: The hospital may charge for the entire bag. Since the HCPCS for platelets is ?per unit?, the hospital is unable to separately report wastage on a separate line. Also, the JW modifier is required on only Status K and G medications. Platelets are assigned OPPS Status Indicator R.

PARA Weekly Update: February 27, 2019

ACAPELLA DEVICE

Currently in our respiratory therapy department's orders/charges, the flutter valve (chest physiotherapy) administration is listed with CPT® codes 94667 (initial) and 94668 (subsequent). We do not believe this is correct, as these CPT® codes are strictly for hands on therapy, i.e. cupping, clapping, etc. The flutter valve (Acapella) is introduced orally, and the patient exhales with only coaching from the respiratory therapist. There is no "hands on" procedure being performed. We feel the 94664 would better describe the procedure, and we did find a reference in CPT®Assistant Sept 2010 but would like your opinion. Also, what CPT®code would be used for administration of a hand held percussor? 94669? Answer: I found the same information you did in CPT® Assistant. According to the September 2010 edition, 94664 is the best choice. The descriptions for many of the respiratory therapy codes do not explicitly include a requirement that the service be manually performed, the RT service must be performed by a qualified health professional to qualify for billing. In other words, if the Acapella device is operated by the patient alone, it is not appropriate to report any CPT® code; the therapist has to be present and coaching the patient in order to form a billable service.

The September 2010 edition of CPT® Assistant offers the guidance we both saw ? here is the pertinent excerpt: ?? Code 94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device, should be reported when treatment is performed using small, hand-held, flow-operated inhaler devices that create a vibrational effect in the airways to help move mucus away from airway walls, but do not involve chest wall manipulation (eg, Acapella®vibratory positive expiratory pressure therapy using an Acapella® flutter valve device).

PARA Weekly Update: February 27, 2019

ACAPELLA DEVICE

When the respiratory therapist uses a hand-held percussor, such as Fluid Flo, you may report the manual therapy code, 94667 and 94668.

The December 2013 edition of CPTÂŽ Assistant offers the following guidance:

PARA Weekly Update: February 27, 2019

GASTRIC INTUBATION

Can 43753 be charged as a facility fee on the UB04 if the nurse performs this procedure? The physician did not perform the procedure. Here is what is documented: 02:36 01/29/19. 14 fr NG tube inserted in right nostril with no difficulty. Placement confirmed by auscultation and return of gastric contents. Return: coffee-ground appearance. Attached to low suction. Gastroccult positive (POC test reference range: negative); patient tolerated procedure well. (Secured at 55 at the nose). Answer: No; unless the gastric intubation requires a physician?s skill, this code should not be reported on a hospital claim. If a nurse performs gastric intubation in the Emergency Department, we recommend considering the nursing procedure as a contributing factor to the level of the ED visit charge. In other words, consider charging a higher ED visit level rather than reporting this specific code on a separate line. Here?s the official definition of 43753:

36589 APC AND PROFESSIONAL FEE Can you confirm if 36589 is another CPTÂŽ that can have a technical and a professional charge? I see in the calculator that it has an APC and a physician fee schedule assigned, but wanted to confirm that this charge should be split billed. thank you! Answer: Yes, HCPCS 36589 may be reported by both the facility and the professional when performed in the outpatient facility setting.

A quick give-away is that there are two rates paid on the Medicare Physician Fee Schedule ? a lower rate for the ?Facility? setting is paid when Medicare expects another entity, such as an outpatient hospital facility, to separately bill for the technical component of the code. I have attached our paper explaining how to identify codes that can be split billed in the outpatient facility setting using the PC/TC indicator on the Medicare Physician Fee Schedule report in the PARA Data Editor Calculator. 9

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

wh at is t h e Lon g-Ter m Car e / Sk illed Nu r sin g Facilit y Pat ien t -Dr iven Paym en t M odel, or PDPM ?

The PDPM is the CMS designated next iteration of payment reform following the Resident Classification System Version 1 (RCS-1) advance notice of rule-making that was released in CY2017. This new payment reform is set to replace the RUGs IV system of reimbursement. PDPM follows suit from RCS-1 in moving away from a ?therapy minutes driven reimbursement system? to a system that is more focused on the ?clinical characteristics of the resident?. Good news to providers, under the PDPM reimbursement will be decided on fewer Minimum Data Set (MDS) assessments. With this being said, there are an expected reduction in scheduled PPS assessments from five to one required assessment and only two unscheduled assessments (the IPA and the Discharge PPS assessments). Just with this reduction in administrative tasks Medicare is expecting to save over $2 billion dollars over a 10 - year period.

https://www.cms.gov/ Medicare/Medicare-Feefor-Service-Payment/ SNFPPS/ therapyresearch.html

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

This payment model is expected to be implemented beginning October 01, 2019. Overview of Case-Mix Categories: Within the new PDPM, resident characteristics will determine the clinical category for care. 1.Acute infection 2.Acute neurological 3.Cancer 4.Cardiovascular and coagulations 5.Major-joint replacement or spinal surgery 6.Medical management 7.Non-orthopedic surgery 8.Non-surgical orthopedic/musculoskeletal 9.Orthopedic surgery 10. Pulmonary These are further grouped into four categories for Occupational Therapy (OT) and Physical Therapy (PT) calculations: 1.Major joint replacement or spinal surgery 2.Other orthopedic 3.Non-orthopedic and acute neurologic 4.Medical Management PDPM uses five case-mix components and a non-case-mix component to determine the rate of reimbursement for the residents stay, which differs from the RUGs IV calculation which only used therapy and nursing components and was weighted by therapy minutes in the higher categories. In PDPM, therapy minutes will not be used in the case-mix calculation, however, they will be required as part of the discharge assessment process. The five designated case mix components are: 1.Physical Therapy (PT) 1.Occupational Therapy (OT) 1.Speech/Language Pathology (SLP) 1.Nursing Non-therapy Ancillaries These five components will be combined with a non-case mix amount to calculate daily reimbursement. SLP will be required to use the presence of comorbidities (i.e.; aphasia, CVA/TIA/stroke, hemiplegia/paralysis, TBI, tracheostomy care, present of ventilator or respiratory, laryngeal cancer, apraxia, dysphagia, ALS, oral cancers and speech /language deficits), cognitive impairment and 11

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

the presence of swallowing disorders or the need for a mechanically altered diet to determine the case mix. The NTA case mix is determined by the need for extensive service covered through the MDS and the part-c risk adjusted model. Points are associated with the services and a total determined, which would place the resident in a case-mix group for NTA. The table below demonstrates how the daily rate for PDPM is calculated by case-mix component for each resident.

)

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

It should be noted, PDPM does not completely do away with the RUGS IV methodology. The Nursing Component uses a modified non-therapy RUG calculation that places residents into one of the 25 categories instead of the previous 43 nursing categories that were under the 66 Grouper. The 25 PDPM RUGs reduces the number of end-splits determined by ADL calculations. An additional change within the PDPM from the previous RUG IV is the ADL score has been updated to include Section GG items. These items are used to calculate LTPAC cross-setting measures as required by the IMPACT Act of CY2014. In PDPM, the four late loss ADLs used in the calculation for RUGS IV would be replaced with items from section GG; an eating and toileting item, three transfer items and two bed mobility items. Refer to the table below:

Nursing CMIs will use staffing data to reflect nursing utilization during care. In addition, PDPM is expected to add an 18% increase for the nursing component when the resident is diagnosed with HIV/AIDS. Payments for Nursing and Speech/Language Pathology will remain constant through the resident?s stay however, PT, OT and Non-therapy Ancillaries will see variable rates over the length of stay. PT and OT will see downward adjustments of 2% at day 20 and then a further 2% decrease every 7th day thereafter. NTA will decrease by two-thirds starting at day 4. So how is this going to impact Skilled Nursing Organizations? 1.PDPM is designed to push SNFs to take on more clinically complex residents. 2.Homes will need to start evaluating current care and staff resources to determine if they are prepared for this shift or will they need to implement systems and training for staff to meet the criteria for this program 3.Therapy that was previously incentivized in the previous payment model is not included in the case mix calculations but the need for therapy based on care requirements is predicted to be the same. PDPM requires 75% of all therapy delivered be individually provided: - Concurrent and group therapies are capped at 25% of total minutes provided, which is a decrease from 50% in RCS-1 4.CMS is predicting that non-profit organizations should see an increase of 1.9%, while government providers should see increases of approximately 4.2%. Smaller SNF providers should see modest increases, while those providers running homes over 100 certified beds may see declines in revenue. 13

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

This table demonstrates the basic differences between RUGs IV and PDPM:

PARA Weekly Update: February 27, 2019

CY2020 SNF PROVIDERS: WHAT IS THE PDPM?

Recommendations for preparing for PDPM Implementation: 1.Providers should begin by reviewing current processes from end-to-end. This activity will assist in determining what processes will need to be changed to meet the criteria for PDPM 2.Training staff on the shift in data capture will be a key point to a successful PDPM implementation. For example, staff need to ensure that all diagnosis and conditions are collected as soon as possible to ensure accurate coding on the MDS 3.Coding staff will need it identify the primary diagnosis that maps to a clinical category where possible 4.Communicating to physicians about the upcoming changes and educating them on the new categories and importance of a correct diagnosis is critical for a successful adoption of PDPM 5.Review of therapy contracts is critical for identifying the business impact from the therapy perspective to avoid any surprises once the facility implements PDPM

PARA Weekly Update: February 27, 2019

CMS ISSUES APPROPRIATE USE FACT SHEET

its first volley of provider education efforts toward meeting its legal obligation under the Protecting Access to Medicare Act (PAMA), Medicare has started outreach efforts to educate providers in the new requirements to use of Appropriate Use Criteria (AUC) in ordering ?advanced diagnostic imaging? studies. The requirement is voluntary until January 1, 2020, when the use of AUC is scheduled to become mandatory. A link and an excerpt of the fact sheet is provided below: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/ MLNProducts/Downloads/AUCDiagnosticImaging-909377.pdf

While appropriate use criteria requirements do not apply to Critical Access Hospitals, all OPPS hospitals should initiate their own efforts to educate ordering providers and offer access to AUC ?Clinical Decision Support Mechanisms? when accepting orders for advanced diagnostic imaging. For additional information, see the PARA Data Editor resources on the Advisor tab ? search on ?Appropriate Use?:

PARA Weekly Update: February 27, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

To determine whether a HCPCS code can be ?split billed? (reported by both the facility and the physician for services performed in the outpatient facility setting) users can refer to Medicare?s payment policy indicators displayed on the PARA Data Editor Professional Fee report on the Calculator tab:

Refer to the PC/TC indicator on the lower left:

PARA Weekly Update: February 27, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

Here are the definitions of the PC/TC Indicators 0 ? 5 and the split billing instructions for services performed in the outpatient facility setting:

PARA Weekly Update: February 27, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

PARA Weekly Update: February 27, 2019

IDENTIFYING HCPCS ELIGIBLE FOR SPLIT BILLING IN OUTPATIENT FACILITIES

PARA Weekly Update: February 27, 2019

2019 CATEGORY III AMA RELEASE

The American Medical Association (AMA) has released mid-year Category III changes for the 2020 CPTÂŽ production cycle. These codes are effective July 1, 2019. Twenty new Category III codes ranging from 0543T to 0562T have been added. These codes can be found in the PARA Data Editor Calculator. New Category III Codes include: Transapical Mitral Valve Repair (MVR) ? 0543T ? 0545T

Radiofrequency spectroscopy and Bone-Material quality testing ? 0546T ? 0547T

Transperineal Periurethral Balloon Continence device ? 0548T ? 0551T

Laser Therapy and Percutaneous Transcatheter placement 0552T ? 0553T

PARA Weekly Update: February 27, 2019

2019 CATEGORY III AMA RELEASE

Bone Strength and Fracture Risk analysis ? 0554T ? 0557T

Anatomic Model 3-D printed image data sets ?0559T -0562T

Category III codes are temporary CPT速 codes identified with five characters (four numerical digits followed by a T). They allow data collection for emerging technologies, services, procedures, and service paradigms, unlike the use of unlisted codes, which does not offer the opportunity for the collection of specific data. If a Category III code is available, this code must be reported in lieu of a Category I unlisted code. Category III codes may or may not eventually receive a Category I CPT速 code. New codes or revised codes in this section are released semi-annually via the AMA CPT速 website to expedite dissemination for reporting. Codes approved for deletion are published annually with the full set of temporary codes for emerging technology, services, procedures, and service paradigms in the CPT速 code set.

PARA Weekly Update: February 27, 2019

CMS EMERGENCY TRIAGE, TREAT AND TRANSFER (ET3) MODEL

14, 2019, CMS ONFebruary Innovation?launched a payment model with new treatment and transport options to ensure the needs of beneficiaries are met more appropriately in emergency situations. At this time, the Emergency Triage, Treat and Transport (ET3) Model is a voluntary, five year payment model designed to allow a greater flexibility to ambulance care teams following a 911 call. Under this model program, CMS will reimburse participating ambulance suppliers and providers to: 1.Transport an individual to a hospital emergency department (ED) or other destination covered under the current regulations 2.Transport to an alternative destination (i.e.; primary care physician office or urgent care clinic) 3.Provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth CMS?intentions with this new innovation model is: - To allow beneficiaries to access the most appropriate emergency services at the right time and place - Encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches, upon successful implementation of the model, by establishing a medical triage line for low-acuity 911 calls - Improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports https://www.cms.gov/newsroom/fact-sheets/ emergency-triage-treat-and-transport-et3-model

PARA Weekly Update: February 27, 2019

CMS EMERGENCY TRIAGE, TREAT AND TRANSFER (ET3) MODEL

Who can participate in this model program? Participants that CMS is expecting to select to participate in the model and have an opportunity for cooperative agreement funding are: - Medicare-enrolled ambulance service suppliers - Hospital-owned ambulance providers - Local governments, their designees, or any other entities that operate or have authority over one or more 911 dispatches in geographical areas Ambulance suppliers and providers together, will focus on direct services, while local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches will create a supportive structure to ensure successful and sustainable delivery of services. How will funding be awarded to model participants? In Summer CY2019, CMS Innovation Center is expecting to release a Request for Applications (RFA). The RFA process will be solicited to Medicare-enrolled ambulance suppliers and providers. Participants will be selected from the RFA applications and upon announcement, the Innovation Center will issue a Notice of Funding Opportunity (NOFO) the following Fall CY2019. The ET3 Model time line is expected to have a five (5) year performance period with an anticipated start date of January CY2020. The performance period for all participants, regardless of their start date in the program, will end at the same time. For more information on this model program, providers are encouraged to the CMS link below: For more information on the ET3 Model, please visit: https://innovation.cms.gov/initiatives/et3/ If stakeholders have questions on the ET3 Model, they can send an email to ET3Model@cms.hhs.gov

PARA Weekly Update: February 27, 2019

RURAL HOSPITAL PROGRAM GRANTS AVAILABLE

Rural hospitals and clinics face their own set of unique and burdensome challenges when it comes to program development, cash management and maintaining volume. That's why it's great when they can get some assistance from external funding sources. At PARA, we've found an excellent source of funding opportunities for rural healthcare facilities. Here are some examples.

340B Drug Pricing Program - The program provides prescription drugs at a reduced cost to eligible entities. Participation in the Program results in significant savings estimated to be 20% to 50% on the cost of pharmaceuticals for safety-net providers. - Registration periods are open 4 times throughout the year, and are processed in quarterly cycles. - Funding cycles are as follows: April 1 - April 15 for a July 1 start date; July 1 July 15 for an October 1 start date; October 1 - October 15 for a January 1 start date

Medicare Rural Hospital Flexibility Program - Emergency Medical Service Supplement Provides up to $250,000 to build an evidence base for rural EMS activities in the Flex Program by funding the implementation of demonstration projects of sustainable rural EMS models and quality metrics, and by sharing the results of those projects with rural EMS stakeholders. Application Deadline:

April 5, 2019

Small Healthcare Provider Quality Improvement Program Provides up to $200,000 per year for three years to demonstrate improvement in rural healthcare, specifically for measuring patient outcomes, chronic disease management, increased engagement between providers and patients, and integration of mental/behavioral health programs in rural communities. Application Deadline: April 22, 2019

PARA Weekly Update: February 27, 2019

MLN CONNECTS PARA invites you to check out the mlnconnects page available from the Centers For Medicare and Medicaid (CMS). It's chock full of news and information, training opportunities, events and more! Each week PARA will bring you the latest news and links to available resources. Click each link for the PDF!

Thursday, February 21, 2019 New s & An n ou n cem en t s

· CMS: Beyond the Policy ? New Podcast · CAR T-cell Therapy: CMS Proposes Coverage with Evidence Development · SNF Provider Preview Reports: Review Your Data by March 4 · IRF-PAI Clinical Help Desk: New Address for Questions · SNF PPS Patient Driven Payment Model: Updated Resources · Promoting Interoperability Program: 2019 Resources · Hospital Quality Reporting: Updated QRDA I Schematron Pr ovider Com plian ce

· Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities ? Reminder Upcom in g Even t s

· MIPS: 2019 QCDR Measure Development and Review Webinar Series ? February 28 and March 5 · Home Health Quality Reporting Program In-Person Training ? March 5 and 6 · Dementia Care & Psychotropic Medication Tracking Tool Call ? March 12 · Open Payments: Transparency and You Call ? March 13 · SNF Value-Based Purchasing Program: Phase One Review and Corrections Call ? March 20 M edicar e Lear n in g Net w or k ® Pu blicat ion s & M u lt im edia

· New HHAs Placed in a Provisional Period of Enhanced Oversight MLN Matters Article ? New · Quality Payment Program: 2017 MIPS Performance Feedback Web-Based Training Course ? New · Appeals Call: Audio Recording and Transcript ? New · LCDs MLN Matters Article ? Revised · How to Use the Medicare National Correct Coding Initiative Tools Booklet ? Revised · How to Use the Medicare Coverage Database Booklet ? Revised · Advance Care Planning Fact Sheet ? Reminder View this edition as a PDF [PDF, 313KB] · CLIA Program and Medicare Laboratory Services Fact Sheet? Revised · Long-Term Care Hospital Prospective Payment System ? Revised · Medicare Advance Written Notices of Noncoverage Booklet? Revised

PARA Weekly Update: February 27, 2019

WEEKLY IT UPDATE

PARA HealthCare Analytics has provided a list of enhancements and updates that our Information Technology (IT) team has made to the PARA Data Editor this past week. The following table includes which version of the PDE was updated, the location within the PDE, and a description of the enhancement.

Week ly IT Updat e

Prev ious Updates

PARA Weekly Update: February 27, 2019

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

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

PARA Weekly Update: February 27, 2019

The link to this Med Learn MM11066

PARA Weekly Update: February 27, 2019

The link to this Med Learn MM11137

PARA Weekly Update: February 27, 2019

The link to this Med Learn MM11135

PARA Weekly Update: February 27, 2019

The link to this Med Learn MM11087

PARA Weekly Update: February 27, 2019

The link to this Med Learn MM11003

PARA Weekly Update: February 27, 2019

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

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

PARA Weekly Update: February 27, 2019

The link to this Transmittal R2265OTN

PARA Weekly Update: February 27, 2019

The link to this Transmittal R2263OTN

PARA Weekly Update: February 27, 2019

The link to this Transmittal R4246CP

PARA Weekly Update: February 27, 2019

The link to this Transmittal R866PI

PARA Weekly Update: February 27, 2019

The link to this Transmittal R867PI

PARA Weekly Update: February 27, 2019

The link to this Transmittal R868PI

PARA Weekly Update: February 27, 2019

The link to this Transmittal R4245CP

PARA Weekly Update: February 27, 2019

The link to this Transmittal R311FM

PARA Weekly Update: February 27, 2019

The link to this Transmittal R2262OTN

PARA Weekly Update: February 27, 2019

The link to this Transmittal R865PI

PARA Weekly Update: February 27, 2019

The link to this Transmittal R2264OTN

PARA Weekly Update: February 27, 2019

Con t act Ou r Team Peter Ripper President

Randi Brantner

pripper @para-hcfs.com

Director Financial Analytics

M onica Lelevich

rbrantner @para-hcfs.com

Director Audit Services

Sonya Sesteli Chargemaster Client Manager ssesteli @para-hcfs.com

mlelevich @para-hcfs.com

M ary M cDonnell Director PDE Training & Development

Sandra LaPlace

mmcdonnell @para-hcfs.com

Account Executive slaplace @para-hcfs.com

Violet Archuleta-Chiu Senior Account Executive

Steve M aldonado

Patti Lew is

Director Marketing

Director Business Operations

smaldonado @para-hcfs.com

varchuleta @para-hcfs.com

plewis @para-hcfs.com

PARA Weekly Update: February 27, 2019