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Today’s Blog Content

News

Medicare Claims Processing Manual, Chapter 30 Revisions

Local Coverage Determinations (LCDs)

CGS Website Search Feature Enhancements

Medicare Credit Balance Quarterly Reminder

Medicare Secondary Payer Explanation Codes

December 2018 Common Reasons for Delays in CMS Application Processing

Provider Contact Center (PCC) Reminders

NHPCO NewsBriefs January 31, 2019

Hospice Alert 19.02

HospiLink | January 30, 2019

Events

Central Utah UHPCO Conference March 15

Save the date! UHPCO 2019 Convention and Annual Meeting Nov 13-14 

Upcoming Hospice Webinar: Hospice Length of Stay–Supporting Longer Stays

Interest Items

UHPCO Members are eligible Discount Pricing on Fluzone

Your new AmazonSmile Valentine’s Day banners

Industry News Articles


News

Medicare Claims Processing Manual, Chapter 30 Revisions

Access the new information here via MLN Connects….

Local Coverage Determinations (LCDs)

Access the new information here via MLN Connects….

CGS Website Search Feature Enhancements

Via CGS: “CGS continually works to improve your experience when you visit the CGS J15 Medicare website.  CGS recently implemented improvements to the website Search function.  Please share the following new features with your staff. Read more…

Medicare Credit Balance Quarterly Reminder

Via CGS: “This is a reminder to submit the Quarterly Medicare Credit Balance Report. The next report is due in our office postmarked by January 30, 2019, for the quarter ending December 31, 2018. Read more…”

Medicare Secondary Payer Explanation Codes

Via CGS: “To assist in processing Medicare Secondary Payer (MSP) claims, CGS developed MSP Explanation Codes for providers to enter into the “Remarks” field on the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Page 04 (UB-04 Form Locator 80) (Loop 2300).  Read more…”

December 2018 Common Reasons for Delays in CMS Application Processing

Via CMS: “The December 2018 common reasons for delays in processing online PECOS and paper CMS-855 applications are now available. These common errors may delay the processing of your application. Please take a moment to review this information to ensure you are submitting a complete and accurate CMS application.”

Provider Contact Center (PCC) Reminders

Via CGS: ” The CGS Medicare Customer Service Representatives (CSR) in our Provider Contact Centers (PCCs) often receive misdirected calls because, when prompted, an incorrect option was selected. To help you reach the correct CGS staff to answer your questions, please review the following selections (options) available when you call. In addition, before calling, check out the website resources listed for answers to your questions. Read more…

NHPCO NewsBriefs January 31, 2019

Check out this edition here.

Hospice Alert 19.02

Via the Health Group:

Item 1: “PHYSICIAN ASSISTANTS AS ATTENDING PHYSICIANS

Effective January 1, 2019, Medicare will pay for medically reasonable and necessary services provided by a physician assistant (“PA”) to Medicare beneficiaries who have elected the hospice benefit and who have selected a PA as their attending physician. PAs are paid 85 percent (85%) of the fee schedule amount for their services as designated attending physicians.

Attending physician services provided by PAs may be separately billed to Medicare only if:

– The PA is the beneficiary’s designated attending physician;

– Services are medically reasonable and necessary;

– Services would normally be performed by a physician in the absence of the PA, whether or not the PA is directly employed by the hospice; and

– Services are not related to the certification of terminal illness.

If the physician assistant is employed by the hospice, the hospice can bill Part A for physician services meeting the above criteria on a hospice claim. If the physician assistant is not employed by the hospice, the physician assistant can bill Part B for physician services meeting the above criteria.

Physician assistants cannot certify or re-certify an individual as terminally ill, meaning that the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course. In the event that a beneficiary’s attending physician is a nurse practitioner or a physician assistant, the hospice medical director or the physician member of the hospice Interdisciplinary Group (“IDG”) certifies the individual as terminally ill. The hospice face-to-face encounter must be performed by a hospice physician or hospice nurse practitioner. PAs may not perform the face-to-face encounter.

Details are available at:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R246BP.pdf”

Item #2: “CAP YEAR REOPENINGS

There is substantial confusion regarding recalculations of CAP liabilities by the Medicare Administrative Contractor (“MAC”).  The following clarification is available from CMS:

“Past cap year determinations for the 2012 cap year and later cap years are subject to reopening; existing re-opening rules allow reopening for up to 3 years from the date of the cap determination, except in cases of fraud, where reopening is unlimited. A revised cap determination letter issued as a result of reopening may itself be reopened, subject to the 3-year limitation on reopening.” (Medicare Benefit Policy Manual, Chapter 9, as revised)

In cases where the MAC has issued a revised CAP liability determination, a new three-year period begins for additional recalculations.  The letter issued by the MAC represents a Notice of Program Reimbursement (“NPR”), as referenced throughout the rules, regulations, and instructions (also referenced in the Medicare Benefit Policy Manual, Chapter 9).

Ted Cuppett, founder of The Health Group, LLC, will be the speaker at a webinar sponsored by the National Association for Homecare & Hospice (“NAHC”) on Tuesday, February 5, 2019.  Additional details are available at https://www.nahc.org/meetings-education/web-events/.

HospiLink | January 30, 2019

The PDF of Optum’s HospiLink publication for 1-30-2019 can be found here….

Events

Central Utah UHPCO Conference 3/15

Early Bird Rates End Feb 5! Hurry!

Save the date! UHPCO 2019 Convention and Annual Meeting Nov 13-14 

This convention will be like no other. Join us at our new venue, Noah’s Event Venue in South Jordan. Vendors can sign up now.

Upcoming Hospice Webinar: Hospice Length of Stay–Supporting Longer Stays

Via CGS: “February 27, 2019 10:30 a.m. – 11:30 p.m. MST. Longer length of stays with hospice patients can draw the attention of medical review and have a higher risk of denials.  How can your documentation support these longer stays?  Let’s discuss the details to show when your patient is still appropriate for your services and when to tell if it’s time to have a graduation party and discharge your patient.  Bring your questions!” Read more here…

Interest Items

UHPCO Members are eligible Discount Pricing on Fluzone

UHPCO members  are eligible for discount pricing on Fluzone through Carepoint with reserved prior to March 31, 2019. Find out more here…

Your new AmazonSmile Valentine’s Day banners

Via AmazonSmile: “Valentine’s Day is February 14 and many of your supporters are starting to shop for gifts. This is a great opportunity to increase Utah Hospice & Palliative Care Organization Inc’s AmazonSmile donations by reminding your supporters to shop at smile.amazon.com.

Use the message and banner below in email, social media, and on your website to spread the word to your donors, staff, and volunteers.

Will you be our Valentine? Shop at smile.amazon.com/ch/87-0509988 and AmazonSmile donates to Utah Hospice & Palliative Care Organization Inc.

Industry News Articles

Shared via The Carolinas Center’s News of Note 1-28-2019:

The ABCs of Provider Compliance: A Necessity in Today’s Healthcare Climate  PR Newswire 01.16.2019

No ‘magic formula’ for containing health care costs  Gaston Gazette 01.24.2019

Shifting ACO Rules Create Uncertainty for Home Health Agencies  Home Health Care News 01.27.2019

Michael Kelly: Why world-class end-of-life care should be our priority… not the slippery slope towards euthanasia  Belfast Telegraph 01.26.2019

Via insidehealthpolicy.com 1-30-2019:

Cassidy, Warner Seek Feedback On Draft Outcome-Based Contract Bill

Idaho Supreme Court Hears Challenge To Medicaid Expansion Initiative

Verma Says Demos For Rural Areas, Duals In the Pipeline

Gottlieb: Legacy Device Safety Is ‘Critical’ Cybersecurity Challenge

Grassley: Azar Should Use IPI Model As Leverage Against Pharma

Dems, GOP Rehash ACA Arguments In Preexisting Conditions Hearing

With Government Open, ACA Suit Appeal Kicks Back In

Advocates Seek Medically Necessary Oral Health Care, CMS Eyes Issue

CMMI Details Expanded VBID Model, Includes ‘Aggressive’ Timeline

Cornyn Positions As Drug Pricing Policy Player, Looks to 2020