PARA Weekly Update For Users 10-31-2018 by CorroHealth

PARA WEEKLY

UPDATE For Users

I mproving T he Business of H ealthCare Since 1985 O ctober 31, 2018 NEWS FOR HEALTHCARE DECISION MAKERS

IN THIS ISSUE QUESTIONS & ANSWERS - Verbal Laboratory Order Diagnosis Update - Therapy Caps In 2018 - HCG Testing Codes INFORMATIVE ARTICLES USING MODIFIER 25 TO REPORT AN E/M WITH INJECTION

MEDICARE ISSUES AUDIT GUIDELINES ON LAB ORDERS FREE DOWNLOADABLE BOOKLET: SERVICES NOT COVERED BY MEDICARE UPDATED 2019 MPFS PROPOSED RULE 2019 CPT® CODE SET RELEASE RURAL HOSPITAL PROGRAM GRANTS I.T. UPDATES : NEW FEATURE!

PARA COMPANY NEWS

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ABOUT PARA

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

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

Administration: Pages 1-60 HIM /Coding Staff: Pages 1-60 Laboratory Svcs: Pages 2,6,9,58 Providers: Pages 2,5,7,9,10,16,19,27,34,47 - Physical Therapy: Page 5 - Pharmacy Svcs: Pages 7,22,30

Finance: Pages 10,22,23,25 PDE Users: Pages 10,11,16,20 ACOs: Pages 24,32 Rural Healthcare: Page 18 Hospice: Pages 26,44 CAHs: Pages 26,44 Imaging Svcs: Pages 28,59

PARA Weekly Update: October 31, 2018

VERBAL LABORATORY ORDER DIAGNOSIS UPDATE

Please review the attached orders. These are copies of orders for clinical accounts that have had a revision/change after the initial order was received and coded. The area circled is the documentation that was added or corrected. These are verbal orders received by hospital staff from the physician's offices or faxed copies from the offices. Our question is the validity of the order without being re-signed and dated by the ordering physician. Is there documentation or guidelines on this subject? Answer: You asked for guidelines -- here is a link and an excerpt from the attached a Medicare publication which discusses this general area of concern:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts /Downloads/LabServices-ICN909221-Text-Only.pdf

In our opinion, even if the diagnosis code on the order was not signed by the physician but communicated in good faith by a responsible member of the physician?s office staff, the hospital may report that diagnosis on its claim. The main concern is whether the physician?s clinic records support the diagnosis codes. Should the hospital be audited for a lab charge with an order indicating an altered diagnosis code communicated by telephone, the hospital should simply provide corroborating evidence from the physician clinic notes which supports the diagnosis code reported. We examined the two orders provided -- the documentation of the orders is sufficient. While Medicare guidance indicates a signature is not required for a laboratory test referral, both were electronically signed by the physician ? the intent is clear and medical necessity is supported with an appropriate ICD10 code supplied by that physician?s office. Your concern is the circled, hand-written entry which appears to update/clarify the diagnosis codes. Here?s the pertinent section of first order (with names blurred out): 2

PARA Weekly Update: October 31, 2018

VERBAL LABORATORY ORDER DIAGNOSIS UPDATE

Interestingly, Medicare?s National Coverage Determination 190.21 for hemoglobin/A1C (83036) accepted E11.329 for coverage until September 30, 2016 ? but it discontinued coverage because that code is not sufficiently specific ? it needs one more digit:

Under the list of covered diagnoses for NCD 190.21, only the more specific codes are acceptable: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/Downloads/manual201801_ICD10.pdf

PARA Weekly Update: October 31, 2018

VERBAL LABORATORY ORDER DIAGNOSIS UPDATE

Since the basic diagnosis of Type 2 diabetes mellitus was not altered, we find the communicated diagnosis is sufficient to support the order. The electronic order meets Medicare requirements, and the handwritten notation does not materially alter the medical necessity of the test. We suggest that the HIM department take this opportunity to educate the referring provider?s office to be more specific by indicating right, left, or both eyes when reporting retinopathy. The second order provided for our review was also for hemoglobin/A1C testing; it includes a hand-written entry with an entirely new diagnosis of pre-diabetes, R73.03:

While this entry makes a more substantive change in diagnosis, it is acceptable provided that the physician?s office notes support that diagnosis. When a change or clarification in diagnosis code is obtained by hospital staff over the phone, the best practice would be to record the full name and credentials of both the person who provided the clarification and the person recording the clarification. Regardless, should the diagnosis be questioned in an audit of medical necessity, the validity of the reported diagnosis is dependent upon the treating physician?s clinical record, not whether the physician signed the updated diagnosis information on the hospital order form.

PARA Weekly Update: October 31, 2018

THERAPY CAPS IN 2018

We?ve received conflicting information re: Medicare caps for physical therapy services. Would PARA be able to identify a definitive answer for us please? At this moment we have several traditional Medicare patients receiving OP PT services. We want to be able to speak accurately to our patients about their available benefits, and at the same time make wise business decisions. Answer: Therapy caps can change each calendar year; in 2018, there was particular confusion because the legal provision which allowed for the KX modifier to be reported for services which exceed the caps expired on December 31, 2017, and was not re-established (retro to 1/1/18) until February 2018 ? thankfully, that provision is now permanent. The following Medicare website offers the information you may be seeking ? we highlighted the words ?add a special notation? ? this is a reference to the KX modifier: https://www.medicare.gov/pubs/pdf/10988-Medicare-Limits-Therapy-Services.pdf

PARA Weekly Update: October 31, 2018

HCG TESTING CODES

Could someone look at these two charges and let me know if the CPT® code is correct for them? 11305 ? HCG Serum ? 84703 11304 ? HCG, Urine ? 84703

Answer: We presume the question arises from the descriptions in the chargemaster -the two line items listed report the same lab test CPT® (84703 - Gonadotropin, chorionic (hcg); qualitative), but the test is performed on different sample sources ? one is urine, the other is for blood. According to the ?Chemistry? section of the 2018 CPT® code book, the material for examination may be from any source unless otherwise specified in the code descriptor. Since there is no specific limitation in the description for 84703, it is appropriate to use that code for testing on either blood or urine.

PARA Weekly Update: October 31, 2018

USING MODIFIER 25 TO REPORT AN E/M WITH INJECTION

hen billing for an office visit during which an injection is performed, it may or may not be appropriate to report both the evaluation and management code (E/M) and an injection administration code. One source of guidance on this point from the American Medical Association CPTÂŽ manual relating to billing an E/M with a vaccines or toxoid injection administration codes: ?If a significantly separately identifiable Evaluation and Management (E/M) service (e.g., office or other outpatient services, preventive medicine services) is performed, the appropriate E/M service code should be reported in addition to the vaccine and toxoid administration codes.? Modifier 25 -- When a procedure, such as an injection administration, is reported with an E/M code (e.g. 99201-99215, or G0463), modifier 25 must be appended to the E/M to attest that the E/M service is ?SIGNIFICANT, SEPARATELY IDENTIFIABLE EVALUATION AND MANAGEMENT SERVICE BY THE SAME PHYSICIAN ON THE SAME DAY OF THE PROCEDURE OR OTHER SERVICE.? If the E/M code documentation does not support a ?separate and distinct? service from the injection, then the modifier should not be appended ? and the E/M service will not be reimbursed.

To qualify for modifier 25, the E/M service must be significant; the problem must warrant medically necessary work. This can be a problem that might ordinarily require another visit to address it. A minor problem or concern addressed at an appointment for an injection may not qualify for modifier 25 unless significant work is documented that supports the separate evaluation and management. The question of whether to append modifier 25 on an E/M in order to receive reimbursement for both the E/M and an injection turns on whether the E/M service is ?integral to? the injection. PARA offers the following tests determine whether the E/M is integral to the injection procedure, and should not be reported separately: - If an injection procedure cannot be properly performed without first performing the E/M, the E/M is ?integral? - If the E/M is always performed in the course of providing the injection, the E/M is ?integral.? Chemotherapy administration offers a perfect example. It is the standard of care to check the overall condition of the patient prior to beginning a chemotherapy procedure. If the evaluation is performed primarily to ensure the patient is capable of undergoing chemotherapy on that day, no separate E/M should be charged. However, patients undergoing chemotherapy often see an oncologist for an office visit on the same day that a chemotherapy procedure is performed. The E/M performed by the oncologist may be more comprehensive than the straightforward ?pre-chemo? health status check. If the oncologist performs a medically necessary evaluation of the patient?s overall condition and progress under the treatment plan, and the physician documentation adequately supports a service that is over and above the routine evaluation required prior to chemotherapy administration on the same day, the E/M service is separately reportable with modifier 25. 7

PARA Weekly Update: October 31, 2018

USING MODIFIER 25 TO REPORT AN E/M WITH INJECTION

According to the Medicare Claims Processing Manual, (Chapter 12 - Physicians/Non-physician Practitioners): https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf ?If a significant separately identifiable evaluation and management service is performed, the appropriate E & M code should be reported utilizing modifier 25 in addition to the chemotherapy administration or nonchemotherapy injection and infusion service. For an evaluation and management service provided on the same day, a different diagnosis is not required.? Medicare Correct Coding Initiative edits for both physicians and facilities reporting an E/M with an immunization administration indicate that the E/M must be ?separate and distinct? from the immunization administration; if the E/M qualifies, modifier 25 may be appended and both services are payable. Providers should not report an E/M service for a planned injection service where the patient presents without complications or a new problem. Appending modifier 25 should not be automatic, it depends on the significance of the E/M service. It is acceptable to report both the E/M and the injection code as long as the documentation supports the E/M as a significant and separately identifiable service. In such cases, modifier 25 should be attached to the E/M code.

PARA Weekly Update: October 31, 2018

MEDICARE ISSUES AUDIT GUIDELINES ON LAB ORDERS

Medicare released an update to the Program Integrity Manual on October 19, 2018 to provide guidance to auditing entities on verification of the physician order for laboratory tests. The guidance should be of interest to providers working to ensure that current lab order documentation practices will meet Medicare guidelines. A link and the pertinent excerpt from the transmittal is provided: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R836PI.pdf

This section applies to MACs, RACs, UPICs, SMRC and CERT.

6.9.1 ? Medical Review of Diagnostic Laboratory Tests (Rev.836; Issued: 10-19-18; Effective: 11-21-18; Implementation: 11-21-2018)

42 CFR ยง410.32 states that all diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests must be ordered by the physician who is treating the beneficiary and that tests not ordered by the physician who is treating the beneficiary are not reasonable and necessary. Pub. 100-02, Chapter 15, Section 80.6.1 states that while a physician order is not required to be signed, the physician must clearly document, in the medical record, his or her intent that the test be performed. Contractors shall consider order requirements for diagnostic laboratory tests met if there is: 1. A signed order or signed requisition listing the specific test; or 2. An authenticated medical record that supports the physician/practitioner?s intent to order tests (e.g. ?order labs, ?check blood?, ?repeat urine?). See Pub. 100-08, Chapter 3, Section 3.3.2.4 for authentication requirements. Regardless of how the order requirements are met, contractors shall verify that the supporting authenticated medical record documentation contains sufficient information supporting the ordered/provided tests are reasonable and necessary per 42 CFR ยง410.32. Note: As noted in Pub. 100-02, Chapter 15, Section 80.6.1, if the order is communicated via telephone, both the treating physician/practitioner or his/her office, and the testing facility must document the telephone call in their respective copies of the beneficiary?s medical records. 9

PARA Weekly Update: October 31, 2018

FREE DOWNLOADABLE BOOKLET FROM CMS

CMS has published a new, easy-to-read booklet entitled "Items And Services Not Covered Under Medicare", explaining four categories of items and services not covered under Medicare. It's important information for all Medicare fee-for-service providers. Get it here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ Downloads/Items-and-Services-Not-Covered-Under-Medicare-Booklet-ICN906765.pdf

PARA Weekly Update: October 31, 2018

2019 CODING UPDATE DOCUMENTS -- NEW DOCS ADDED TO PDE

In pr epar at ion f or t h e year -en d CPT® / HCPCS u pdat e, PARA h as pr epar ed a n u m ber of sh or t , on e t o t w o- page ?2019 Codin g Updat e? docu m en t s list in g delet ed codes an d added codes w it h in a par t icu lar clin ical ar ea or pr ocedu r e gr ou p. M or e paper s h ave been added du r in g t h e m on t h of Oct ober , 2018. The coding topics addressed do not encompass all CPT® updates, only those which are most likely to be ?hard-coded? to a line item in a facility chargemaster. Topics are divided into immediately related areas, and more than one paper may contain information useful to a service line manager. Due to CPT® licensing restrictions, these documents cannot be published within the PARA Weekly Update. PARA Data Editor users may access the information on the Advisor tab; search ?Coding Update? in the type field, and/or 2019 in the subject field, as illustrated below:

Documents may be updated as we learn more information about the new codes; updates will be announced in the PARA Weekly. It is important to note that we do not have Medicare coverage information on the new codes at this time. Following the release of the OPPS Final Rule in November, coding update papers may be revised to indicate whether Medicare will accept/cover new HCPCS. PARA Data Editor users can identify updated papers by the word ?Revised? in the title and the date issued will be updated.

PARA Weekly Update: October 31, 2018

UPDATED: 2019 MPFS PROPOSED RULE - E/M PAYMENT POLICY CHANGES

Significant changes for professional fee reimbursement are proposed by Medicare for 2019. The full text of the 2019 Medicare Physician Fee Schedule Proposed rule is available on the PARA Data Editor Advisor tab using the search phrase ?2019?:

For 2019, CMS estimates that the RVU conversion factor (CF) national rate will be $36.0463, a slight increase over the $35.9996 CF for 2018. Changes to Evaluation and Management payments, documentation standards, and coding. Although physicians will continue to report E/M levels using the 992XX codes, CMS proposes significant changes to payment methods in 2019. Under the proposal, Medicare will simplify payment to only one rate for 99202-99205 (new patient) and one rate for 99212-99215 (established patient). It will also provide new add-on codes for additional reimbursement for certain specialists, primary care, and prolonged E/M services. Additionally, Medicare is proposing a multiple procedure payment adjustment that would reduce the EM payment when an E/M visit is furnished in combination with a procedure on the same day. CMS also proposes to eliminate the restriction that prohibits payment of two different physicians of the same specialty practicing in the same group billing for E/M services on the same DOS. Page 370 of the Proposed Rule offers the following example to summarize the new methodology: ?As an example, in CY 2018, a physician would bill a level 4 E/M visit and document using the existing documentation framework for a level 4 E/M visit. Their payment rate would be approximately $109 in the office setting. If these proposals are finalized, the physician would bill the same visit code for a level 4 E/M visit, documenting the visit according to the minimum documentation requirements for a level 2 E/M visit and/or based on their choice of using time, MDM, or the 1995 or 1997 guidelines, plus either of the proposed add-on codes (HCPCS codes GPC1X or GCG0X) depending on the type of patient care furnished, and could bill one unit of the proposed prolonged services code (HCPCS code GPRO1) if they meet the time threshold for this code. The combined payment rate for the generic E/M code and HCPCS code GPRO1 would be approximately $165 with HCPCS code GPC1X and approximately $177 with HCPCS code GCG0X.?

You 'll w an t t o pr in t t h is ar t icle. 12

PARA Weekly Update: October 31, 2018

UPDATED: 2019 MPFS PROPOSED RULE - E/M PAYMENT POLICY CHANGES

In an open letter to physicians dated July 17, 2018, CMS Administrator Seema Verma summed it up this way: ?The current system of codes includes 5 levels for office visits ? level 1 is primarily used by nonphysician practitioners, while physicians and other practitioners use levels 2-5. The differences between levels 2-5 can be difficult to discern, as each level has unique documentation requirements that are time-consuming and confusing. ?We?ve proposed to move from a system with separate documentation requirements for each of the 4 levels that physicians use to a system with just one set of requirements, and one payment level each for new and established patients. Most specialties would see changes in their overall Medicare payments in the range of 1-2 percent up or down from this policy, but we believe that any small negative payment adjustments would be outweighed by the significant reduction in documentation burden. ? ? https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/ 2018-08-22-PFS-Presentation.pdf

PARA Weekly Update: October 31, 2018

UPDATED: 2019 MPFS PROPOSED RULE - E/M PAYMENT POLICY CHANGES

Physicians and qualified non-physician practitioners would continue to report the eight most common E/M codes 99202-99205 (new patient) and 99212-99215 (established patient), but Medicare?s payment and documentation rules would be simplified as follows: - Medicare payment would be at one uniform rate regardless of level for new patients, and one uniform rate regardless of level for established patients; - A new add-on G-code worth approximately $14.00 would be reported by certain specialists to facilitate additional reimbursement when reported with an E/M code billed without another procedure (available for specialists in endocrinology, rheumatology, hematology/oncology, urology, neurology, obstetrics/gynecology, allergy/immunology, otolaryngology, cardiology, or interventional pain management-centered care) - A new add-on G-code worth approximately $5.00 in reimbursement would be reported by primary care providers to earn additional reimbursement when the office visit includes primary care services - A new add-on G-code worth approximately $67.00 would be reported by providers to indicate each 30 minutes spent in face-to-face time required beyond the ?typical? time standard currently described in the CPTÂŽ code descriptions 99202-99205 and 99212-99215 - Medicare would establish two new G-codes for podiatrist visits (one for new patients, the other for established patients) which Medicare deems would overpaid if reimbursed under the uniform same new or established patient E/M payments designed for non-podiatrist providers. Payment for the two new G-codes is proposed at $22.53 for new patients, and $17.07 for HCPCS code for established patients. These values are based on the average rate for the level 2 and 3 E/M codes (CPTÂŽ codes 99201-99203 and CPTÂŽ codes 99211-99212, respectively) - Required documentation to support the uniform payment for E/M services will be streamlined to meet only one low-level E/M (99212) using either the 1995 or 1997 CMS documentation guidelines. Visits that consist predominately of counseling and/or coordination of care will use time as the key or controlling factor to qualify for a particular level of E/M services - A new multiple procedure payment adjustment would reduce the payment of the E/M code by 50% when an E/M visit is furnished in combination with a procedure on the same day (reported with modifier 25.) The multiple procedure reductions for non-E/M procedures would not change from the current policy

Physicians and qualified non-physician practitioners would continue to report the eight most common E/M codes 99202-99205 (new patient) and 99212-99215 (established patient)

PARA Weekly Update: October 31, 2018

UPDATED: 2019 MPFS PROPOSED RULE - E/M PAYMENT POLICY CHANGES

Additionally, Medicare proposes to eliminate the Group Practice E/M rule under which Medicare will deny payment of two E/Ms for same patient, same date of service when provided by two separate physicians of the same specialty working in the same medical group. This policy has caused many physician groups to require patients to schedule visits on two separate days in order that both visits can be paid. For instance, two ophthalmologists cannot both be paid for an E/M on the same patient on the same DOS, even though one ophthalmologist may super-specialize in cornea disease, and the other may specialize in retina. ?We believe that eliminating this policy may better recognize the changing practice of medicine while reducing administrative burden. The impact of this proposal on program expenditures and beneficiary cost sharing is unclear. To the extent that many of these services are currently merely scheduled and furnished on different days in response to the instruction, eliminating this manual provision may not significantly increase utilization, Medicare spending and beneficiary cost sharing.? The 2019 Medicare Physician Fee Schedule Proposed Rule is available at the following link: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/ PFS-Federal-Regulation-Notices-Items/CMS-1693-P.html

This year, Medicare offers a slide deck presentation with highlights of their proposal: https://www.cms.gov/About-CMS/Story-Page/2019-Medicare-PFS-proposed-rule-slides.pdf

PARA Weekly Update: October 31, 2018

2019 CPT® CODE SET RELEASE

PARA is in receipt of the pre-production 2019 CPT® Code Update release. In the coming weeks, our staff will begin preparing the mapping files for the January 1, 2019 coding update. The CPT® update consists of the following: - 212 Added Codes - 73 Deleted Codes - 50 Revised Codes The 2019 Appendix B (Summary of Additions, Deletions, and Revisions) is available within the PDE Calculator tab and the data is in several formats. To view the Additions, Changes, or Deletions by type, there are separate radio buttons:

PARA Weekly Update: October 31, 2018

2019 CPTÂŽ CODE SET RELEASE

An electronic copy of the Appendix B is available by clicking the ?Changes? hyperlink:

And updates to Coding Guidelines are available at the ?Guidelines? hyperlink:

When the HCPCS code update is released in November, those changes will be incorporated into the mapping files created for our clients to prepare for the January 1 implementation of new codes. If you have any questions or require assistance with the Calculator, please contact your PARA Account Executive or your Technical Support person, listed on the Select tab of the PDE. 17

PARA Weekly Update: October 31, 2018

RURAL HOSPITAL PROGRAM GRANTS AVAILABLE

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

Healthy Start: Eliminating Disparities In Prenatal Health - Provides up to $950,000 for each of five years for programs that improve access to quality healthcare and services for women, infants, children, and families through outreach, care coordination, health education, and linkage to health insurance - Strengthen the health workforce, specifically those individuals responsible for providing direct services - Application Deadline: November 27,2018

HRSA Remote Pregnancy Monitoring Challenge Grant - Provides up to $150,000 to support technological solutions to help prenatal care providers remotely monitor the health and well being of pregnant women - Priority is given to benefit women in rural and medically underserved areas. - Application Deadline: November 27, 2018

Small Rural Hospitals Improvement Program (SHIP) - Provides $12,000 for each of four years to help hospitals with 49 or fewer beds to purchase hardware, software and training - To join or become accountable care organizations and/or create shared savings programs - Purchase health information technology, equipment or training to comply with quality improvement activities. - Application Deadline: January 3, 2019 18

PARA Weekly Update: October 31, 2018

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, October 25, 2018 New s & An n ou n cem en t s

· New Medicare Card: Handouts and Videos for Patients · DME: Formal Telephone Discussion Demonstration Expansion · Emergency Preparedness: Hospital-based Incident Command System, Earthquakes, Medical Surge Pr ovider Com plian ce

· Coding for Specimen Validity Testing Billed in Combination with Urine Drug Testing ? Reminder Upcom in g Even t s

· Physician Compare: Preview Period and Public Reporting Webcast ? October 30 · Meeting the Needs of Dually Eligible Older Adults with Schizophrenia Webinar ? November 6 · IRF Payment and Coverage Policies: FY 2019 Final Rule Call ? November 15 M edicar e Lear n in g Net w or k ® Pu blicat ion s & M u lt im edia

· Order Requirements When Prescribing Practitioner is DMEPOS Supplier MLN Matters Article ? New · Updating CY 2019 MDPP Payment Rates MLN Matters Article ? New · Quality Payment Program 2018 MIPS Cost Performance Category Web-Based Training Course ? New · Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course ? Revised

· Quality Payment Program 2018 MIPS APMs Web-Based Training Course ? Revised · Quality Payment Program 2018 Advanced APMs Web-Based Training Course ? Revised · Items and Services Not Covered under Medicare Booklet ? Revised View t h is edit ion as a PDF [PDF, 252KB]

PARA Weekly Update: October 31, 2018

IT WEEKLY UPDATE

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

Week ly IT Updat e

Week Ending O ctober 26, 2018

PARA Weekly Update: October 31, 2018

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

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

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM11016

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10960

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10907

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10959

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10967

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10937

PARA Weekly Update: October 31, 2018

The link to this Med Learn MM10877

PARA Weekly Update: October 31, 2018

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

FIND ALL THESE TRANSMITTALS IN THE ADVISOR TAB OF THE PDE

PARA Weekly Update: October 31, 2018

The link to this Transmittal R4154CP

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The link to this Transmittal R2174OTN

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The link to this Transmittal R213DEMO

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The link to this Transmittal R2156OTN

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The link to this Transmittal R2154OTN

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The link to this Transmittal R4150CP

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The link to this Transmittal R2158OTN

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The link to this Transmittal R2157OTN

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The link to this Transmittal R2159OTN

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The link to this Transmittal R2160OTN

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The link to this Transmittal R2161OTN

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The link to this Transmittal R2162OTN

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The link to this Transmittal R2164OTN

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The link to this Transmittal R2165OTN

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The link to this Transmittal R4152CP

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The link to this Transmittal R2163OTN

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The link to this Transmittal R2166OTN

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The link to this Transmittal R4153CP

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The link to this Transmittal R308FM

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The link to this Transmittal R2167OTN

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The link to this Transmittal R2168OTN

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The link to this Transmittal R2172OTN

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The link to this Transmittal R2171OTN

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The link to this Transmittal R2170OTN

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The link to this Transmittal R2175OTN

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The link to this Transmittal R2173OTN

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The link to this Transmittal R839PI

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The link to this Transmittal R2153OTN

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The link to this Transmittal R836PI

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The link to this Transmittal R208NCD

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