Knowledge Base Article

MEDICARE TRANSMITTALS

Revisions to the Telehealth Billing Requirements for Distant Site Services

Implements requirements for billing modifier GT for Telehealth Distant Site Services. As of January 1, 2018, the GT modifier is only allowed on institutional claims billed by a Critical Access Hospital (CAH) Method II.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10583.pdf

Implementation of Changes to the Pre-Payment Additional Documentation Request (ADR) Letters for Medical Review

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R2083OTN.pdf

Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10642.pdf

Updates to Publication 100-04, Chapters 1 and 27, to Replace Remittance Advice Remark Code (RARC) MA61 with N382

MACs will use N382 in place of MA61 to communicate reject/denials for patient identifiers (HICN or MBI) in all remittance advices and 835 transactions. However, MACs will continue to use RARC MA61 only when/if communicating rejections/denials related to a missing/incomplete/invalid social security number.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10619.pdf

Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) PPS Extensions per the Advancing Chronic Care, Extenders, and Social Services (ACCESS) Act Included in the Bipartisan Budget Act of 2018

Information and implementation instructions for:

• Section 50204 – Extension of Increased Inpatient Hospital Payment Adjustment for Certain Low-Volume Hospitals
• Section 50205 – Extension of the Medicare-Dependent Hospital (MDH) Program
• Section 51005 – Adjustments to the LTCH Site Neutral Payment Rate

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10547.pdf

Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) – REVISED

The article was revised on May 15, 2018, to clarify that one of the requirements of the SET program is it must be conducted in a hospital outpatient setting or in a physician’s office.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10295.pdf

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update – REVISED

A sentence is added to show that Part B payment for Q9995 includes the clotting factor furnishing fee.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10624.pdf

Intent to Reopen

Provides instructions for contractors to: provide notification of the reopening process and to notify the provider or supplier of their intent to reopen a specific claim when requested documentation is received after a denial of the claim has been made.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R796PI.pdf

Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNmattersArticles/downloads/MM10620.pdf

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2018 Update

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNmattersArticles/downloads/MM10644.pdf

MEDICARE COVERAGE UPDATES

 International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs)

CR10622 makes coding and clarifying adjustments to the following NCDs:

• NCD 110.18 Aprepitant
• NCD 150.3 Bone Mineral Density Studies
• NCD 190.11 Prothrombin Time/International Normalized Ratio (PT/INR)
• NCD 220.6.16 Positron Emission Tomography (PET) for Infection/Inflammation
• NCD 220.6.17 PET for Solid Tumors
• NCD 220.13 Percutaneous Image-Guided Breast Biopsy

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNmattersArticles/downloads/MM10622.pdf

MEDICARE PRESS RELEASES

CMS Announces Agency’s First Rural Health Strategy

The agency’s first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-05-08.html

CMS Unveils Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices

For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices.

https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2018-Press-releases-items/2018-05-15.html

MEDICARE EDUCATIONAL RESOURCES

Palmetto JM Provider Contact Center (PCC) Frequently Asked Questions (FAQs): January 2018 - April 30, 2018

https://www.palmettogba.com/palmetto/providers.nsf/ls/JM%20Part%20A"AYKQC62336?opendocument&utm_source=J11AL&utm_campaign=JMALs&utm_medium=email

MLN Fact Sheet Complying with Medicare Signature Requirements

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf

Targeted Probe and Educate Video

https://my.happify.com/hd/why-gratitude-is-the-best-gift-we-can-give-our-children/?et=e2e969ce-70c2-474e-873b-a6e3fb839cf1

MEDICARE RULES

 Hospital IPPS and LTC 2019 FY Proposed Rule

The proposed rule proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). Also includes proposal concerning Quality Programs, EHR Incentive Programs, Cost-Reporting and Physician Claim Certifications.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-08705.pdf

Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities (SNF) Proposed Rule for FY 2019, SNF Value-Based Purchasing Program, and SNF Quality Reporting Program

This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2019.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-09015.pdf

Inpatient Rehabilitation Facility Prospective Payment System for Federal Fiscal Year 2019

This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities (IRFs) for federal fiscal year (FY) 2019.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-08961.pdf

FY 2019 Inpatient Psychiatric Facilities Prospective Payment System and Quality Reporting Updates for Fiscal Year Beginning October 1, 2018 (FY 2019)

This proposed rule would update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital.

https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-09069.pdf

OTHER MEDICARE UPDATES

Kepro Case Review Connections, Acute Care Edition, Spring 2018

A quarterly e-newsletter from your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO).

https://www.keproqio.com/providers/spring-2018-acute-newsletter/

Trump Administration Releases Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

https://www.hhs.gov/about/news/2018/05/11/trump-administration-releases-blueprint-lower-drug-prices-and-reduce-out-pocket-costs.html