PARA Analytics's Weekly eJournal September 18, 2019 by CorroHealth

PARA

September 18, 2019 an HFRI Company

HealthCare Analytics

Weekly

eJOURNAL

NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Mid-Line Catheter Placement - Two Units, 51798 - Faculty and Pro Fees - PA IV Starts

Page 6

BOOSTING CYBERSECURITY REDUCING DENIALS IN THE EMERGENCY DEPARTMENT CONVERSATION STARTERS FOR PROVIDERS INTEROPERABILITY: 2020 CMS UPDATES

The number of new or revised Med Learn articles released this week.

The number of new or revised Transmittals released this week.

CMS TWO-MIDNIGHT RULE

What every revenue cycle professional should know.

44 NEW HCPCS CODES MLNCONNECTS NEWSLETTER

PA IV St ar t

PARA

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COMPANY NEWS

SERVICES

ABOUT PARA

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Administration: Pages 1-32 HIM /Coding Staff: Pages 1-32 Providers: Pages 3,10,16 Nursing: Page 2 Urology: Page 3 Finance: Pages 6,8,19,25 M id-Level Providers: Page 5

Speci al Pu l l ou t Sect i on

Emergency Dept: Page 8 Pain M gmt: Pages 10,23 Compliance: Page 15 Inpatient Svcs: Pages 16,30 Pharmacy: Pages 19,27 Hospice: Page 23 IT Services: Page 6

PARA Weekly eJournal: September 18, 2019

MID-LINE CATHETER PLACEMENT

Can we bill CPTÂŽ 36568 for a hospital inpatient on the floor with the nurse installing the midline cath? What revenue code should be used? What are others charging for this procedure?

Answer: Attached is our paper on bedside procedures, and also a coding Q&A we have previously published regarding midline catheters. PARA recommends that all services performed for an inpatient by regularly assigned unit nursing staff should be considered a component of the room rate. If the bedside procedure is performed by a ?traveler?, i.e. a PICC line team/nurse that moves from unit to unit as needed for this specific procedure, then a separate charge is customary. According to AHIMA, "Midline" catheters by definition terminate in the peripheral venous system. They are not central venous access devices and may not be reported as a PICC service. Midline catheter placement may be reported with 36400, 36405, 36406, or 36410. Also attached are Market Pricing reports for 36400, 36405, 36406, 36410, 36568 and 36569 from the PARA Data Editor. For assistance with pricing, please reach out to Randi Brantner on our staff at rbrantner@para-hcfs.com.

PARA Weekly eJournal: September 18, 2019

TWO UNITS, 51798

Our hospital just opened a Urology Provider Based practice in August. Nursing would like to charge for a pre and post bladder scan 51798. Is there special documentation or rules that require an RN or NP to perform in order to bill? Can a Medical Assistant perform and charge?

Answer: The description of 51798 is ?post-voiding? residual urine and/or bladder capacity measurement; we are not sure that the code 51798 describes a ?pre? scan ? you might want to get more information from the nurses to explain what exactly they would do. Under Medicare rules, the professional fee portion of a claim for service in a provider-based clinic is limited to only those services personally performed by the billing provider. The hospital cannot report services performed by nursing personnel as if the physician performed that service. In the hospital setting, nurses and MAs may perform medically necessary services which are consistent with state scope of practice laws according to their licensure, so long as the services are on the orders of a physician. The facility may report the HCPCS for nursing services on an outpatient claim, so long as the claim is compliant with the coding rules, including CCI edits and Medically Unlikely Edits (MUEs.) On a Method II CAH claim, the services of nursing personnel are reported under the facility fee revenue codes on the claim, not under the professional fee revenue codes. 51798 has a Medicare MUE of 1 per day; however, since the MUE Adjudication Indicator (MAI) is 3, Medicare will consider paying additional units when justified. Therefore, if there are extenuating circumstances that require the performance of 2 units of 51798, a second unit could be reported on a separate line with modifier GD (Units of service exceeds medically unlikely edit value and represents reasonable and necessary services) appended. A comment explaining the reason that two units were performed must be provided in the remarks section of the claim, then the Medicare Administrative Contractor will use the comment code to determine whether to allow it, request additional documentation, or deny that line item.

PARA Weekly eJournal: September 18, 2019

FACULTY AND PRO FEES

I have a concern regarding the revenue codes on the PARA Data Editor for CPTÂŽ codes 99217, 99218, 99219 and 99220. Our CFO is creating a new department for our hospitalist and we are building the charges. She had 982 as the revenue code for the majority of the OBS and Inpatient initial and subsequent visits, and I wanted to make sure these were correct before we had them built. All other codes in the daily hospital visits are stating 987 or 657. Codes 99217, 99218, 99219 and 99220 are stating to use 762 as the revenue code. Is this correct?? Answer: We would recommend using revenue code 0960 for the 99218/9/220 daily for pro fees and then 0762 (Method II) with G0378 for the hourly hospital. The revenue codes reported in the PARA Data Editor are derived from the HCPCS to Revenue Code crosswalk in the UB Editor. The UB Editor is primarily interested in facility fee billing, therefore no professional fee revenue codes are provided in the HCPCS to Rev Code crosswalk. Facility fees for patients in observation status are generally reported under revenue code 0762, that is why you will see that revenue code listed with the CPTÂŽs 99217-99220. For facility fees, we recommend reporting HCPCS G0378 for hourly observation care. A CAH Method II may report physician charges for outpatient services on a UB04/837i claim, of course. The professional fee revenue codes are in the ranges 096X, 097X, and 098X. Therefore, if reporting a professional fee, it is acceptable to report the services within those codes. While we prefer the most general professional fee revenue code 0960, it is also acceptable to report 0982 for physician outpatient services, such as observation ? but it would not be appropriate to report 0982 for a physician?s services in rendering inpatient care. Here are most of the professional fee revenue codes: In order to avoid unnecessary edits due to a mismatch in the revenue code, we recommend sticking with the 0960 general classification professional fee revenue code for hospitalist services.

PARA Weekly eJournal: September 18, 2019

PA IV START

Is a Physician Assistant able to bill separately for starting IV's with ultrasound guidance in the Outpatient and Inpatient setting?

Answer: No. The PA should not generate a professional fee claim for starting an IV in the hospital setting, inpatient or outpatient. There is no HCPCS code for simply starting an IV. Even if the IV start resulted in an infusion or injection via IV, the Medicare NCCI Edit manual explains that Physicians and non-physician practitioners should not report IV therapy codes in the facility setting: https://apps.para-hcfs.com/para/documents/CHAP11-CPTcodes90000-99999_final103118.pdf CHAPTER XI MEDICINE / EVALUATION AND MANAGEMENT SERVICES 7. CPT codes 96360-96379, 96401-96425, and 96521-96523 are reportable by physicians for services performed in physicians?offices. These drug administration services shall not be reported by physicians for services provided in a facility setting such as a hospital outpatient department or emergency department. Drug administration services performed in an Ambulatory Surgical Center (ASC) related to a Medicare approved ASC payable procedure are not separately reportable by physicians. Hospital outpatient facilities may separately report drug administration services when appropriate. For purposes of this paragraph, the term ?physician? refers to M.D.?s, D.O.?s, and other practitioners who bill Medicare claims processing contractors for services payable on the ?Medicare Physician Fee Schedule?. If the IV start is successful and IV therapy is administered, which therapy is not part of a surgical procedure, the facility may report the appropriate HCPCS code (i.e. 96360-96379, 96401-96425) as a facility fee charge. The facility may also report 76937 - ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES, DOCUMENTATION OF SELECTED VESSEL PATENCY, CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF VASCULAR NEEDLE ENTRY, WITH PERMANENT RECORDING AND REPORTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) if a permanent record of the ultrasound is retained.

PARA Weekly eJournal: September 18, 2019

BOOSTING CYBERSECURITY IN THE FACE OF A HACKING TIDAL WAVE

Despite widespread industry determination to bolster healthcare information security, the number of health data cyberbreaches continues to explode nationwide, causing chaos for providers and payers and putting millions of patients at risk for identity theft. More than 25 million patient records have already been breached in 2019, up 66 percent from the 15 million records stolen through all of 2018, and up 400 percent from the 5 million records exposed in 2017.[1] The onslaught highlights the systemic vulnerability of the healthcare sector and reflects the value hackers place on patient information, which typically offers a trove of rich personal data for identity thieves.

Fighting on two fronts Experts say thwarting cyberattacks requires hospitals and physician groups to fight on two fronts: Internal systems and networks must be secured, and breaches initiated through connected third parties must be prevented. The latter threats can be extensive, due to providers?increased reliance on third parties for a wide range of support services. Defending against third-party hazards also is problematic, since provider knowledge about the security of third- and even fourth- or fifth-party platforms is necessarily limited. Moreover, the ability to impose fixes typically is out of reach. The good news is that momentum is building behind an industry-led effort aimed at creating the same level of security for information sharing in healthcare that has long existed across the payment processing industry. Known as HITRUSTÂŽ, the initiative provides a risk management framework, standards and guidance for systematically securing information and sharing it in compliance with HIPAA and other applicable guidelines. In essence, HITRUST offers a detailed roadmap for achieving and maintaining compliance with over 40 authoritative sources, including HIPAA.

Weak links The avalanche of breach events so far in 2019 underscores just how vulnerable providers are to cyberattacks originating outside their walls. Three of the five largest healthcare breaches this year, in fact, involved third parties:[2] - A billing vendor, American Medical Collection Agency, was hacked for eight months straight between August 2018 and March 2019. Patient data from at least six covered entities was affected. So far, it is believed a least 25 million patient files were exposed, including approximately 12 million from lab giant Quest Diagnostics and 7.7 million from competitor LabCorp. - Insurer Dominion National experienced ongoing hacking for nine years before the breach was spotted and sealed in April of this year. Data on an estimated 2.9 million patients was potentially exposed. A ransomware attack on Wolverine Solutions Group, a company providing multiple outsourced business services to healthcare companies, is believed to have compromised information on more than 600,000 patients. Many providers and payers in Michigan were especially hard hit. 6

PARA Weekly eJournal: September 18, 2019

BOOSTING CYBERSECURITY IN THE FACE OF A HACKING TIDAL WAVE

HITRUST certification To limit third-party breaches, the HITRUST process focuses on the HITRUST CSF, which synthesizes multiple compliance standards and guidelines, including HIPAA, PCI, ISO/27001 and ISO/27002, and NIST SP 800-53.[3][4] In addition to strengthening vendor security, certification creates what is, in effect, a Good-Housekeeping-like seal of approval for vendors that allows them to quantify their security competencies to existing or potential customers. The CSF addresses 19 different domains?from third party security and network protection to mobile device security?and requires readiness assessments against 135 specific controls.[5] HITRUST offers three progressive levels or degrees of assurance, from a HITRUST-issued CSF Self-Assessment Report to CSF-Validated and finally CSF-Certified. The latter may take up to three months to complete.[6] For vendors and providers, ensuring HITRUST certification represents a significant improvement over traditional, ?take your word for it? business agreements between vendors and covered entities that relied primarily on self-attesting compliance with HIPAA.[7]

An active defense Beyond requiring HITRUST certification from vendors as a condition for doing business, providers can also boost third-party security through efforts in four key areas, according to the Healthcare Information and Management Systems Society (HIMSS). These include:[8] - Conducting thorough vendor due diligence - Classifying the level of risk associated with each vendor function and relationship - Ensuring ongoing communications with vendors about emerging security concerns - Exploring cyber-liability insurance to mitigate the cost of potential breaches

Practicing what you preach A leader in accounts receivable recovery and resolution, several of Healthcare Financial Resources (HFRI) key systems are HITRUST CSFÂŽ certified to help ensure the highest level of security for protected health information.

[1] Jessica Davis, ?The 10 Biggest Healthcare Data Breaches of 2019, So Far,? Health IT Security, July 23, 2019. [2] Ibid. [3] Travis Good, ?What is HITRUST?,? Datica.com, May 10, 2018. [4] ?Comparing the CSF, ISO/IEC 27001 and NIST SP 800-53,? HITRUST. June 2014. [5] Ibid. [6] Ibid [7] Rob Pierce, ?What is HITRUST? A Practical Guide to Certification,? Linford & Company LLP, September 26, 2018. [8] Ronald Hirsch, MD, ?Vendor Security Risk Management for Healthcare Organizations,? HIMSS Privacy and Security Committee Brief, 2015

PARA Weekly eJournal: September 18, 2019

REDUCING DENIALS IN THE EMERGENCY DEPARTMENT

Because hospital emergency departments serve as important gateways for inpatient admissions, it is essential that patient information, especially insurance data, is captured accurately at the time of service. Unfortunately, the hectic pace and critical nature of ED services often means that confirming coverage takes a back seat to more pressing concerns. But with emergency volume rising and two-thirds of all admissions coming through the ED,[1] hospitals risk growing denials and write-offs if they can?t effectively collect payment information at the outset of the care event. Mistakes or omissions that occur during the initial encounter affect not only payment for emergent services, but also can flow downstream to impact reimbursement opportunities along the entire continuum of care. ED denial causes Healthcare Financial Resources (HFRI) works with a range of hospital clients to identify and mitigate the root cause issues that trigger denials for emergent, inpatient, outpatient and ancillary services. From this experience, we?ve determined that inaccurate or invalid insurance information is the most common cause of denials in the ED. The problem is extensive: internal analysis has shown that around 40 percent of ED patients have invalid insurance or no insurance when they present for care. In one case, almost 75 percent of patients who presented at a hospital emergency room had expired or non-existent insurance. Changing payer policies also are contributing to ED denials. In 2015, one major payer began retrospectively denying ED claims it deemed unnecessary based on a pre-specified list of non-emergent conditions. A subsequent study concluded that as many as one in six adults could face denials for ED coverage if similar policies were adopted by other insurers.[2] Given the financial risk denials present for hospitals, it is imperative that accurate information about that patient?s coverage, or lack thereof, be obtained as soon as possible and before any claims are submitted. After-care meetings Specifically, hospitals should implement edits in their intake systems that can block claims submissions if there is no active insurance. Staff also needs to be trained in the appropriate steps to take. Too often, we?ve seen hospital personnel submit claims to the insurance company on record, even if an automated rejection has already indicated that the coverage is no longer in force. A second important step is to create an intervention process that allows staff to discuss the issue of payment with patients who do not have appropriate insurance. This can be impractical and even ill-advised before coverage is provided. But it should be undertaken as soon as possible once the patient is stable or discharged. 8

PARA Weekly eJournal: September 18, 2019

REDUCING DENIALS IN THE EMERGENCY DEPARTMENT

A brief post-care meeting allows hospital staff to inform the patient that their coverage isn?t valid and to ask for their assistance in determining if another policy might be available. If there is no other insurance, a payment plan can be discussed. When post-care meetings are not practical or the opportunity to meet passes, the hospital may need to balance-bill the patient if there isn?t an accurate insurance policy on record. This is something many facilities don?t like to do. However, when practical, it should gain the patient?s attention and potentially compel them to seek out their existing insurance, if available. If there is no insurance, the invoice again creates an opportunity for the hospital and patient to jointly discuss a reasonable plan for payment. Return on investment Ultimately, reducing denials in the ED comes down to developing systems that immediately flag expired or non-existent coverage and then establishing a process to identify available insurance or develop alternative payment plans. Supporting this approach requires appropriately trained and motivated intake personnel. In our experience, many hospitals seem inclined to view registration staff as lower-level employees and therefore pay them accordingly. But the reality is that a hospital?s health and survival depend on how effectively these employees perform. As a result, investments in both human and technological resources that streamline the intake process inevitably produce a worthwhile return on investment. HFRI capabilities Healthcare Financial Resources (HFRI) specializes in AR recovery and resolution. We work as a virtual extension of your hospital central billing office to help you resolve and collect more of your insurance accounts receivable faster and improve operating margins through a seamless and collaborative partnership with your internal team. HFRI utilizes proprietary intelligent automation and staff specialization to efficiently process all claims regardless of size or age. Clients can gain a 25 percent improvement in resolution cycle time and cash recovery rates that often exceed 75 percent on problematic AR claims ? double the performance of most legacy AR management vendors. In addition to our resolution capabilities, HFRI also can provide denial management assistance by conducting root cause analysis and recommending process improvements to help decrease aged and denied claims going forward. Importantly, HFRI is HITRUST CSF-certified to help ensure the highest levels of protected health information (PHI) security and compliance. [1] James J. Augustine, MD, ?Long-Term Trends in Emergency Department Visits, Patient Care Highlighted in National Reports,? ACEP Now, Jan. 11, 2017 [2] Gina Shaw, ?Studies Rebut Anthem?s Retrospective ED Denials,? Emergency Medicine News, February 2019

PARA Weekly eJournal: September 18, 2019

CONVERSATION STARTERS: ACUTE PAIN

PARA Weekly eJournal: September 18, 2019

CONVERSATION STARTERS: CHRONIC PAIN

PARA Weekly eJournal: September 18, 2019

CONVERSATION STARTERS: PRESCRIPTION OPIOIDS

PARA Weekly eJournal: September 18, 2019

CONVERSATION STARTERS: REDUCING RISK

PARA Weekly eJournal: September 18, 2019

IT'S HERE! GET YOURS TODAY

It's here. Thi s i s the defi ni ti ve gui de coveri ng the new and proposed rules and payment rates and schedules from In thi s speci al edi ti on of the PARA week ly eJournal, we bri ng together i nformati on every revenue cycle professi onal, healthcare provi der and fi nance executi ve needs to k now, all i n one place.

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If you haven't signed up to receive PARA HealthCare Analytics's free weekly eJournal, now's the time. Click here https:/ / para-hcfs.com/ newsletter 14

PARA Weekly eJournal: September 18, 2019

2020 CMS UPDATES PROMOTE INTEROPERABILITY PROGRAM

Interoperability

The Final Rule for Medicare Hospital Inpatient Prospective Payment System for Acute Care Hospitals and Long-Term Care Hospitals was published by CMS on August 2, 2019. Within this rule, CMS continues advancement of its Promoting Interoperability Program (formerly known as Medicare and Medicaid EHR Incentive Programs). The intent of this program is to demonstrate meaningful use of certified EHR technology (CEHRT). A link to the 2020 IPPS Final Rule is available on the Advisor tab of the PARA Data Editor. It can be found by entering 2020 in the Summary field.

CMS made the following program changes: - Finalized EHR reporting period to a minimum 90 consecutive days for new and returning participants - Changed the Query of Prescription Drug Monitoring Program (PDMP) from required to optional and available for five bonus points. This measure also changes from a numerator/denominator to a yes/no attestation for calendar year 2019 - Lines up the electronic Clinical Quality Measures (CQM) requirements with the Hospital Inpatient Quality Reporting Program (IQR) beginning calendar year 2021. This includes adding a new opioid-related quality measure Safe Use of Opioids Concurrent Prescribing CQM - Removes the Verify Opioid Treatment Agreement from the measures beginning calendar year 2020 - Continues the requirement that all eligible hospitals and CAHs use 2015 edition of certified electronic health record technology (CEHRT) - Requires certification of EHR technology for electronic clinical quality measures (eCQMs) reported in the calendar year 2020 reporting period - Requires hospitals submit one, self-selected calendar quarter of discharge data for four self-selected eQMs in the Hospital IQR Program measure set beginning calendar year 2020 15

PARA Weekly eJournal: September 18, 2019

CMS TWO-MIDNIGHT RULE

Un cer t ain t y Clou ds CM S Tw o-M idn igh t Ru le; Poses On goin g Den ial Risk Difficult and sometimes treacherous for ships at sea, navigating in the dark can be equally perilous for hospitals struggling to comply with Medicare?s murky two-midnight inpatient admissions rule. The rule was created by the Centers for Medicare and Medicaid Services (CMS) five years ago as means of assisting hospitals in determining whether patients should be admitted as in-patients or placed in observation as outpatients, if ordered by the physician. CMS?goals were to reduce unnecessary admissions and help ensure patients received quality care at the appropriate time and place. Despite the passage of time and multiple rule modifications, confusion continues to surround the regulation for many. This uncertainty has translated into a substantial risk of denials for inpatient admissions CMS does not consider justified. It also can lead to lost revenue on legitimate inpatient admissions down-coded as observational.

To minimize two-midnight denials and optimize collections, hospitals must ensure that both clinicians and utilization management staff have a concise understanding of how the rule works. As part of this effort, they need to be sure all relevant medical necessity documentation is provided to support the clinician?s inpatient determination. Replaced severity and intensity of service Developed as part of the 2014 Inpatient Prospective Payment System Final Rule, the two-midnight rule states that a hospital admission is generally considered reasonable and necessary if the physician or qualified practitioner orders the admission based on the expectation that the patient will require medically necessary hospital care that spans at least two midnights. Patients that aren?t expected to require a stay extending through two or more midnights are classified as outpatients receiving observation services (OBS) and the hospital is reimbursed at outpatient rates. If, however, care for patients in OBS status extends toward a second midnight, they may be formally admitted as inpatients. The rule replaced previous inpatient guidelines that were based on severity of illness and intensity of service. Since the rule was implemented, some hospitals have continued to rely primarily on severity and service intensity as the key factors in deciding whether or not to admit. Others erroneously have assumed that the shift to a time-based admission calculus means that documenting medical necessity is no longer necessary. 16

PARA Weekly eJournal: September 18, 2019

CMS TWO-MIDNIGHT RULE Knee replacement confusion Although uncertainty surrounds the interpretation of the two-midnight rule across a range of procedures and morbidities, CMS policies regarding total knee arthroplasty (TKA) have resulted in confusion. Effective Jan. 1, 2018, CMS removed TKA from the Inpatient Only List (IPO) and assigned the procedure an Ambulatory Payment Classification. But even though removal from the IPO means the procedure is paid as an outpatient service, it still must be performed in a hospital.[1] At the same time, CMS has noted that shifting from the IPO ?does not require the procedure to be performed only on an outpatient basis.? Yet the agency provided no guidance on how hospitals should determine which cases can be performed inpatient.[2] A good first step in resolving this dilemma is to review the historical length of stay for TKA patients to determine if the two-midnight rule is met. Even with this information, however, the rules can be tricky: According to published reports, if physicians routinely have kept patients over two midnights in the past, that doesn?t mean they automatically are meeting medical necessity requirements for inpatient level of care now.[3] Adding to the uncertainty, CMS will allow cases with less than two midnights to be paid at inpatient rates if the admitting physician indicates a need for inpatient hospital care in the documentation.[4] To ease the confusion, experts recommend that orthopedic surgeons and health system utilization management staff create detailed protocols for designating inpatient and outpatient procedures immediately after the fact. These rules should consider pre-operative history and comorbidities, signs and symptoms severity, anesthesia risks, as well as unanticipated surgical events and any post-procedure complications.[5] Proposed changes in the 2020 OPPS Proposed Rule CMS has proposed the removal of total hip arthroplasty, CPTÂŽ code 27130, from the IPO list and has requested public comment by September 27 on the potential removal of the following procedures from the IPO list. Table 23: IPO List of CPT Codes to be Potentially Removed from the IPO List [6]

PARA Weekly eJournal: September 18, 2019

CMS TWO-MIDNIGHT RULE CMS is also ?proposing to establish a 1-year exemption from Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs) referrals to Recovery Audit Contractors (RACs) and RAC reviews for ?patient status? (that is, site-of-service) for procedures that are removed from the inpatient only (IPO) list under the OPPS beginning on January 1, 2020.?[7] Utilization management must take the lead Regardless of the illness or procedure, it?s essential that clinicians provide detailed documentation surrounding the initial assumption that the patient will likely require a minimum of 24-to-48 hours of care, depending on the time of admission. Utilization management should take the lead in ensuring that clinicians are aware of their responsibilities with respect to appropriate documentation. They should also make it a priority to keep up with the latest interpretations of the two-midnight rule, and immediately convey this guidance to clinical staff. Additionally, all admissions should be reviewed during or after discharge to confirm that inpatient admission was justified, based on documented risks, complications, need for therapy or need for inpatient skilled nursing care.[8] When inpatient admission cannot be justified, hospitals can attempt to change the claim to outpatient status by following the condition code 44 process. Or they can simply self-deny and rebill as an outpatient service. In these cases, the patient and physician must be notified.[9] Your AR specialists Healthcare Financial Resources (HFRI) specializes in accounts receivable recovery and resolution and serves as a virtual extension of your hospital central billing office to help you quickly resolve and collect more of your insurance accounts receivable. We utilize proprietary intelligent automation and staff specialization to efficiently process all claims regardless of size or age. In addition to our resolution capabilities, HFRI also can provide denial management assistance by conducting root cause analysis and recommend process improvements to help decrease aged and denied claims going forward. Contact HFRI today to learn more about how we can help you with your hospital?s accounts receivable management.

[1] Debbie Sconce, ?Total knee arthroplasty ? No longer inpatient only,? Becker?s Hospital Review, April 17, 2018. [2] Ibid. [3] Ibid. [4] Ibid. [5] Ibid. [6] ?Medicare Program: Proposed Changes to Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs,? ederal Register 84 FR 39398. Aug. 9, 2019. [7] Ibid [8] Ronald Hirsch, MD, ?Two-midnight Rule Remains Confusing; Total Knee Replacements Frustrating to Many,? RACmonitor, May 16, 2018. [9] Ibid

PARA Weekly eJournal: September 18, 2019

44 NEW HCPCS CODES: OCTOBER 2019 OPPS UPDATE

Effective October 1, 2019, CMS added 44 new HCPCS codes in the category of Drugs and Biologicals, changed the wording on the descriptor for seven established HCPCS, and deleted two others. Since the OPPS Addendum B for October 1 has not yet been published, payment status indicators and APCs for the new codes have not yet been announced. PARA will update this paper with payment status codes when that information is released. https://www.cms.gov/Outreach-and-Education/ Medicare-Learning-Network-MLN/MLNMattersArticles/ Downloads/MM11422.pdf

PARA Weekly eJournal: September 18, 2019

44 NEW HCPCS CODES: OCTOBER 2019 OPPS UPDATE The 44 new codes are:

PARA Weekly eJournal: September 18, 2019

44 NEW HCPCS CODES: OCTOBER 2019 OPPS UPDATE

In addition, CMS revised the descriptions of seven HCPCS and deleted two others, listed on the following page. 21

PARA Weekly eJournal: September 18, 2019

44 NEW HCPCS CODES: OCTOBER 2019 OPPS UPDATE New description wording is underlined, deleted wording is indicated by strikethrough:

And finally, CMS deleted two HCPCS:

Information regarding payment status on the new and revised HCPCS will follow the release of Medicare's Addendum B update for October 1, 2019.

PARA Weekly eJournal: September 18, 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, September 12, 2019 New s

· New Medicare Card: Transition Period Ends in Less Than 4 Months · New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid, and CHIP · Different-Day Upper and Lower Endoscopy: Comparative Billing Report in September · Hospices: Call for Panel on Assessment Instrument and Quality Measures ? Nominations due September 30 · Local Coverage Determination Meetings · Pain Management: CDC Conversation Starters for Patients and Their Doctors · Healthy Aging® Month: Discuss Preventive Services with your Patients Com plian ce

· Bill Correctly for Device Replacement Procedures Claim s, Pr icer s & Codes

· Average Sales Price Files: October 2019 Even t s

· Opioids: What?s an ?Outlier Prescriber ?? Listening Session ? September 17

· Different-Day Upper and Lower Endoscopy: Comparative Billing Report Webinar ? September 24 M LN M at t er s® Ar t icles

· Hurricane Dorian and Medicare Disaster Related State of North Carolina Claims Disproportionate Share (DSH) Payment Adjustment for Cost Reports that Involve SSI Ratios for Fiscal Year (FY) 2004 and Earlier, or SSI

PARA Weekly eJournal: September 18, 2019

There was ONE new or revised Med Learn (MLN Matters) article 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 eJournal: September 18, 2019

The link to this Med Learn MM11413

PARA Weekly eJournal: September 18, 2019

There were FIVE 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 eJournal: September 18, 2019

The link to this Transmittal R4396CP

PARA Weekly eJournal: September 18, 2019

The link to this Transmittal R4392CP

PARA Weekly eJournal: September 18, 2019

The link to this Transmittal R4393CP

PARA Weekly eJournal: September 18, 2019

The link to this Transmittal R4394CP

PARA Weekly eJournal: September 18, 2019

The link to this Transmittal R4395CP

PARA Weekly eJournal: September 18, 2019

Con t act Ou r Team

Peter Ripper

M onica Lelevich

Randi Brantner

President

Director Audit Services

Director Financial Analytics

m lelevich@para-hcfs.com

rbrantner@para-hcfs.com

pripper@para-hcfs.com

Violet Archuleta-Chiu Senior Account Executive

Sandra LaPlace

Steve M aldonado

Account Executive

Director Marketing

slaplace@para-hcfs.com

smaldonado@para-hcfs.com

varchuleta@para-hcfs.com

In t r odu cin g, ou r n ew par t n er .

Nikki Graves

Sonya Sestili

Deann M ay

Senior Revenue Cycle Consultant

Chargemaster Client Manager

h f r Review i.n et Claim Specialist

ngraves@para-hcfs.com

ssestili@para-hcfs.com

dmay@para-hcfs.com

M ary M cDonnell

Patti Lew is

Director, PDE Training & Development

Director Business Operations

mmcdonnell@para-hcfs.com

plewis@para-hcfs.com