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Part A Medicare Quarterly Updates

A/B MAC - Palmetto GBA Provider Outreach & Education

September 12, 2018

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Disclaimer

This information is current as of September 6, 2018 Any changes or new information superseding this

webcast is provided in articles with publication dates after September 6, 2018, posted on our

website at: www.PalmettoGBA.com

CPT® only copyright 2018 American Medical Association. All rights reserved.

The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2018 American Dental

Association (ADA). All rights reserved.

2

http:www.PalmettoGBA.com

PALMETTO GBA.., A CEL ER I AN GROU P CO M P ANY

Objective

To provide pertinent updates, changes and reminders to assist our provider community in staying compliant with Medicare rules and regulations.

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Agenda

− Change Requests Updates & CMS Initiatives

− Comprehensive Error Rate Testing (CERT)

− Palmetto GBA Updates

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Change Request Updates & CMS Initiatives

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Quarterly Provider Updates

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Quarterly Provider Updates Comprehensive CMS resources! • Purpose of publications: – Provide non-regulatory changes – Define policy & manual instructions – Information about new developments – Clarification & understanding of CMS policies

& programs

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Quarterly Pro,ider Update-Regulations July 1 - September 30, 2018

Key:

ASCs - Ambulatory Surgical Centers IDTF - I ndependent Diagnostic Testing Facility CU A - Clinical Diagnostic Laboratories MA - Medicare Advantage CMHCs - Community Mental Health Centers OPO - Organ Procurement Organization CORF - comprehensive outpatient Rehabilitation Facility OPT - outpatient Physical Therapy DME - Durable Medical Equipment RNHCI - Religious Non-medical Health Care I nst itution DMEPOS - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies RHC - Rural Health Clinic FQHC - Federally Qualified Health Center SNF - Skilled Nursing Facility HHA- Home Health Agency

Issue or Provider Code Subiect Publication Date Tvoe

CMS-3348-N Secretarial Review and Publication of the National Quality Forum 07/25/2018 All Providers 2017 Annual Report to Congress and the Secretary of the Department of Health and Human Services Submitted by the Consensus-Based Entity ReQardinQ Performance Measurement

CMS-9920-F Adoption of the Methodology for the HHS-operated Permanent Risk Adjustment 07/30/2018 All Providers Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year

CMS-9924-F Short Term Limited Duration Insurance 08/03/2018 All Providers CMS-9919-P Patient Protection and Affordable Care Act; Adoption of the Methodology for the 08/1 0/2018 All Providers

HHS-operated Permanent Risk Adjustment Program for the 2018 Benefit Year Proposed Rule

CMS-3362-PN Medicare and Medicaid Programs : Application From the 07/26/2018 ASC

Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) for

Continued Approval of Its Ambulatory Surgical Center Accreditation

Program CMS-1695-P CY 2019 Hospital Outpatient PPS Policy Changes and Payment Rates and 07/31 /2018 ASC

Ambulatory Surgical Center Payment System Policy Changes and Payment Rates

CMS-1689-P Medicare and Medicaid Programs; CY 2019 Home Health Prospective 07/13/2018 HHA Payment System Rate Update and CY 2020 Case-Mix Adjustment Methodology Refinements; Home Health Value-Based Purchasing Model; Home Health Quality Reporting Requirements; Home Infusion Therapy Requirements; and Training Requirements for Surveyors of National Accrediting Organizations

PALMETTO GBA.., A CEL ER I AN GROU P CO M P ANY 8

Change Request (CR) 10518 CR Title Eff. Date Imp. Date

For claims 10518 Modifying FISS Part B 10/01/1 received Claims Overlaps Edits 8 on or after 10/01/18

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Change Request (CR) 10519 CR Title Eff. Date Imp.

Date

10519 Phase 4 - Updating FISS 1/1/16 10/1/18 to Make Payment for Drugs & Biologicals Services for OPPS Providers

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CR 10519 Medicare SSM Updates • Includes allowed amount for pass-thru & non-pass

thru drugs/biologicals towards accumulation of expenses subject to deductible

• Modifies claim logic for TOB 12x or 13x with line items dates of service on or after 01/01/2016 to: – HCPCS Pricing indicator is "N" and no longer "B“ – Status Indicator (SI) = G or K – Payment Indicator (PI) = 2

MACs will adjust claims brought to our attention!

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Change Requests (CR) 10525 CR Title Eff. Date Imp. Date

10525 Implementation of 10/1/18 10/1/18 changes to Pre-Payment Additional Documentation Request (ADR) letters for Medical Review

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CR 10525 • Pre-Payment ADR letters will include: – Title = Additional Documentation Request – Jurisdiction – Due Date = Response must be submitted • MM/DD/YYYY

– Respond to Address/Fax/esMD = Modes listed – Additional FISS Comments – Medical Record Number or Patient Account

Number = Only if it is submitted on the claim

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Change Requests (CR) 10549 CR Title Eff. Date Imp. Date

10549 Increased 10/1/18 10/1/18 Ambulance Payment Reduction for Non-Emergency Basic Life Support (BLS) Transports to & from Renal Dialysis Facilities

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CR 10549 • Existing edits/logic set in CR 8269 will be

kept that apply to reduces AFS payment rate in place; however, – Claims with DOS on or after 10/1/18, MACs will

increase reduction from 10% to 23% – Apply 23% reduction to lines containing A0425

& A0428 with origin/destination modifier G or J in any position

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Change Requests (CR) 10574 CR Title Eff.

Date Imp. Date

10574 Updates to Peritoneal 10/1/1 10/1/18 Dialysis Claims Processing, 8 Provider Statistical & Reimbursement Report (PSR) & Payment for Ultrafiltration for Beneficiaries with Acute Kidney Injury (AKI)

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CR 10574 Acute Kidney Injury (AKI) claims • 72x TOB billed with revenue code 881 – Revenue codes 84X & 85X are not accepted

• CPT G0491 • Condition code 84 (passed to the PS&R) • ICD-10 diagnosis codes: – N17.0, N17.1, N17.2, N17.8, N17.9, T79.5XXA,

T79.5XXD, T79.5XXS, N99.0

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Change Requests (CR) 10583 CR Title Eff. Date Imp.

Date

10583 Revisions to Telehealth 10/1/18 10/1/18 Billing Requirements for Distant Site Services

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CR 10583 • As of October 1, 2018, a GT modifier is only

allowed on institutional claims billed under CAH Method II

• CAH II TOBs contain: • HCPCS Q3014 and revenue code 96X, 97X, 98X;

or • HCPCS G0420, G0421 and revenue code 942

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Date

10602 Update to Hospital 10/1/18 10/1/18 Transfer Policy for Early Discharges to Hospice Care

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CR 10602 • Postacute care transfers limited to when

the patient is transferred to: – Hospital distinct part unit (DPU) – Skilled nursing facility (SNF) or – Discharged with a written plan for home health

services commencing within 3 days of discharge

• Effective 10/1/18 - discharges to hospice care also qualify as postacute care transfer & subject to payment adjustments

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Date

10/1/18 10827 Quarterly Update to 10/1/18 NCCI Procedure-to-Procedure (PTP) Edits, Version 24.3

CMS NCCI webpage is available at: http://www.cms.gov/Medicare/Coding/NationalCorrect

CodInitEd/index.html

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http://www.cms.gov/Medicare/Coding/NationalCorrect


Date

10834 Quarterly Healthcare 7/12/18 10/1/18 Common Procedure Coding System (HCPCS) Drug/Biological Code Changes

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CR 10834 • Effective with DOS on or after July 12, 2018: – HCPCS code Q5108: Injection, pegfilgrastim-

jmdb, biosimilar, (fulphila), 0.5 mg is payable – Type of Service (TOS) Codes are 1, P and

MPFSDB Status Indicator is E

• Note: MACS will hold claims for Q5108 until CR 10834 is implemented on 10/1/18

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Date

10/1/18 10852 Quarterly Update to 10/1/18 2018 Annual Update of HCPCS Codes used for SNF Consolidated Billing

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CR 10852 • Services excluded from the SNF PPS & CB

may be paid to other providers -– Even when patient is in a SNF stay

• Services not on the exclusion lists will not be paid to any providers other than a SNF

SNF CB is available at: http://www.cms.gov/Medicare/Billing/SNFConsolidat

edBilling/index.html

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http://www.cms.gov/Medicare/Billing/SNFConsolidat


CR 10852 • SNF CB applies to non-therapy services,

only when services are furnished to a SNF resident during a covered Part A stay

• SNF CB applies to PT, OT & SLP services whenever furnished to a SNF resident -– Regardless of whether Part A covers the stay

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CMS 2018 MLN Matters Articles are located on the CMS Website

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018-Transmittals.html

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https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/2017-MLN-Matters-Articles.htmlhttps://www.cms.gov/Regulations-and

T h ,e M edicare· L ear n iin 1g Network®

F ,ee, e ducation.a l m a t e r i a lls f o r h ea It h c a r e p rofess io n a Is on C l'v1 S p irog 1r a rns . po I i c ie,s ,

a rnd in irt iativ es _

Get qui ck a o cess t o the i n fo 1Tll111a t:Jio n you rneedl _

Publications & Mu ltimed i

lrmwl • Publications • Nat -on a l Prrovi dle r Calls & E v ernts

• M LIN M a tte r s A rtic le,s • 'Web-Based Training

• Multirne d-a

NeV1Tsletters & Socia Continuing Edu cation

• M LN Corn n ect s • Eam o o ntinuing ,edu caltion c r edit

m 1edicar-e j' Learinrng

netwloi'll . ::,,-T lh e M edic a r e L e ·a rrn i rn g N le ·two rk®, ML N Gornnect s ® •, and r\11 LN

(\/l a tters® a r e reg1is t e red 1i:raderna r •ks of t h e, u _s _ Dep,artm e nt of IHea llt h & H u man Services ( H HS)_

29

e-News • Weekly Official – News & Announcements – Provider Compliance – Claims, Pricers & Codes – Upcoming Events – MLN Publications & Multimedia

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Thursday, May 24, 2018

• Provider Compliance

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ICN 902283, April 2018

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MLN Learning Management System Revised Web-Based Training Courses • World of Medicare (program fundamentals) • Your Office in the World of Medicare – Impact of regulations, policies and Federal law on office

practices and how to locate forms/resources

• Your Institution in the World of Medicare – Beneficiary health insurance options, eligibility &

enrollment, how Medigap & Medicaid work with Medicare https://learner.mlnlms.com/Default.aspx

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https://learner.mlnlms.com/Default.aspx

Comprehensive Error Rate Testing (CERT)

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New Provider Minute

Go to Part A CERT Task Force at www.palmettogba.com

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http://www.palmettogba.com/

New Provider Minute

Go to Part A CERT General Information at: www.palmettogba.com

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http:www.palmettogba.com

OIG Work Plan - 2019

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Upcoming MLN Call

• Dementia Care: Opioid Use & Impact for Persons Living with Dementia – September 18, 2018; 1:30 pm to 3 pm ET – Presentation available prior to event – Audio recording & transcript available two weeks

after event

• Register at: https://tinyurl.com/y9wptvfu

38

https://tinyurl.com/y9wptvfu


August 2018 Audit Announcement

Expected issue date = 2019 • Hospital’s compliance with Medicare's

Transfer Policy with resumption of Home Health services & use of condition codes – Report Number W-00-18-35815

• https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000318.asp

39

https://oig.hhs.gov/reports-and

MAC Updates

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eServices System Security Updates

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eServices System Security Updates

• Users must sign into eServices account at least once every 30 days.

Lock-out Timeframe From Account Inactivity

Session Timeout

• If there is no activity for 15 minutes, eService users will be logged out. A pop up message will display at 10 minutes to give the user a warning.

Invalid Log On Attempts Lock-Out

• Three invalid login attempts in a 120 minute period = eServices account will be locked indefinitely. The account will remain locked until the user calls the Provider Contact Center to verify their identity. Select the ‘EDI’ option to speak with a representative.

• Three invalid login attempts in a 121 minute period = eServices account will not be locked out.

Passwords

• Users are required to change a minimum of six characters when prompted to create a new password. It is permissible to shift the characters to different positions to achieve this.

42

Medicare Beneficiary Identifier (MBI) Look-Up Tool

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Transition Period • From April 1, 2018 to December 31, 2019: – System will accept both HICNs & MBIs – Including eligibility requests & claims – Providers should not submit both numbers on

the same transaction

• May only use MBIs beginning in January 2020 – Limited exceptions

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Claims Payment Issues Log (CPIL)

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CPIL Reporting

CMS •CMS Directives

MAC •MAC Discovery

Provider •Provider Discovery

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CPIL Notification

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Webinar s .,, 'Vid eos,, In te ractive T ools & Websit e Ed uca t ion

mat e r ia ls

• •

•

••

Speaker Re q uest s "' W o r ksh ops a n d

Pa r t n e r ship Ev e n t s

D Di

Specia lt y C o n f eren ces a n d Ask t h e Con t ractor Teleconfe r e n ces (A c n

PALMETTO G B A .., A CEL ER I AN GROU P CO M P ANY

About our Education Program

Please use POE Education Request Form 48

Claims Submission Error Help JJ Quarterly (April - June Total Denials

49

JM Quarterly (April - June) Total Denials

50

Job Aids

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Self-Paced Learning • Encore presentations of live webcast – Webcast Library is our Palmetto GBA Channel!

• Instructional Videos – Tutorials of valuable information

• Tools, Modules and more! – Interactive educational resources

52

Palmetto GBA Event Registration Portal

53

MACtoberfest®

https://palmgba.com/events/MACtoberfest2018/index.php

54

https://palmgba.com/events/MACtoberfest2018/index.php

MACtoberfest®

https://palmgba.com/events/MACtoberfest2018/indexC.php

55

https://palmgba.com/events/MACtoberfest2018/indexC.php


MACtoberfest® • Participating functional areas: – Appeals – Audit & Reimbursement/Finance – Electronic Data Interchange (EDI) – Medical Review – Provider Enrollment – Provider Outreach & Education – And More!!!

56

Provider Contact Center JM 855-696-0705 JJ 877-567-7271

57

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��Part A Medicare�Quarterly Updates�DisclaimerObjectiveAgendaChange Request Updates & CMS Initiatives�Quarterly Provider UpdatesQuarterly Provider UpdatesSlide Number 8Change Request (CR) 10518Change Request (CR) 10519CR 10519 Medicare SSM UpdatesChange Requests (CR) 10525CR 10525Change Requests (CR) 10549CR 10549Change Requests (CR) 10574CR 10574Change Requests (CR) 10583CR 10583Change Requests (CR) 10602CR 10602Change Requests (CR) 10827Change Requests (CR) 10834CR 10834Change Requests (CR) 10852CR 10852CR 10852Slide Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number 32MLN Learning Management SystemComprehensive Error Rate Testing (CERT)New Provider MinuteNew Provider MinuteOIG Work Plan - 2019Upcoming MLN Call August 2018 Audit AnnouncementMAC UpdateseServices System Security UpdateseServices System Security UpdatesMedicare Beneficiary Identifier (MBI) Look-Up Tool Transition Period Claims Payment Issues Log (CPIL)CPIL ReportingCPIL NotificationAbout our Education ProgramClaims Submission Error HelpJM Quarterly (April - June) Total DenialsJob AidsSelf-Paced LearningPalmetto GBA Event Registration PortalMACtoberfest®MACtoberfest®MACtoberfest®Slide Number 57Slide Number 58

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