PARA Weekly HealthCare eJournal September 16, 2020 by CorroHealth

September 16, 2020

PARA

WeeklyeJOURNAL NEWS FOR HEALTHCARE DECISION MAKERS

MSP Questionnaire Page

Telehealth Reimbursement Page

SPECIAL NOTICE

48 - PICC Lin e Billin g - Couplet Care - CM S Pr ovides HCPCS M u lt iple Un it s - 2021 DRG Table 5 Comparison - CM S Pr ovides HCPCS Pr ocedu r e List For

FAST LINKS

M odif ier CS - October 1, 2020 OPPS HCPCS Update - M edi-Cal Updat e: CPT Codes 86408 & 86409 As New Ben ef it s - "Breakthrough" Devices

Administration: Pages 1-49 HIM /Coding Staff: Pages 1-49 Providers: Pages 2,10,15,22,25 IV Therapy: Page 2 Obstetrics: Page 3 Laboratory: Pages 4, 17 Health Plans: Page 61

COVID-19 Updat e Page 21

- Telehealth Page 10 - Finance/Billing: Pages 6,13,21,28,48 - RHCs & FQHCs: Page 15 - California Providers: Page 22 - Hospice: Page 35 - Inpatient Rehab: Page 35

PARA Weekly eJournal: September 16, 2020

PICC LINE BILLING

Is PICC Line Insertion (CPTÂŽ 36569), billable on Inpatient Visits, or is it only billable to Outpatients when they are in surgery, ER or observation? If the hospital RN is doing the PICC line procedure in the inpatient medical-surgical room, would it be billable or part of the Room and Board charge?

Answer:Please see our Bedside Procedures paper that I have attached. Report procedures on outpatient claims when they require HCPCS codes to describe the service performed. On an inpatient claim, unless the PICC line insertion is performed by a ?traveling nurse,? the nursing service is considered part of the daily room and board charge. Some hospitals have a dedicated PICC line team that travels to the nursing unit specifically to insert a PICC line. In a case as such, a separate charge would be appropriate. CMS advises that the revenue code should be assigned to the same cost center that performed the services.

This is found in Chapter 4 of the Medicare Claims Processing Manual: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c04.pdf

PARA Weekly eJournal: September 16, 2020

COUPLET CARE

Our facility has begun training to begin offering Couplet Care. It has been requested if PARA can provide any feedback or guidance to Couplet Care charging and billing. Specifically, can PARA recommend a charge set up and anything else you would find useful for us to know regarding starting this service. Answer: This is our interim response based on our understanding that ?couplet care? is a model of inpatient maternity/nursery nursing care that emphasizes mother and baby being cared for together, as a pair or ?couplet,? during their entire hospital stay. As we understand it, couplet care does not change the basic nature of inpatient services; it is a nursing approach which is designed to improve the hospital experience and outcomes from the inpatient stay. If that corresponds to the meaning of this phrase at your hospital, we would not recommend a different charge for couplet care. Services performed for an inpatient by regularly assigned unit nursing personnel should be considered covered by the room and board charge.

PARA Weekly eJournal: September 16, 2020

MULTIPLE UNITS

CPT® 82024 and CPT® 82533 both came back from the reference lab as "X8": 82024x8 and 82533x8 Cortisol and ACTH releasing study. Am I supposed to bill out 8 quantity of each of these? 82024 states "Collection: 1. Place EDTA tube on ice prior to collection. 2. Draw and gently invert 8 to 10 times" 82533 only refers to three specimens. How do I bill these out? Answer: CPT® 82024 (ACTH) represents a test of pituitary gland function, and 82533 is run to test adrenal gland function. Typically, the 82024 (ACTH) stimulation test is run in conjunction with 82533 (Cortisol), and the tests are repeated at different time intervals to measure the body?s response to ACTH: - Blood is drawn for an initial, baseline level (pre-stimulation) - The patient is given an injection of a manufactured fragment of ACTH (cosyntropin or tetracosactide). The manufactured fragment may be injected into a muscle or vein. When the manufactured ACTH fragment is administered, it acts like the body's own ACTH and stimulates the adrenal glands to produce cortisol - Blood is drawn again after a specified amount of time (30 minutes and/or 60 minutes) - The cortisol level is measured in both the first (baseline) and subsequent samples Medicare has an established Medically Unlikely Edit (MUE) value of 4 units for 82024 ? therefore the quantity of 8 exceeds Medicare?s ?Medically Unlikely Edit? and will cause the line item to be denied. However, the MUE Adjudication Indicator (MAI) is 3, which indicates that if the provider can supply information which justifies units over the MUE, an appeal will be considered. https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1421OTN.pdf

?MUEs for HCPCS codes with a MAI of ?3? will be date of service edits. These are ?per day edits based on clinical benchmarks?. If claim denials based on these edits are appealed, contractors may pay UOS in excess of the MUE value if there is adequate documentation of medical necessity of correctly reported units. If contractors have pre-payment evidence (e.g. medical review) that UOS in excess of the MUE value were actually provided, were correctly coded and were medically necessary, the contractor may bypass the MUE for a HCPCS code with an MAI of ?3? during claim processing, reopening or re-determination, or in response to effectuation instructions from a reconsideration or higher level appeal.? 4

PARA Weekly eJournal: September 16, 2020

MULTIPLE UNITS

The cortisol test, 82533, has an MUE of 5, with the same MAI of 3:

We would expect line items reporting 8 units of both of these tests would be denied (if billing Medicare). The appropriate recourse is to appeal with documentation from the provider. If many other providers also appeal, and succeed based on the documentation submitted, Medicare may increase the MUE value at some future time.

PARA Weekly eJournal: September 16, 2020

MSP QUESTIONNAIRE UPDATE EFFECTIVE 12/7/2020

In an update to the Medicare Secondary Payer Manual that will become effective 12/7/2020, CMS modified the questions that providers should ask Medicare beneficiaries to verify whether Medicare should be a secondary payer to any other health coverage. While the patient need not sign an attestation in response to these questions, the provider should maintain its record of having completed MSP questionnaires ? both negative and positive responses ? for a period of 10 years for audit purposes. The announcement regarding this update is available at the following link: https://www.cms.gov/files/document/mm11945.pdf

PARA Weekly eJournal: September 16, 2020

MSP QUESTIONNAIRE UPDATE EFFECTIVE 12/7/2020

At the time of this publication, the link to the same section in Chapter 3 of the Medicare Secondary Payer manual displays the language that remains in effect until December 7, 2020: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/msp105c03.pdf The new language in Chapter 3 of the Medicare Secondary Payer (MSP) Manual is indicated in italicized red font on the following pages. Medicare Secondary Payer Manual ? Chapter 3 ? language effective 12/7/2020 20.2.1 - Model Admission Questions to Ask Medicare Beneficiaries (Rev.10342, Issued: 09-04-2020, Effective: 12-07- 2020, Implementation: 12-07-2020) The following outline of questions provides points of data to gather from Medicare beneficiaries that are helpful for providers to determine who has primary payment responsibility for a claim or set of claims by asking the questions upon each inpatient and outpatient admission. The information assists in the proper coordination of benefits to ensure adherence to Medicare Secondary Payer (MSP) provisions as outlined in section 1862(b) of the Social Security Act. Part I. INFORMATION ABOUT BLACK LUNG, WORKERS?COMPENSATION (WC), NOFAULT AND LIABILITY - Are you receiving benefits under the Black Lung Benefits Act (BL)? - If yes, the following BL information is required to submit claims appropriately: - Date Black Lung Benefits began Note: BL is the primary payer for claims related to BL - Was the illness/injury due to a work-related accident/condition? - If yes, the following WC information is required to submit claims appropriately: - Name and address of employer - Name and address of insurance carrier - Policy or claim number - Date of the workplace illness or the injury Note: WC is the primary payer only for services related to work-related injuries or illness - Are you receiving treatment for an injury or illness covered under no-fault (and/or medical-payment coverage) including premises or automobile? - If yes, the following no-fault/auto insurance information is required to submit claims appropriately: - Name and address of insurance carrier - Policy or claim number - Date of illness or injury Note: No-fault insurance is the primary payer only for services related to the accident - Are you receiving treatment for an injury, or illness, which another party may be liable? - If yes, the following liability information is required to submit claims appropriately: - Name and address of insurance carrier - Policy or claim number - Date of illness or injury Note: Liability insurance is the primary payer only for services related to the liability settlement, judgment, or award.

PARA Weekly eJournal: September 16, 2020

MSP QUESTIONNAIRE UPDATE EFFECTIVE 12/7/2020

Part II. INFORMATION ABOUT MEDICARE ENTITLEMENT AND GROUP HEALTH PLANS - Are you entitled to Medicare based on Age, Disability or ESRD? Note: If entitlement is based solely on ESRD, skip Part II and complete Part III. Stop after completing Part II if you are entitled to Medicare based on Age or Disability. - Do you have group health plan (GHP) coverage based on your own current employment, or the current employment of either your spouse or another family member? If yes, the employer GHP may be primary to Medicare. Continue below. If no, stop here as Medicare is primary. - How many employees, including yourself or spouse, work for the employer from whom you have GHP coverage? (1-19, 20 ? 99 or 100 or more) Note: If you are aged and there are 20 or more employees, your GHP is primary. If you are disabled and your employer, spouse, or family member employer, has 100 or more employees, your GHP is primary. - The following employer GHP information is required to submit claims appropriately: - Name and address of the employer (your own or your spouse?s/family member?s) through which you receive GHP coverage - Name and address of GHP - Policy number (sometimes referred to as the health insurance benefit package number) - Group number - Date the GHP coverage began - Name of policyholder (if coverage is through your spouse/other family member) - Relationship to patient (if other than self) Part III. INFORMATION ABOUT THE PATIENT IF ESRD MEDICARE ENTITLEMENT APPLIES (INCLUDING DUAL ENTITLEMENT: AGE AND ESRD OR DISABILITY AND ESRD) - Do you have employer group health plan (GHP) coverage through yourself, a spouse, or family member if dually entitled based on Disability and ESRD? If yes, the employer GHP may be primary to Medicare. Continue below. - Have you received a kidney transplant? - Date of transplant - Have you received maintenance dialysis treatments? - Date dialysis began - Are you within the 30-month coordination period? Note: the 30-month coordination period starts the first day of the month an individual is eligible for Medicare (even if not yet enrolled in Medicare) because of kidney failure (usually the fourth month of dialysis) regardless of entitlement due to age or disability. If the individual is participating in a self dialysis training program, or has a kidney transplant during the 3-month waiting period, the 30-month coordination period starts with the first day of the month of dialysis or kidney transplant. - Were you receiving GHP coverage prior to and on the date of Medicare entitlement due to ESRD (or simultaneous entitlement due to ESRD and Age or ESRD and Disability)? Note: If yes, the GHP is primary during the 30-month coordination period.

PARA Weekly eJournal: September 16, 2020

MSP QUESTIONNAIRE UPDATE EFFECTIVE 12/7/2020

- The following information is required to submit claims appropriately: - Name and address of the employer (your own or your spouse?s/family member?s) through which you receive GHP coverage - Name and address of GHP - Policy number (sometimes referred to as the health insurance benefit package number) - Group number - Name of policyholder (if coverage is through your spouse/other family member) - Relationship to patient (if other than self)

20.2.2 - Documentation to Support the Admission Process (Rev.10342, Issued: 09-04-2020, Effective: 12-07- 2020, Implementation: 12-07-2020)The provider retains a copy of completed admission questions, the CWF print out or copy of the 271 response including all notations, in its files (or online) for audit purposes to demonstrate that development for primary payer coverage takes place. It is not necessary that the beneficiary sign the completed questions.However, providers may identify the date when the questions are asked.

Medicare permits providers to retain hard copy questions and responses on paper, optical image, microfilm, or microfiche. Hard copy and data described in this paragraph must be kept for at least 10 years after the date of service that appears on the claim. (See Chapter 5 for information about the documentation to be used in a hospital review.) If the provider's admissions questions are retained online, Medicare requires it to retain negative and positive responses to admission questions for 10 years with DOJ's record retention requirements, after the date of service. Online data may not be purged before then.

PARA Weekly eJournal: September 16, 2020

STAYING ABEAST OF EVOLVING TELEHEALTH REIMBURSEMENT

As the use of telehealth skyrockets due to the COVID-19 pandemic, financially hard-hit providers must consider new revenue cycle management protocols to ensure the best chance for full reimbursement. In March 2020, telehealth utilization exploded 4,300% from a year earlier as patients and providers sought alternatives to office visits for routine care. Yet long-term uncertainty about Medicare reimbursement and wide disparities in the way commercial payers and Medicaid programs reimburse for telehealth mean providers must be extra-vigilant to limit denials and underpayments.[1] Key steps like ensuring complete documentation of services, including the audio and/or visual functionality used to deliver the care, as well as close scrutiny of telehealth claims, are essential to maximize reimbursement, revenue cycle experts with Healthcare Financial Resources (HFRI) say. ?With telehealth services accounting for an ever-larger percentage of care, making sure you?re collecting every telehealth dollar you?re entitled to will be critical to sustaining cash flow in the months and years to come, particularly amid the lingering downturn triggered by COVID-19,? said Dan Low, HFRI?s director of operations. As defined by the American Medical Association, telehealth services generally fall into one of four modalities: - Real-time, audio-visual communications that link physicians and patients - Store-and-forward technologies that collect images and data to be transmitted and interpreted later - Remote patient-monitoring tools such as wearable devices, blood pressure monitors and other devices that record and communicate biometric data - Verbal and text virtual check-ins made through patient portals and messaging apps.[2] Telehealth can be administered by a range of clinicians, including physicians, nurse practitioners, physician assistants, clinical nurse specialists and psychologists. Economic pressure mounting Physician offices and hospitals have been slammed economically by sharp drops in office visits and elective procedures as a result of the pandemic. Although volume has begun to recover, the American Hospital Association is predicting hospitals and health systems could still lose $120.5 billion between July 2020 and the end of the year, or about $20 billion a month.[3] Primary care doctors, meanwhile, may lose approximately $15 billion in 2020.[4] 10

PARA Weekly eJournal: September 16, 2020

STAYING ABEAST OF EVOLVING TELEHEALTH REIMBURSEMENT

Permanent changes sought At the outset of the pandemic, statutes preventing expanded access to telehealth for Medicare beneficiaries were waived by Congress as part of the declaration of a public health emergency. The temporary move allowed a wider range of providers to deliver more telehealth services with a greater variety of technology and without geographic or originating site limitations. This flexibility helped accelerate the expansion of telehealth across the care continuum, with over nine million Medicare beneficiaries participating from mid-March through mid-June, according to internal Centers for Medicare and Medicaid Services (CMS) analysis.[5] Although the initial telehealth waivers were initially set to expire on July 25, 2020, the U.S. Department of Health and Human Services (HHS) extended the federal public health emergency on July 24 through October 23, 2020, thus ensuring continued telehealth coverage through the ongoing public emergency. This waiver must be renewed every 90 days.[6] Separately, the CMS 2021 Physician Fee Schedule Draft has proposed nine new telehealth CPTÂŽ codes. The agency also has developed a new Category 3 for codes that will be covered during the COVID-19 emergency only. This category contains approximately 50 codes created during the COVID-19 pandemic, as well as 13 new codes and other changes.[7] Several telehealth bills likewise have been introduced to help expand the service and ensure telehealth regulations remain intact beyond the pandemic.[8] Commercial, Medicaid payer confusion The increased statutory flexibility has made it easier to be reimbursed for Medicare telehealth services. But at least for now, inconsistent and conflicting policies across the commercial landscape have created major payment hurtles for some providers. Although many insurance companies have asserted that, like M edicaid Medicare, they will reimbursement at 100% of the in-person rate for a range of virtual visits, the reality is far less straightforward. r eim bu r sem en t , Clinicians say some insurance companies are unable to provide updated information about telehealth payment policies and much m ean w h ile, var ies f r om uncertainty exists about what companies will pay for and what st at e t o st at e, w it h they won?t. Medicaid reimbursement, meanwhile, varies from state to state, with telehealth payment policies clearly defined in t eleh ealt h paym en t some states but not in others.

policies clear ly def in ed in som e st at es bu t n ot in ot h er s.

Revenue Cycle safeguards Regardless of the payer, providers should make a point to include all pertinent information on telehealth claims to limit the risk of denials. Specifically, claims should incorporate: - Date, time and location of service - Appropriate use of GT (telehealth) modifiers - Emergency room or outpatient consultation - Recommendations and scheduled follow-ups - Type of technology used - Proof of patient consent with systems that are not privacy protected (e.g. Skype) 11

PARA Weekly eJournal: September 16, 2020

STAYING ABEAST OF EVOLVING TELEHEALTH REIMBURSEMENT

Providers also should conduct ongoing audits to be sure telehealth claims are being coded, documented and filed accurately. Close monitoring of, and communications with, payers of all types likewise are important to maintain an up-to-date understanding of telehealth policies. ?Consistent monitoring of telehealth CARC AND RARC reason codes from the insurance carrier will help you to identify what rejections the payers are applying to your telehealth services,? Low said. The new normal Most observers expect the waivers granted for Medicare telehealth will be made permanent and that commercial payment policies eventually will become more coherent and consistent. Assuming providers remain vigilant about reimbursement policies, the telehealth wave unleashed by COVID-19 ultimately could support a new paradigm for providing high-quality, cost-efficient care, not only for outpatient services but inpatient and remote patient monitoring as well. HFRI can help Staying abreast of the latest coding directives regarding telehealth reimbursement and denials can be a challenge. This is especially true when coverage varies between government and commercial payers and from state to state. Healthcare Financial Resources has a large footprint across the U.S. Our experts have a thorough knowledge of each state?s requirements and can help you with comprehensive revenue cycle services to support accurate coding, clean claims and timely and appropriate reimbursement. Contact us today to learn more about the many ways we can help your organization. [1] Heather Landi, ?More than 300 organization, physician groups push Congress to take action on telehealth policies,? Fierce Healthcare, June, 30, 2020. [2] ?AMA Telehealth quick guide,? American Medical Association, updated July 6, 2020. [3] Robert King, ?AHA: Hospitals could lose $20B a month for the rest of 2020 due to COVID-19 impact,? Fierce Healthcare, June 30, 2020. [4] Robert King, ?Study: Primary care practices could lose $15B in 2020 due to COVID-19,? Fierce Healthcare, June 26, 2020. [5] Seema Verma, ?Early Impact of CMS Expansion of Medicare Telehealth During COVID-19,? Health Affairs, July 15, 2020. [6] ?Renewal of Determination that a Public Health Emergency Exists,? Kaiser Family Foundation, July 1, 2017. [7] Eric Wicklund, ?How CMS Changes, Trump?s Executive Order Affect Telehealth Coverage,? mHEALTH INTELLIGENCE, August 6, 2020. [8] Eric Wicklund, ?The COVID-19 Telehealth Expansion Bills Are Starting to Pile Up,,? mHEALTH INTELLIGENCE, July 31, 2020.

PARA Weekly eJournal: September 16, 2020

2021 DRG TABLE 5 COMPARISON

In Sept em ber 2020, t h e Cen t er s f or M edicar e & M edicaid Ser vices (CM S) r eleased t h e 2021 DRG Table 5. This table lists the MS-DRGs, Relative Weight Factors and Geometric and Arithmetic Mean Lengths of Stay for 2021. PARA has performed a comparison between the 2020 DRGs and the 2021 DRGs and found the following: For 2021, there were twelve DRGs added to the DRG Table 5. M S-DRG

M S-DRG Descr ipt ion

018

CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY

019

SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS

140

MAJOR HEAD AND NECK PROCEDURES WITH MCC

141

MAJOR HEAD AND NECK PROCEDURES WITH CC

142

MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC

143

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

144

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC

145

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

521

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC

522

HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC

650

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC

651

KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC

Also, six DRGs were removed from the DRG Table 5 for 2021: M S-DRG

M S-DRG Descr ipt ion

129

MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE

130

MAJOR HEAD & NECK PROCEDURES W/O CC/MCC

131

CRANIAL/FACIAL PROCEDURES W CC/MCC

132

CRANIAL/FACIAL PROCEDURES W/O CC/MCC

133

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC

134

OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC

PARA Weekly eJournal: September 16, 2020

2021 DRG TABLE 5 COMPARISON

The DRG Table 5 comparison is accessible on the Calculator tab of the PARA Data Editor.

PARA Weekly eJournal: September 16, 2020

CMS PROVIDES HCPCS PROCEDURE LIST FOR MODIFIER CS

On August 27, 2020, CMS clarified the correct use of modifier CS by providing a list of HCPCS codes which are appropriate for waiving cost-sharing for physicians, hospitals, and RHCs/FQHCs when providing medically necessary COVID-19 related Medicare Part B services. CMS waives beneficiary coinsurance and deductible amounts for these services when Modifier CS is appended. CMS will return claims containing modifier CS on procedure codes which are not listed.

CMS provides separate lists of CS-eligible HCPCS code for three categories of medical providers: - Physicians/Non-physician Practitioners - Hospital OPPS Outpatient Departments - RHCs and FQHCs The document instructs Critical Access Hospitals to use the lists applicable to their billing method (Method I or Method II.) https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email -archive/2020-08-27-mlnc#_Toc49329805

PARA Weekly eJournal: September 16, 2020

CMS PROVIDES HCPCS PROCEDURE LIST FOR MODIFIER CS

The CMS spreadsheet is available in the Advisor tab of the PARA Data Editor. Enter ?Cost? in the summary field for quick access:

CMS also revised its MLN on Medicare Fee-For-Service Response to the PHE on Coronavirus. The update can be found using the link below: https://www.cms.gov/files/document/se20011.pdf

Additionally, CMS continues to update tje ?COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing? document posted on the CMS ?Current Emergencies? website. https://www.cms.gov/files/document/03092020 -covid-19-faqs-508.pdf

PARA Weekly eJournal: September 16, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

CMS released documents with details of the October, 2020 OPPS Update and the Integrated Outpatient Code Editor update on August 28, 2020. PARA chargemaster clients will be notified by email prior to 10/1/2020 of any required chargemaster updates. Links are provided on the last page of this paper. Specifically, the OPPS updates to HCPCS codes include the following actions: - Reaffirms and updates COVID-19 Lab Testing HCPCS ? repeating previously established codes and adding new codes developed since the 7-1-2020 update - U0001 CDC 2019 Novel Coronavirus (2019-nCoV) RealTime RT-PCR Diagnostic Panel; Effective 2/4/2020, OPPS Status A - U0002 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC;Effective 2/4/2020, OPPS Status A - 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique; Effective 3/13/2020, OPPS Status A - 86328 Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); Effective 4/10/2020; OPPS status A - 86408 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); screen; Effective 8/10/2020, OPPS status A - 86409 Neutralizing antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]); titer 08/10/2020 A N/A 86769 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 04/10/2020 A N/A 87426 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzymelinked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]); Effective 6/25/2020, OPPS status A - U0003 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique, making use of high throughput technologies as described by CMS-2020- 01-R; Effective 4/14/2020, OPPS status A - U0004 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC, making use of high throughput technologies as described by CMS-2020- 01-R; Effective 4/14/2020, OPPS status A

PARA Weekly eJournal: September 16, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

- 0202U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected 05/20/2020 A N/A 0223U Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected; Effective 6/25/2020, OPPS status A - 0224U Antibody, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed; Effective 6/25/2020, OPPS Status A - 0225U Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected; Effective 8/10/2020, OPPS status A - 0226U Surrogate viral neutralization test (sVNT), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), ELISA, plasma, serum ; Effective 8/10/2020, OPPS status A - G2023 Specimen collection for severe acute respiratory syndrome coronavirus ?2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), any specimen source; Effective 3/1/2020, OPPS status B - G2024 Specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]) from an individual in a SNF or by a laboratory on behalf of a HHA, any specimen source; Effective3/1/2020, OPPS status B - 0014M Liver disease, analysis of 3 biomarkers (hyaluronic acid [ha], procollagen iii amino terminal peptide [piiinp], tissue inhibitor of metalloproteinase 1 [timp-1]), using immunoassays, utilizing serum, prognostic algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical events within 5 years; Effective 4/1/2020, OPPS status Q4 - C9803 Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sarscov-2) (coronavirus disease [covid-19]), any specimen source; Effective 03/01/2020, OPPS status Q1 Adds three new surgical HCPCS Codes: - C9761 Describing Vacuum Aspiration of the Kidney, Collecting System and Urethra (OPPS status J1) - C9768 Describing Endoscopic Ultrasound-guided Direct Measurement of Hepatic Portosystemic Pressure Gradient (OPPS status N) - C9769 Describing Cystourethroscopy with Insertion of a Temporary Prostatic Implant or Stent with Anchor and Incisional Struts (OPPS status J1)

PARA Weekly eJournal: September 16, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

Adds two new CPTÂŽ Administrative Codes for Multianalyte Assays with Algorithmic Analyses (MAAA), and assigns them OPPS status Q4 (payment often packaged) - 0015M Adrenal cortical tumor, biochemical assay of 25 steroid markers, utilizing 24-hour urine specimen and clinical parameters, prognostic algorithm reported as a clinical risk and integrated clinical steroid risk for adrenal cortical carcinoma, adenoma, or other adrenal malignancy - 0016M - Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)

Establishes payment policy for 20 new CPTÂŽ Proprietary Laboratory Analyses (PLA) Codes (0203U through 0221U) Effective October 1, 2020 Adds 18 new HCPCS Codes and Dosage Descriptors for Certain Drugs, Biologicals, Radiopharmaceuticals, and skin substitutes - 8 new codes will be assigned Pass-Through Status (separately payable) - C9060 Fluoroestradiol F18, diagnostic, 1 mCi - C9062 Injection, daratumumab 10 mg and hyaluronidase-fihj - C9064 Mitomycin pyelocalyceal instillation, 1 mg - C9065 Injection, romidepsin, non-lypohilized (e.g. liquid), 1mg - C9066 Injection, sacituzumab govitecan-hziy, 10 mg - C9067 Gallium ga-68, dotatoc, diagnostic, 0.01 mCi - J7351 Injection, bimatoprost, intracameral implant, 1 microgram - J9227 Injection, isatuximab-irfc, 10 mg - 2 new drug HCPCS will be status E2, excluded ? but status may change next quarter - J1437 Injection, ferric derisomaltose, 10 mg - J9304 Injection, pemetrexed (PEMFEXY), 10 mg - 4 new HCPCS will replace drugs with temporary C-codes, all remain pass-thru status G: - J1632 Inj., brexanolone, 1 mg -- replaces C9055 - J1738 Inj. meloxicam 1 mg ? replaces C9059 - J3241 Inj. teprotumumab-trbw 10 mg ? replaces C9061 - J3032 Inj. eptinezumab-jjmr 1 mg ? replaces C9063 - 4 new skin substitute codes will be status N, payment packaged - Q4249 Amniply, for topical use only, per square centimeter - Q4250 AmnioAMP- MP, per square centimeter

PARA Weekly eJournal: September 16, 2020

OCTOBER 1, 2020 OPPS HCPCS UPDATE

- Q4254 Novafix dl, per square centimeter - Q4255 Reguard, for topical use only, per square centimeter

Updates the status of three existing HCPCS Codes to Pass-Through Status - Q5112 Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg (prior status K) - Q5113 Injection, trastuzumab-pkrb, biosimilar, (Herzuma), 10 mg (prior status K) - Q5121 Injection, infliximab-axxq, biosimilar, (avsola), 10 mg (prior status E2) Stops pass through status forQ5121(Infliximab-axxq, biosimilar (avsola) 10 mg., effective September 30, 2020 Revises the long descriptor for J9305(injection pemetrexed, 10 mg) to ?Injection, pemetrexed, not otherwise specified, 10 mg? Implements the regular quarterly update to drug payment rates which are based on the Average Sales Price, including some retroactive updates. Reassigns 3 skin substitute HCPCS to the ?High Cost Skin Substitute Group? as of 10/1/20 ? this means that the corresponding skin substitute application code for these products must be reported using the 15271-15278 codes set for OPPS hospitals (if a low-cost skin substitute is reported, OPPS hospitals must use the C5271-C5278 application code set.) - Q4205 Membrane graft or wrap sq cm - Q4226 Myown harv prep proc sq cm - Q4234 Xcellerate, per sq cm Full details of the update are available at the link below: https://www.cms.gov/files/document/r10331cp.pdf

Readers interested in additional updates to the Integrated Outpatient Code Editor, which includes ICD10 updates (among many other changes), should visit the following webpage: https://www.cms.gov/files/document/mm11944.pdf

PARA Weekly eJournal: September 16, 2020

COVID-19 CODING UPDATE AS OF 9/1/2020

Preface PARA continues to update COVID-19 coding and billing information based on frequently changing guidelines regulations from CMS and payers. All coding must be supported by medical documentation. ICD-10-CM Official Coding and Reporting Guidelines for Coronavirus, effective April 1, 2020 through September 30, 2020, may be downloaded from the link below: https://www.cms.gov/files/document/se20015.pdf

Download The Entire 20-Page Updated Document By Clicking The Icon To The Left.

PARA Weekly eJournal: September 16, 2020

ALERT! CPT® CODES 86408 AND 86409 ARE NEW BENEFITS

Effective retroactively to August 10th, 2020 CPT® Codes 86408 and 86409 for COVID-19 Antigen Testing will be a new Medi-Cal benefit.

These CPT® Codes do not have any gender or age restrictions but do have a frequency limitation of once per day. These CPT® Codes can be billed with any ICD-10 codes; the Medi-Cal manual will be updated to reflect these changes. Reimbursement for CPT® Codes 86408 and 86409 has not yet been determined. Medi-Cal will update the fee schedule to reflect payment rates for these codes on September 16th, 2020. An Erroneous Payment Correction (EPC) will be implemented to reprocess affected claims. Claims submitted previously should automatically reprocess; providers should resubmit any claims that receive errors or denials for CPT® Codes 86408 and 86409 for reimbursement if claims are not automatically reprocessed. https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_30339_87.aspx?utm_source= iContact&utm_medium=email&utm_campaign=medi-cal-newsflash&utm_content=30339.87

PARA Weekly eJournal: September 16, 2020

CMS PROPOSES PROMPT COVERAGE FOR "BREAKTHROUGH DEVICES"

SEVERAL

months ago, the Office of M anagement and Budget,

which is part of the Office of the President, began considering a policy which would require Medicare and other insurers to provide coverage for the FDA?s ?Breakthrough Medical Devices? for 3 to four years after receiving FDA approval. The experience during that 3 to 4 years would develop the rationale for continued support, or limitation, of coverage thereafter. On Monday, August 31, 2020, CMS issued a Proposed Rule that would grant Medicare coverage to ?Breakthrough Devices? immediately upon the date of FDA market authorization, rather than waiting for the current National Coverage Determination process, which takes 9 to 12 months. Under the proposed rule, Medicare coverage would be provided for four years after approval from the FDA, and would be consistent nationwide (rather than vary due to Local Coverage Determinations made by MACs.) Devices which received approval in 2019 and 2020 would be eligible for this special treatment.Public comments on the proposed rule will be accepted until November 2, 2020. Typically, CMS will issue a Final Rule 30 to 45 days following the end of the public comment period.

PARA Weekly eJournal: September 16, 2020

CMS PROPOSES PROMPT COVERAGE FOR "BREAKTHROUGH DEVICES"

https://s3.amazonaws.com/ public-inspection.federal register.gov/2020-19289.pdf

The FDA?s Breakthrough Medical Devices program is intended to expedite the development and prioritize the review of certain medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. The Breakthrough Devices Program is for medical devices and device-led combination products that meet two criteria: 1.The device provides for more effective treatment or diagnosis of life-threatening or irreversibly debilitating human disease or conditions 2.The device must satisfy one of the following elements: it represents a breakthrough technology; no approved or cleared alternatives exist; it offers significant advantages over existing approved or cleared alternatives, including additional considerations outlined in the statute; or device availability is in the best interest of patients At the end of the 4-year MCIT pathway, coverage of the breakthrough device would be subject to one of these possible outcomes: - NCD (affirmative coverage, which may include facility or patient criteria); - NCD (non-coverage); or - MAC discretion (claim-by-claim adjudication or LCD) CMS proposes that reimbursement for MCIT devices would follow the current reimbursement processes for New Technology. - Under the Inpatient Prospective Payment System, the amount of additional reimbursement, above the DRG varies depending on the hospital?s cost to charge ratio and the DRG reimbursement.At most, the add-on would be one-half the cost of the MCIT device (for full details, see section 160 of Chapter 3 of the Medicare Claims Processing Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf#.) - Under the Outpatient Prospective Payment System, HCPCS for New Technology items are paid under OPPS as pass-through status G, which utilizes the hospital?s cost-to-charge ratio applied to billed charges in calculating reimbursement.

PARA Weekly eJournal: September 16, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE Visit ? Evaluation and Management Levels Physician, Nursing and Rehab Therapists Procedures Hyperbaric Oxygen Therapy (HBO) Diagnostic testing Application of Skin Substitutes High Cost Skin Substitute HCPCS List ? as of October 1, 2020 Low Cost Skin Substitute HCPCS List ? as of October 1, 2020 Medications Medical supplies/Dressings Mechanically Powered Negative Pressure Wound Therapy Local Coverage Determinations Wound Care Coding Scenarios Scenario #1: An established patient presents with an open wound along an incision in the right lower extremity, and an open wound of the left lower extremity. Our usual weekly visit services include debridement of devitalized tissue to both sites, then application of Unna boots to both lower extremities. Usually we would charge one selective debridement and one Unna boot. Scenario #2: Patient presents with five wounds and sutures on the right lower extremity. The physician examines the patient and orders sutures to be removed, continue the Unna boots. Can we charge an E/M level 3 (follow-up, 2-5 wounds, suture removal =60 points) AND for 2 Unna boot applications? Scenario 3: An established patient came in for her first wound care visit, referred by her family physician.The wound clinic RN assessed and called the physician for orders.The patient requires a Hoyer lift, therefore additional staff is required, and patient is unable to assist with undressing or dressing.Culture was obtained, pulses assessed -- care takes well over an hour, no procedure was performed.Are we limited to charge only a nursing visit E/M level 99211, or can we charge a higher level such as 99212-99215? Scenario 4: We have been seeing a patient for debridement of lower extremity ulcers and application of Unna boots bilaterally.During the visit, the patient is measured for a pressure garment.The patient requires assistance in dressing, and additional staff to help transfer the patient to and from a wheelchair is required.Can we charge a level 3 E/M and the procedure code? Scenario 5: We have been seeing a patient who presents with no new signs or symptoms; we performdebridement to wounds on the lower extremities and apply Unna boots bilaterally.Additional staff is required due to the emotional state of the patient.During the visit, the physician examines the patient and decides to do a puncture biopsy.Can we charge a level 2 E/M (99212) and the puncture biopsy as well as the debridement?

PARA Weekly eJournal: September 16, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE

Visit ? Evalu at ion an d M an agem en t Levels E&M levels are divided into two types of patient, new and established.For facility fee billing, a new patient is one who has not been a patient at the facility within the last three years. There are five levels for both the new and established patient visits; for facility fee billing, the E/M level assignment is determined by hospital policy. PARA recommends facility fee E/M level assignment in keeping with time spent in delivering face-to-face care. Although the level of E/M is important for commercial billing, Medicare requires OPPS facilities to report only one code regardless of the visit level, G0463.

PARA Weekly eJournal: September 16, 2020

WOUND CARE CHARGE PROCESS: OCTOBER 2020 UPDATE

Modifier 25: In general, an E&M level should not be charged if the visit is scheduled to perform a procedure.If there is a separate and distinct reason for an E&M service which is beyond the routine patient interaction required to properly perform a procedure, such as a new diagnosis or condition or a new wound, a separate E&M may be billed.If an E&M is billed on the same date as a procedure, modifier ?25 - separate and distinct? must be appended to the E&M code to qualify for payment.

Download The Entire 20-Page Updated Document By Clicking The Icon To The Right.

PARA Weekly eJournal: September 16, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN CMS is delaying use of Advance Beneficiary Notice (ABN) Form, CMS-R-131 due to COVID-19 concerns. The form may be implemented prior to the mandatory deadline, but CMS has extended the deadline from August 31, 2020 to January 1, 2021. The expiration date of the new form is 06/30/2023. The updated ABN form, in both PDF and Microsoft Word versions with instructions in English and Spanish are available for download using the link below: https://www.cms.gov/Medicare/Medicare-General-Information/BNI/ABN

Chapter 30 of the Medicare Claims Processing Manual beginning Section 50.3 provides information and instructions on the requirements of completing and issuing an Advance Beneficiary Notice: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c30.pdf

Providers must issue an ABN when a service to a Medicare beneficiary is expected to be denied.Medicare lists three ?triggering events? when ABNs are appropriate. - Initiations: Noncovered or non reasonable and necessary services beginning a new treatment - Reductions: Medicare has determined a reduction in frequency of treatment is appropriate, but beneficiary chooses to continue with care at same rate or frequency higher than approved by Medicare, knowing that the care is no longer considered medically reasonable and necessary - Terminations: The beneficiary wants to continue with no longer medically reasonable and necessary services after meeting treatment goals

PARA Weekly eJournal: September 16, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN

PARA Weekly eJournal: September 16, 2020

CMS DELAYS DEADLINE FOR MANDATORY USE OF REVISED ABN

PARA Weekly eJournal: September 16, 2020

COV ID-19 august , t w ent y-t w ent y

Special

publication

Questions about how to manage the COVID-19 emergency are multiplying almost as fast as the virus itself. This Resource Guide is brought to you by PARA Healt hCare Analyt ics and Healt hcare Financial Resources (HFRI), the experts answer coding and financial questions.

PARA Weekly eJournal: September 16, 2020

COVID-19 Resou r ce Gu ide Coronavirus

For healt h care facilit ies

When President Trump declared a national emergency on March 13, 2020,CMS took action nationwide to aggressively respond to Cororavirus.

2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios (PDF)(4/13/20)

Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Hospitals, Psychiatric Hospitals, and Critical Access Hospitals (CAHs): FAQs, Considerations for Patient Triage, Placement, Limits to Visitation and Availability of 1135 waivers(4/8/20)

Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Outpatient Settings: FAQs and Considerations(4/8/20)

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs) and Psychiatric Residential Treatment Facilities (PRTFs)(4/8/20)

Emergency Medical Treatment and Labor Act (EMTALA) Requirements and Implications Related to Coronavirus Disease 2019 (COVID-19)UPDATED (4/8/20)

- CMS Non-Emergent, Elective Medical Services, and Treatment Recommendations (PDF)(4/6/20)

Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) in Dialysis FacilitiesUPDATED (4/8/20)

COVID-19 Long-Term Care Facility Guidance (PDF)(4/3/20)

- CMS Adult Elective Surgery and Procedures Recommendations (PDF)(3/19/20)

Accelerated and Advanced Payments Fact Sheet (PDF)(3/28/2020)

Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in Nursing Homes-REVISED (PDF)(3/13/20)

Guidance for Use of Certain Industrial Respirators by Health Care Personnel(3/10/20)

ÂˇYou can read the blanket waivers for COVID-19 in the List of Blanket Waivers (PDF)UPDATED (4/9/20). Secretary Azar used his authority in the Public Health Service Act to declare a public health emergency (PHE) in the entire United States on January 31, 2020 giving us the flexibility to support our beneficiaries, effective January 27, 2020 Get waiver & flexibilit y informat ion General informat ion & updat es: - Coronavirus.gov is the source for the latest information about COVID-19 prevention, symptoms, and answers to common questions. - USA.gov has the latest information about what the U.S. Government is doing in response to COVID-19. - ÂˇCDC.gov/coronavirus has the latest public health and safety information from CDC and for the overarching medical and health provider community on COVID-19. Clinical & t echnical guidance: For all clinicians - CMS Dear Clinician Letter (PDF) (4/6/20) For all healt h care providers

- Fact sheet:Additional Background: Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge(3/30/20) - Guidance memo - Exceptions and Extensions for Quality Reporting and Value-based Purchasing Programs (PDF)(3/27/20)

PARA Weekly eJournal: September 16, 2020

COVID-19 Resou r ce Gu ide - Guidance for Infection Control and Prevention Concerning Coronavirus Disease 2019 (COVID-19) by Hospice Agencies(3/9/20)

- Fact sheet:Medicare Telemedicine Healthcare Provider Fact Sheet(3/17/20) - Medicare Telehealth Frequently Asked Questions(3/17/20)

- Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge(3/4/20)

- MLN Matters article:Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (PDF)(3/17/20)

- Information for Healthcare Facilities Concerning 2019 Novel Coronavirus Illness (2019-nCoV)(2/6/20)

- Frequently Asked Questions about Medicare Fee-for-Service Emergency-Related Policies and ProceduresW it hout an 1135 Waiver (PDF)(3/16/20)

For Labs - Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency (PDF)(3/27/20)

- Frequently Asked Questions about Medicare Fee-for-Service Emergency-Related Policies and ProceduresW it han 1135 Waiver (PDF)(3/16/20)

- Notification to Surveyors of the Authorization for Emergency Use of the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel Assay and Guidance for Authorized Laboratories(2/6/20)

- Fact sheet:Medicare Administrative Contractor (MAC) COVID-19 Test Pricing (PDF)(3/13/20)

For Programs of All-Inclusive Care for t he Elderly (PACE) Organizat ions

- Fact sheet:Medicaid and CHIP Coverage and Payment Related to COVID-19 (PDF)(3/5/20)COVID-19: New ICD-10-CM Code and Interim Coding Guidance(2/20/20)

- Frequently Asked Questions from the PACE Community (PDF)(4/14/20) - Guidance for PACE Organizations Regarding Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) (PDF)(3/17/20)

For Healt h Care Facilit ies -

2019 Novel Coronavirus (COVID-19) Long-Term Care Facility Transfer Scenarios (PDF)(4/13/20)

Guidance for Infection Control and Prevention of Coronavirus Disease (COVID-19) in Outpatient Settings: FAQs and Considerations(4/8/20)

Billing And Coding Guidance: - Frequently Asked Questions to Assist Medicare Providers (PDF)UPDATED (4/11/20) - CMS Dear Clinician Letter (PDF)(4/6/20) - Fact sheet: Expansion of the Accelerated and Advance Payments Program for Providers and Suppliers During COVID-19 Emergency (PDF)(3/30/20) - Fact sheet:Medicare Coverage and Payment Related to COVID-19 (PDF)UPDATED (3/23/20)

PARA Weekly eJournal: September 16, 2020

COVID-19 Resou r ce Gu ide Survey And Cert ificat ion Guidance:

- FAQs on Essential Health Benefit Coverage and the Coronavirus (COVID-19) (PDF)(3/13/20)

- Clinical Laboratory Improvement Amendments (CLIA) Laboratory Guidance During COVID-19 Public Health Emergency(3/27/20)

- Guidance to help Medicare Advantage and Part D Plans Respond to COVID-19 (PDF)(3/10/20)

- Prioritization of Survey Activities(3/23/20)

- Fact sheet:Medicaid and CHIP Coverage and Payment Related to COVID-19 (PDF)(3/5/20)

- Frequently Asked Questions for State Survey Agency and Accrediting Organization Coronavirus Disease 2019 (COVID-19) (PDF)(3/10/20)

- Fact sheet:Individual and Small Group Market Insurance Coverage (PDF)(3/5/20)

- Frequently Asked Questions and Answers on EMTALA (PDF)(3/9/20)

Provider Enrollment Guidance: -

Guidance for Processing Attestations from Ambulatory Surgery Centers (ASCs) Temporarily Enrolling as Hospitals During the COVID-19 Public Health Emergency(4/3/20)

Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)-UPDATED (3/30/20) (PDF)

- Suspension of Survey Activities(3/4/20) Coverage Guidance: - Frequently Asked Questions to Assist Medicare Providers (PDF)UPDATED (4/11/20) - VIDEO-MLN Medicare Coverage and Payment of Virtual Services(4/10/20)

Medicaid & CHIP Guidance: - Families First Coronavirus Response Act (FFCRA), Public Law No. 116-127 Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law No. 116-136 Frequently Asked Questions (FAQs)(4/15/20)

- CMS Dear Clinician Letter (PDF)(4/6/20) - Long-Term Care Nursing Homes Telehealth and Telemedicine Toolkit (PDF)(3/27/20)

- Federal Medical Percentage Map (FMAP)&Families First Coronavirus Response Act ? Increased FMAP FAQs3/27/20

- Fact sheet:Medicare Coverage and Payment Related to COVID-19 (PDF)UPDATED (3/23/20)

- State Medicaid Director Letter (SMDL) #20-002 with New Section 1115 Demonstration Opportunity to Aid States With Addressing the Public Health Emergency(3/22/20)

- General Telemedicine Toolkit (PDF)(3/20/20) - End-Stage Renal Disease (ESRD) Provider Telehealth and Telemedicine Toolkit (PDF)(3/20/20)

- Section 1135 Waiver Checklist (3/22/20)

- FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19) (PDF)(3/19/20)

- Section 1915 Waiver, Appendix K Template(3/22/20)

- Fact sheet:Medicare Telemedicine Healthcare Provider Fact Sheet(3/17/20)

- State Plan Flexibilities(3/22/20)

- Medicare Telehealth Frequently Asked Questions(3/17/20)

PARA Weekly eJournal: September 16, 2020

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!

Th u r sday, Sept em ber 10, 2020 New s

·CMS Care Compare Empowers Patients When Making Important Health Care Decisions ·Open Payments: Adding 5 Provider Types in 2021 ·Breast Re-Excision: Comparative Billing Report in September Even t s

·CMS-CDC Fundamentals of COVID-19 Prevention for Nursing Home Management Call ? September 10 ·Dementia Care Call ? September 22 M LN M at t er s® Ar t icles

·October 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) ·Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index and Hospice Pricer for FY 2021 ·Inpatient Rehabilitation Facility (IRF) Annual Update: Prospective Payment System (PPS) Pricer Changes for FY 2021 ·Internet Only Manual Update to Pub. 100-04, Chapter 16, Section 60.1.2 and Pub. 100-04, Chapter 26, Section 10.4, Item 19 ·Update to the Model Admission Questions for Providers to Ask Medicare Beneficiaries ·National Coverage Determination (NCD 30.3.3): Acupuncture for Chronic Low Back Pain (cLBP) ? Revised Pu blicat ion s

·Understanding Your Remittance Advice Reports ·Home Health, Hospice, IRF, LTCH, & SNF Quality Reporting Programs: COVID-19 Public Reporting M u lt im edia

·Pain Management Listening Session: Audio Recording & Transcript ·Introduction to the LTCH Quality Reporting Program Web-Based Training ·Introduction to the Home Health Quality Reporting Program Web-Based Training 35 View this edition as PDF (PDF)

PARA Weekly eJournal: September 16, 2020

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

FIND ALL THESE MEDLEARNS IN THE ADVISOR TAB OF THE PDE

PARA Weekly eJournal: September 16, 2020

The link to this MedLearn MM11945

PARA Weekly eJournal: September 16, 2020

The link to this MedLearn MM11963

PARA Weekly eJournal: September 16, 2020

The link to this MedLearn MM11837

PARA Weekly eJournal: September 16, 2020

There were SEVEN 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 16, 2020

The link to this Transmittal R10345PI

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10346NCD

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10349CP

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10348CP

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10353PI

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10359MSP

PARA Weekly eJournal: September 16, 2020

The link to this Transmittal R10352OTN

PARA Weekly eJournal: September 16, 2020

Special Notice PDE Ch ar ge Qu ot e/ Sh ar e Of Cost Updat es In an ongoing effort to increase pricing transparency, PARA has made some upgrades to the Charge Quote/Share of Cost module within the PDE.In addition to increasing functionality in Medicare Critical Access Hospital settlement, quote creators now have more flexibility in choosing what prices appear within the quote itself. With the increased transparency in price selection, some functionality has changed.Prices will no longer automatically load into the quote, unless the item is a single line item in the chargemaster. If there are multiple line items in the chargemaster with the same CPTÂŽ code, users will be presented with all line items for selection, instead of an average price being calculated.Users will be required to select a line item for the price to be added to the quote:

All Prices, revenue codes, department codes and usage quantity appear, allowing the creator to select the most appropriate item for addition to the quote.Client and Peer market averages are also still available, as is the multiple of Medicare option.Selection of packages and the Search function have not been affected. If you have any questions or need assistance with any of the new functionality, please contact Mary McDonnell at (800) 999-3332 ext. 216 or mmcdonnell@para-hcfs.com.

PARA Weekly eJournal: September 16, 2020 Get power on your side and maintain your cash flow.

As provider staffing issues arise it can seem like you're holding back everything you've built.

BE EM POW ERED

When you need extra strength, PARA / HFRI remote services can step in to continue seamless insurance accounts receivable collections.

W HAT W E OFFER - Guaranteed Results

- Contingency-Based Flat Rate Fee Schedule

- Improved Insurance Collections

- 25% Reduction In Account Lifecycle

Staffing Shortages Recent Legacy Conversion Write-offs Over 2.5% Small Balance Accounts That Are Untouched For 30 Days Net A/R Days Greater Than 45

CONTACT OUR EXPERTS Violet -Archulet a-Chiu Senior Account Executive

Sandra LaPlace Account Executive

800.999.3332 X219

Randi Brant ner Vice President of Analytics 719.308.0883

varchuleta@para-hcfs.com 800.999.3332 X225 slaplace@para-hcfs.com

rbrantner@hfri.net