November 17 2017 PARA Weekly Update For Users by CorroHealth

Date

PARA WEEKLY

UPDATE For Users

Improving T he Businessof HealthCare Since 1985 November 17, 2017 NEWS FOR HEALTHCARE DECISION MAKERS IN THIS ISSUE QUESTIONS & ANSWERS

- Mast Cell Sarcoma - Reference Lab Cytomegalovirus - Clostridium Difficile Recurrent - Inpatient Psychiatric AND AN UPDATED AND EXPANDED LIST OF CMS UPDATES FOR 2018 2018 CODING UPDATE DOCUMENTS

NEW!

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.

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Speci al Arti cle 2018 MEDICARE THERAPY BENEFIT CAP

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.

PARA COMPANY NEWS ABOUT PARA SERVICES CONTACT US

FAST LINKS: Click on the link for special areas of interest: Page

Administration: Pages 1-38 HIM/Coding Staff: Pages 14-19 Providers: Pages 2,4,5,23 Finance Dept: Page 6 Imaging Dept: Page 26

Laboratory Services: Page 3 PFS Depts: Pages 2-38 Rural Health Clinics: Pages 24, 29 Psychiatric Services: Page 5 Home Health: Page 25

PARA Weekly Update: November 17, 2017

MAST CELL SARCOMA

Question: What is the appropriate ICD-10 CM code(s) formast cell sarcoma? Answer: Report ICD-10 CM code C96.22, Mast Cell Sarcoma.Mast cell sarcoma is an aggressive form of sarcoma made up of malignant neoplastic mast cells. A sarcoma is a tumor made of cells from connective tissue. Pathology examination of the tumor will reveal malignancy with an aggressive growth pattern and metastatic potential. Effective October 1, 2017, ICD-10 CM has revised the title of ICD-10 CM codeC96.2- Malignant mast cell tumor to indicate malignant mast cell neoplasm. An additional fifth character has been added to indicate the type of mast cell neoplasm. This advice is supported by Coding Clinic for ICD-10 CM 4thQtr 2017 provided below. 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: Mastocytosis and Certain Other Mast Cell Disorders Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 5 Currently in ICD-10-CM, mastocytosis and mast cell neoplasms are classified to a few different categories. Subcategory C96.2, Malignant mast cell neoplasm, has been expanded and new codes created. Certain types of mastocytosis are malignant and are classified to code C96.2, Malignant mast cell tumor. New codes have been created for unspecified malignant mast cell neoplasm (C96.20), aggressive systemic mastocytosis (C96.21), mast cell sarcoma (C96.22), and other malignant mast cell neoplasm (C96.29). Mast cell leukemia is classified to subcategory C94.3, Mast cell leukemia. Mastocytosis comprises a set of disorders involving abnormal proliferation and accumulation of clonal mast cells in one or multiple organ systems. Symptoms can be due to release of substances such as histamine, and can include headaches, dizziness, flushing, tachycardia, hypotension, syncope, nausea, vomiting, abdominal pain, and diarrhea. There are two forms of mastocytosis: cutaneous and systemic. Cutaneous mastocytosis (CM) is diagnosed by the presence of typical skin lesions and a positive skin biopsy demonstrating characteristic clusters of mast cells.

PARA Weekly Update: November 17, 2017

REFERENCE LAB CYTOMEGALOVIRUS

Question: We send CPTÂŽ 87497 Cytomegalovirus out to a reference lab for processing. They bill us and we bill for the test. If the test is negative they only charge us 132.60 but if the test is positive they do additional processing and charge us more. Our charge if the test is positive is $647.00 but our Lab Manager feels that if the test is negative the charge should be less. My issue is that it is charged before we know the results. How do other facilities handle this issue? Should we have a base rate and then an additional charge if the result is positive? Is there actually a different CPTÂŽ for those additional processes that occur once the positive result is found? Answer: Our research indicates that 87497; if reflexed, would likely add a charge for CMV Antiviral Drug Resistance by Sequencing, HCPCS 87910 (infectious agent genotype analysis by nucleic acid (dna or rna); cytomegalovirus). The hospital may need to hold the claim for the initial test until the vendor reports the results. Alternately, a corrected claim may be submitted subsequent to learning that the initial test was reflexed to add CMV Antiviral Drug Resistance by Sequencing. Under the Medicare Clinical Lab Fee Schedule, the reflexed test is reimbursed at a much higher rate than the initial.

To go to the full set of regulations, just double-click on the document to the left.

PARA Weekly Update: November 17, 2017

CLOSTRIDIUM DIFFICILE RECURRENT

Question: What is the appropriate ICD-10 CM code(s) for recurrent Enterocolitis due to Clostridium Difficile (C-difficile)? Answer: Report ICD-10 CM code A04.71, Enterocolitis due to C-difficile, recurrent.Coding Clinic for ICD-10 CM 4thQtr 2017 states, ?Approximately 83,000 of the patients who developed C. difficileexperienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis." Effective October 1, 2017, ICD-10 CM has expanded the code set for Enterocolitis due to C difficile (A04.7) to further specify the condition as recurrent or not specified as recurrent.This expansion in the code description is identified with an additional fifth character of the ICD-10 CM 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: Clostridium Difficile Enterocolitis Coding Clinic for ICD-10-CM/PCS, Fourth Quarter 2017: Page 4 Code A04.7, Enterocolitis due to Clostridium difficile, has been expanded to distinguish recurrent (A04.71) and not specified as recurrent (A04.72).Approximately 83,000 of the patients who developedC. difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. The 2013 American College of Gastroenterology (ACG) practice guidelines for diagnostic testing and pharmacologic therapy forC. difficileinfection (CDI) defined recurrence as an "episode of CDI that occurs eight weeks after the onset of a previous episode, provided the symptoms from the previous episode resolved." Recurrence is associated with greater morbidity and the management of such patients is different from treatment of the initial episode. Code selection for recurrent enterocolitis due to C. difficileis based on provider documentation.

PARA Weekly Update: November 17, 2017

INPATIENT PSYCHIATRIC

Question: For inpatient psychiatric patients, we have been billing only the room charge and administering flu vaccines. We are pretty sure we are missing some charge opportunities. Can we bill for therapy sessions (Individual, family, sex offender, substance abuse). I have noted CPTÂŽ s to use would be 90853, 90832, 90834, 90837, 90846. And, we want to bill for Health Checks, using CPTÂŽ ?s 99383-7. Is it compliant to bill these additional charges along with the room rates? Any other thoughts, or resources I can tap? I am going to search for MLN letters, now. Answer: Any services performed by regularly-assigned unit nursing personnel are considered a component of the daily room rate; no additional charges on the facility claim are appropriate. If, however, services are performed by ?travelers?, i.e. individuals with specialized expertise who serve numerous departments in the hospital, an additional charge may be appropriate ? for example, a PICC line started by a PICC team member may accrue an additional facility fee. The additional charge enables the hospital to return revenue for a cost center that contributed to care in an area outside of the department of origin. The HCPCS mentioned in your email would therefore be considered a component of the daily inpatient room rate for facility fees. If the hospital employs ?Medicare-recognized? healthcare providers, such as psychologists, ARNP?s, PA?s, or physicians, a professional fee could be charged for professional services rendered in addition to the facility room rate. LCSW?s should not charge for services rendered to inpatients, however. Finally, 99383 is a comprehensive evaluation of a new patient. Most psychiatric patients enter inpatient status through the emergency department, where we would expect an evaluation and management code such as 99284 or 99285 to be charged for the initial evaluation. Professional fees for the management of an inpatient (99221) may be charged, in most circumstances, by the physician who assumed the care of the patient after the emergency department entry. However, the facility should not charge for both the ED facility visit and a new patient exam by the attending.

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP Latest update to the Medicare Access and CHIP Reauthorization Act (MACRA) expanded revisions to Medicare law for therapy caps and related provisions. The cap rate for Physical Therapy (PT) and Speech Therapy (SLP) combined will be $2,010, and the Occupational Therapy Cap limit will also be $2,010. The threshold for all therapy services will continue to be $3,700 for physical therapy, speech therapy, and occupational therapy services over the established threshold amount designated until December 31, 2017. Changes have not been implemented to date in the CMS Claims Processing Manual. When updates are completed by CMS, PARA will re-publish this paper with the updated links. In the interim, please refer to updates that have been made in bold type. With the signing of MACRA: - The therapy caps exceptions process was extended through December 31, 2017 - The manual medical review for services over $3,700 therapy thresholds has been modified - The application of therapy cap, and related provisions, to outpatient hospitals has been extended until December 31, 2017 https:/ / www.cms.gov/ Regulations-and-Guidance/ Guidance/ Transmittals/ 2017Downloads/ R3918CP.pdf

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP Critical Access Hospitals -Effective January 01, 2016, previous regulations and guidelines established for Critical Access Hospitals (CAH) remain unchanged. http:/ / www.cms.gov/ Newsroom/ MediaReleaseDatabase/ Fact-Sheets/ 2013-Fact-Sheets-Items/ 2013-11-27-2.html

Skilled Nursing Facilities-- The benefit caps and functional reporting requirements do not apply to Skilled Nursing Facility residents in a covered PART A stay, including Swing Beds. http:/ / www.cms.gov/ Medicare/ Billing/ TherapyServices/ index.html?redirect=/ TherapyServices/

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP The following types of Medicare-enrolled therapy providers are subject to the caps in the outpatient setting: - Physical, speech, and occupational therapists in private practice - Physician offices ? Private practices - Home Health therapy providers, where therapy is offered outside the home health benefit (TOB 34X) - Hospital outpatient therapy departments - Critical Access Hospitals (CAH) ?Effective 01/ 01/ 2014 - SNF providers (Part B billing where the patient has no Part A benefit) - Comprehensive outpatient rehabilitation facilities (CORFs) Beneficiaries Benefit Limitations Only original Medicare beneficiaries are subject to the benefit limitations imposed by Medicare and described in this paper.Beneficiaries who are members of Medicare Advantage programs, such as Medicare HMOs, may have benefits which are designed differently by the HMO and may be more or less restrictive than Original Medicare.Always consult with the primary insurer to verify patient benefits. Medicare supplement plans (Medi-Gap insurance) are provided to Medicare beneficiaries as a secondary insurance plan which helps pay the patient liability (deductible and coinsurance) on only Medicare-covered services.If an original Medicare patient has a Medi-Gap plan, and receives therapy services which are not covered by original Medicare because the services do not meet medical necessity requirements, the Medi-Gap policy will not cover those services either. Some Medicare beneficiaries, especially those who may be both eligible for Medicare and employed, may have other commercial coverage either primary or secondary to Medicare.Commercial insurance coverage might cover services which Medicare will not cover, but it is wise to verify benefits and eligibility for any other insurance prior to rendering services. Services Subject to Therapy Benefit Limits The CPTÂŽ / HCPCS codes which are always subject to the therapy benefit limitations are referred to asAlways Therapycodes.These codes are those that are always performed pursuant to a Plan of Care. Always Therapycodes are subject to the benefit limitations when performed in the outpatient setting. Sometimes Therapycodes are subject the benefit limitations when performed by a therapist and/ or performed subject to a therapy plan of care.

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP The Medicare Claims Processing Manual, Chapter 4, section 200.9 sets forth ?Billing for ?Sometimes Therapy? services that May be Paid as Non-Therapy Services for Hospital Outpatients?: ?Under the OPPS, separate payment is provided for certain services designated as ?sometimes therapy? services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified therapy plan of care. Specifically, to be paid under the OPPS for a non-therapy service, hospitals SHOULD NOT append the therapy modifier GP (physical therapy), GO (occupational therapy), or GN (speech language pathology), or report a therapy revenue code 042x, 043x, or 044x in association with the ?sometimes therapy? codes listed in the table below.

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP The ?Sometimes? and ?Always? Annual Therapy code listing has been updated for CY 2015. To view the complete listing follow the link below: **this website has not been updated by CMS to date** Please see page 9 for CY2017 coding changes that will be updated on the Annual Therapy Code Listing by CMS*** http:/ / www.cms.gov/ Medicare/ Billing/ TherapyServices/ AnnualTherapyUpdate.html

An excerpt from the Excel file above:

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP Claims for Always and Sometimes therapy services will be subject to the Therapy benefit limitations if the service is performed under a plan of care and the claim for outpatient PT/ ST or OT is billed on either a UB04 or CMS1500: - Hospital outpatient claims submitted by hospitals on a UB04/ 837i claim will be bill type 13X, with charges billed as Always or Sometimes therapy service HCPCS code(s) with modifiers GP for PT, GO for OT, or GN for SLP, and assigned to revenue codes 042X, 043X, and/ or 044X, which indicate the procedure was performed by a physical, occupational, or speech language therapist. - Professional Fee CMS 1500/ 837p claims used by independent therapy clinics with a Therapist modifier (modifiers GP for PT, GO for OT, or GN for SLP) appended to the Always or Sometimes therapy service HCPCS code(s). CPTÂŽ / HCPCS code definitions, reimbursement, and appropriate revenue codes are available for efficient review in the PARA Data Editor (PDE)Calculator.For example, CPTÂŽ / HCPCS 97101:

Therapy capare limitations on the financial value of therapy services covered by Medicare per beneficiary in a single calendar year. As of January 1 each year, Original Medicare beneficiaries receive a new cap for outpatient therapy services. - Benefits for physical therapy and speech language pathology services are combined for 2018 under a cap of $2,010. - Occupational therapy is a separate cap for the beneficiary and for 2017 is limited to $2,010. - Deductible and coinsurance amounts count toward the cap.

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP Exceptions allowing payment for services in excess of the Benefit Cap may be granted at two levels, above the cap($2,010)and above the threshold ($3,700): - Automatic Exceptionsfor services above the$2,010cap but below the $3,700 threshold; As of April 01, 2015, this process is extended to December 31, 2017. - Manual Medical Reviewexceptions offer coverage above the $3,700 threshold. This Manual Medical Review process was extended through December 31, 2017. (KX Modifier scenarios) Automatic Exceptions are available for services above the $2,010 cap but below a $3,700 threshold if the beneficiary?s diagnosis qualifies, limited to those procedures that are directly related to the patient condition. Codes for medically necessary therapy services above $2,010 and below $3,700 must be appended with the ?KX modifier, which serves as the therapist attestation as to the necessity of the services. For Automatic Exceptions, no pre-payment review is required, although any claim submitted to Medicare may be audited at a later time. To qualify for an Automatic Exceptions, claims must meet the following criteria: - Services are rendered on the order of a Physician under a Certified Treatment Plan. The Physician is required to sign the Certified Treatment Plan and review it periodically. - The beneficiary requires the services to meet a medical need - The services were performed for the beneficiary while the beneficiary was under the care of a physician - All therapy services must be furnished on an outpatient basis. CMS makes an exception to the cap for certain evaluation services necessary to determine whether the patient requires additional therapy.**CMS has not completed manual updates *** http:/ / www.cms.gov/ Regulations-and-Guidance/ Guidance/ Manuals/ Downloads/ clm104c05.pdf

PARA Weekly Update: November 17, 2017

2018 UPDATE: MEDICARE THERAPY BENEFIT CAP Therapy coding changes that will be implemented on the CMS Annual Therapy Coding Update for January 01, 2017: There were 8 new codes created by CPT® that are set to replace current CPT® codes 97001 ? 97004 as they related to physical therapy services (PT) and occupational therapy services (OT). The new codes are intended for reporting of evaluation procedures to for both modalities with components that will require reporting as well as correspond with typical face-to-face times. The newly created codes are based on the patient complexity and the level of clinical decision-making (low, moderate and high) involved for the management of the patient. The three new PT evaluation codes 97161, 97162, and 97163 replace code 97001: -

Add: 97161 - PT EVAL LOW COMPLEX 20 MIN Add: 97162 - PT EVAL MOD COMPLEX 30 MIN Add: 97163 - PT EVAL HIGH COMPLEX 45 MIN Delete: 97001 ? PT EVALUATION

The new PT re-evaluation code 97164 replaces code 97002: - Add: 97164- PT RE-EVAL EST PLAN CARE - Delete: 97002 ? PT RE-EVALUATION The three new OT evaluation codes 97165, 97166, and 97167 replace code 97003: -

Add: 97165 - OT EVAL LOW COMPLEX 30 MIN Add: 97166 - OT EVAL MOD COMPLEX 45 MIN Add: 97167 - OT EVAL HIGH COMPLEX 60 MIN Delete: 97003 ? OT EVALUATION

The new OT re-evaluation code 97168 replaces 97004: - Add: 97168 - OT RE-EVAL EST PLAN CARE - Delete: 97004 ? OT RE-EVALUATION

PARA Weekly Update: November 17, 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: November 17, 2017

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: November 17, 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: November 17, 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: November 17, 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: November 17, 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: November 17, 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: November 17, 2017

There were EIGHT 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: November 17, 2017

The link to this Med Learn: MM9911

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10098

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10333

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10308

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10319

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10318

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10374

PARA Weekly Update: November 17, 2017

The link to this Med Learn: MM10350

PARA Weekly Update: November 17, 2017

There were ELEVEN 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: November 17, 2017

The link to this Transmittal #R3920CP

The link to this Transmittal #R3924CP

PARA Weekly Update: November 17, 2017

The link to this Transmittal #R3922CP

The link to this Transmittal #R1979OTN

PARA Weekly Update: November 17, 2017

The link to this Transmittal #R171SOMA

The link to this Transmittal #R3923CP

PARA Weekly Update: November 17, 2017

The link to this Transmittal #R2383CP

The link to this Transmittal #R3921CP

PARA Weekly Update: November 17, 2017

The link to this Transmittal #R203NCD

The link to this Transmittal #R1978OTN

PARA Weekly Update: November 17, 2017

The link to this Transmittal #R12P240

PARA Weekly Update: November 17, 2017

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

PARA Weekly Update: November 17, 2017