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JM HHH Medicare AdvisoryLatest Medicare News for HHH

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April 2020Volume 2020, Issue 04

The JM HHH Medicare Advisory contains coverage, billing and other information for Jurisdiction M HHH. This information is not intended to constitute legal advice. It is our official notice to those we serve concerning their responsibilities and obligations as mandated by Medicare regulations and guidelines. This information is readily available at no cost on the Palmetto GBA website. It is the responsibility of each facility to obtain this information and to follow the guidelines. The JM HHH Medicare Advisory includes information provided by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The information is subject to change at any time. This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no-cost from our website at http://www.PalmettoGBA.com/Medicare.

CPT only copyright 2019 American Medical Association. All rights reserved. CPT is a registered trademark of the Ameri-can Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2012 American Dental Association (ADA). All rights reserved.

What’s Inside...MLN Connects ..............................................................................................................3

Weekly Articles .......................................................................................................3Special Edition Articles ..........................................................................................4CMS Announces Actions to Address Spread of Coronavirus ..................................4CMS Develops Additional Code for Coronavirus Lab Tests ...................................6COVID-19 Response: CMS Issues FAQs to Assist Medicare Providers .................8COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage ...................................................................................................9Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article .............................................................................................9Essential Health Benefits (EHB) Coverage ............................................................10Medicare FFS Response to COVID-19 ..................................................................10COVID-19 Nursing Home Visitor Guidance .........................................................10President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak ..............................................................................................11

Coronavirus (COVID-19) Information .....................................................................13Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) ............................................................................13

MAC Satisfaction Indicator (MSI) Survery Information .......................................19MSI Live Announcement: Evaluate Our Services .................................................19

Home Health and Hospice Information ....................................................................20Ensure Required Patient Assessment Information for Home Health Claims .........20Accepting Payment from Patients with a Medicare Set-Aside Arrangement ........22April 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.1 ............................................................................................................25Claims Payment Issues Log ...................................................................................29eTicket Enables Providers to Save Time with Every Call ......................................29Never Share Your eServices User ID and Password ..............................................30ePass is Now Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA’s Provider Contact Center .......................................31Get Your Medicare News Electronically ................................................................32Medicare Learning Network® (MLN) ...................................................................32

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CPT codes, descriptors and other data only are copyright 2019 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data con-tained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Medicare Beneficiary Identifier (MBI) Information ................................................33Medicare Beneficiary Identifier (MBI) Look-up Tool ............................................33

Electronic Data Interchange (EDI) Information ......................................................36Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update ....................36

eServices Information .................................................................................................38New eServices Appeals Feature .............................................................................38eServices Profile Verification Timeframes .............................................................38Do You Have a Question Regarding eServices? We Can Help! .............................39How Can We Be of “eService” to You? .................................................................39

Fee Schedule Information ..........................................................................................39Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update ..................................................................................................39

Home Health Review Choice Demonstration (RCD) Information .........................432020 Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference Schedule ........................................................................................43

Learning and Education Information .......................................................................442020 Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference Schedule ........................................................................................44Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA ................................................................................................44

Provider Enrollment Information .............................................................................46You Can Track Your Enrollment Application .........................................................46

Tools That You Can Use ..............................................................................................48Medicare Secondary Payer (MSP) Coding Module ...............................................48

Helpful Information ....................................................................................................49Contact Information for Palmetto GBA Home Health and Hospice ......................49

Upcoming Home Health and Hospice Educational Events

2020 Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference SchedulePalmetto GBA will host a series of Medical Review Hot Topic Targeted Probe and Educate (TPE) Teleconferences in 2020. These calls are open to all providers. Please mark your calendars to join our Medical Review Subject Mat-ter Experts as they discuss and answer your questions concerning current TPE process.

For more information and registration instructions to attend these education sessions, please go to Page 44 of this issue.


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MLN CONNECTS

MLN Connects will contain Medicare-related messages from the Centers of Medicare & Medicaid Services (CMS). These messages ensure planned, coordinated messages are delivered timely about Medicare-related topics. Please share with appropriate staff. To view the most recent issues, please copy and paste the following links into your Web browser:

Weekly Articles

March 19, 2020https://www.cms.gov/files/document/2020-03-19-mlnc.pdf

March 12, 2020https://www.cms.gov/files/document/2020-03-12-mlnc.pdf

March 5, 2020https://www.cms.gov/files/document/2020-03-05.pdf

February 27, 2020https://www.cms.gov/files/document/2020-02-27.pdf

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Special Edition Articles

Wednesday, March 4, 2020

CMS Announces Actions to Address Spread of Coronavirus

CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus

On March 4, the Centers for Medicare & Medicaid Services (CMS) announced several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections exclusively on issues related to infection control and other serious health and safety threats, like allegations of abuse – beginning with nursing homes and hospitals. Critically, this shift in approach, first announced yesterday by Vice President Pence, will allow inspectors to focus their energies on addressing the spread of COVID-19.

As the agency responsible for Medicare and Medicaid, CMS requires facilities to maintain infection control and prevention policies as a condition for participation in the programs. CMS is also issuing three memoranda to State Survey Agencies, State Survey Agency directors and Accrediting Organizations – to inspect thousands of Medicare-participating health care providers across the country, including nursing homes and hospitals. “Today’s actions, taken together, represent a call to action across the health care system,” said CMS Administrator Seema Verma. “All health care providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC). We sincerely appreciate the proactive efforts of the nursing home and hospital associations that have already galvanized to provide up-to-the-minute information to their members. We must continue working together to keep American patients and residents safe and healthy and prevent the spread of COVID-19.”

The first memorandum provides important detail with respect to the temporary focus of surveys on infection control and other emergent issues. Importantly, it notes that, in addition to the focused inspections, statutorily-required inspections will also continue in the 15,000 nursing homes across the country using the approximately 8,200 state survey agency surveyors. Surveys will be conducted according to the following regime:

• All immediate jeopardy complaints (a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment or death or harm) and allegations of abuse and neglect;

• Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses;

• Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities);


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• Any re-visits necessary to resolve current enforcement actions;

• Initial certifications;

• Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years;

• Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy.

The memorandum also includes protocols for the inspection process in situations in which COVID-19 is identified or suspected. These protocols include working closely with CMS regional offices, coordinating with CDC, and other relevant agencies at all levels of government. The agency is also providing key guidance related to inspectors’ usage of adequate personal protective equipment.

The other two memoranda provide critical answers to common questions that nursing homes and hospitals may have with respect to addressing cases of COVID-19. For example, the memoranda discuss concerns like screening staff and visitors with questions about recent travel to countries with known cases and the severity of infection that would warrant hospitalization instead of self-isolation. They detail the process for transferring patients between nursing homes and hospitals in cases for which COVID-19 is suspected or diagnosed. They also describe the circumstances under which providers should take precautionary measures (like isolation and mask wearing) for patients and residents diagnosed with COVID-19, or showing signs and symptoms of COVID-19.

Finally, the agency is announcing that it has deployed an infection prevention specialist to CDC’s Atlanta headquarters to assist with real-time in guidance development.

These actions from CMS are focused on protecting American patients and residents by ensuring health care facilities have up-to-date information to adequately respond to COVID-19 concerns while also making it clear to providers that as always, CMS will hold them accountable for effective infection control standards. The agency is also supplying inspectors with necessary and timely information to safely and accurately inspect facilities.

To view each memo, please visit:

• Suspension of Survey Activities (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/suspension-survey-activities)

• Guidance for Infection Control and Prevention Concerning Coronavirus Disease (COVID-19): FAQs and Considerations for Patient Triage, Placement and Hospital Discharge (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-concerning-coronavirus-disease-covid-19-faqs-and )

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• Guidance for Infection Control and Prevention of Coronavirus Disease 2019 (COVID-19) in nursing homes (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and/guidance-infection-control-and-prevention-coronavirus-disease-2019-covid-19-nursing-homes)

March 6, 2020

CMS Develops Additional Code for Coronavirus Lab Tests

Agency Issues Fact Sheets Detailing Coverage under Programs

On March 6, CMS took additional actions to ensure America’s patients, healthcare facilities and clinical laboratories are prepared to respond to the 2019-Novel Coronavirus (COVID-19).

CMS has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests to help increase testing and track new cases. In addition, CMS released new fact sheets that explain Medicare, Medicaid, Children’s Health Insurance Program, and Individual and Small Group Market Private Insurance coverage for services to help patients prepare as well.

“CMS continues to leverage every tool at our disposal in responding to COVID-19,” said CMS Administrator Seema Verma. “Our new code will help encourage doctors and laboratories to use these essential tests for patients who need them. At the same time, we are providing critical information to our 130 million beneficiaries, many of whom are understandably wondering what will be covered when it comes to this virus. CMS will continue to devote every available resource to this effort, as we cooperate with other government agencies to keep the American people safe.”

HCPCS is a standardized coding system that Medicare and other health insurers use to submit claims for services provided to patients. Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.

The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.


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To ensure the public has clear information on coverage and benefits under CMS programs, the agency also released three fact sheets that cover diagnostic laboratory tests, immunizations and vaccines, telemedicine, drugs, and cost-sharing policies.

Medicare Fact Sheet Highlights (https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf):In addition to the diagnostic tests described above, Medicare covers all medically necessary hospitalizations, as well as brief “virtual check-ins,” which allows patients and their doctors to connect by phone or video chat.

Medicaid and Children’s Health Insurance Program (CHIP) Fact Sheet Highlights (https://www.cms.gov/files/document/03052020-medicaid-covid-19-fact-sheet.pdf):Testing and diagnostic services are commonly covered services, and laboratory and x-ray services are a mandatory benefit covered and reimbursed in all states. States are required to provide both inpatient and outpatient hospital services to beneficiaries. All states provide coverage of hospital care for children and pregnant women enrolled in CHIP. Specific questions on covered benefits should be directed to the respective state Medicaid and CHIP agency.

Individual and Small Group Market Insurance Coverage (https://www.cms.gov/files/document/03052020-individual-small-market-covid-19-fact-sheet.pdf): Existing federal rules governing health insurance coverage, including with respect to viral infections, apply to the diagnosis and treatment of with Coronavirus (COVID-19). This includes plans purchased through HealthCare.gov. Patients should contact their insurer to determine specific benefits and coverage policies. Benefit and coverage details may vary by state and by plan. States may choose to work with plans and issuers to determine the coverage and cost-sharing parameters for COVID-19 related diagnoses, treatments, equipment, telehealth and home health services, and other related costs.

Summary of CMS Public Health Action on COVID-19 to date:

On March 4, 2020, CMS issued a call to action to healthcare providers nationwide to ensure they are implementing longstanding infection control procedures and issued important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare facilities to focus exclusively on issues related to infection control and other serious health and safety threats. For more information on CMS actions to prepare for and respond to COVID-19, visit: CMS Announces Actions to Address Spread of Coronavirus (https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus).

On February 13, 2020, CMS issued a new HCPCS code for healthcare providers and laboratories to test patients for COVID-19 using the CDC-developed test. For more information about this code: Public Health News Alert: CMS Develops New Code for Coronavirus Lab Test (https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test).

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On February 6, 2020, CMS issued a memo (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov) to help the nation’s healthcare facilities take critical steps to prepare for COVID19.

On February 6, 2020, CMS also gave CLIA-certified laboratories information about how they can test for SARS-CoV-2. Read more: Suspension of Survey Activities (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt) memorandum

For the updated information on the range of CMS activities to address COVID-19, visit the Current Emergencies (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page) webpage.

March 9, 2020

COVID-19 Response: CMS Issues FAQs to Assist Medicare Providers

On March 6, CMS issued frequently asked questions and answers (FAQs) (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page) for health care providers regarding Medicare payment for laboratory tests and other services related to the 2019-Novel Coronavirus (COVID-19). The agency is receiving questions from providers and created this document to be transparent and share answers to some of the most common questions.

Included in the FAQs is:

• Guidance on how to bill and receive payment for testing patients at risk of COVID-19.

• Details of Medicare’s payment policies for laboratory and diagnostic services, drugs, and vaccines under Medicare Part B, ambulance services, and other medical services delivered by physicians, hospitals, and facilities accepting government resources.

• Information on billing for telehealth or in-home provider services. Since 2019, the Trump Administration has expanded flexibilities for CMS to pay providers for virtual check-ins and other digital communications with patients, which will make it easier for sick patients to stay home and lower the risk of spreading the infection.

This FAQ, and earlier CMS actions in response to the COVID-19 virus are part of the ongoing White House Task Force efforts. To keep up with the important work CMS is doing in response to COVID-19, visit the Current Emergencies website at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.


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Below is an updated list of CMS’ actions to date:

• March 5 (https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests): Issued a second Healthcare Common Procedure Coding System (HCPCS) code for certain COVID-19 laboratory tests, in addition to three fact sheets about coverage and benefits for medical services related to COVID-19 for CMS programs

• March 4 (https://www.cms.gov/newsroom/press-releases/cms-announces-actions-address-spread-coronavirus): Issued a call to action to health care providers nationwide and offered important guidance to help State Survey Agencies and Accrediting Organizations prioritize their inspections of healthcare

• February 13 (https://www.cms.gov/newsroom/press-releases/public-health-news-alert-cms-develops-new-code-coronavirus-lab-test): Issued a new HCPCS code for providers and laboratories to test patients for COVID-19

• February 6 (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/notification-surveyors-authorization-emergency-use-cdc-2019-novel-coronavirus-2019-ncov-real-time-rt): Gave CLIA-certified laboratories information about how they can test for SARS-CoV-2

• February 6 (https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/information-healthcare-facilities-concerning-2019-novel-coronavirus-illness-2019-ncov): Issued a memo to help the nation’s health care facilities take critical steps to prepare for COVID-19

March 13, 2020

COVID-19: Test Pricing; Diagnostic Lab Tests, Pricing & Codes; and EHB Coverage

On March 12, CMS posted a fact sheet (https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf) with information relating to the pricing of both the Centers for Disease Control and Prevention (CDC) and non-CDC tests.

Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment MLN Matters® Article

A new MLN Matters Article MM 11681 on Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (https://www.cms.gov/files/document/mm11681.pdf) is available. Learn about Advanced Diagnostic Laboratory Tests, pricing, and new codes. On page 3, we reference new COVID-19 codes.

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Essential Health Benefits (EHB) Coverage

On March 12, CMS issued Frequently Asked Questions (FAQs) (https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf) about EHB (https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf) to ensure individuals, issuers, and states have clear information on coverage benefits for COVID-19. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.

These FAQs, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19; visit the CDC’s Coronavirus Disease 2019 webpage (https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/EHB-Benchmark-Coverage-of-COVID-19.pdf).

For information specific to CMS, please visit the Current Emergencies website (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page).

March 16, 2020

Medicare FFS Response to COVID-19

The HHS Secretary declared a public health emergency, which allows for CMS programmatic waivers based on Section 1135 of the Social Security Act. An MLN Matters Special Edition Article SE20011 on Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (https://www.cms.gov/files/document/se20011.pdf) is available. Learn about blanket waivers issued by CMS. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency.

See the press release (https://www.cms.gov/newsroom/press-releases/cms-takes-action-nationwide-aggressively-respond-coronavirus-national-emergency) outlining our announcement.

COVID-19 Nursing Home Visitor Guidance

On March 13, as part of the broader Trump Administration announcement, CMS announced critical new measures designed to keep America’s nursing home residents safe from the 2019 Novel Coronavirus (COVID-19). The measures take the form of a memorandum (https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf) and is based on the newest recommendations from the Centers for Disease Control and Prevention (CDC) (https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html). It directs nursing homes to significantly restrict visitors and nonessential personnel, as well as restrict communal activities inside nursing homes. The new


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measures are CMS’s latest action to protect America’s seniors, who are at highest risk for complications from COVID-19. While visitor restrictions may be difficult for residents and families, it is an important temporary measure for their protection.

For More Information:

• Press Release (https://www.cms.gov/newsroom/press-releases/cms-announces-new-measures-protect-nursing-home-residents-covid-19)

• Memo Nursing Home Guidance QSO-20-14 –NH (https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf)

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit the coronavirus.gov webpage (https://www.cms.gov/files/document/3-13-2020-nursing-home-guidance-covid-19.pdf).

For information specific to CMS, visit the Current Emergencies (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page) website

March 17, 2020

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak

CMS Outlines New Flexibilities Available to People with Medicare

The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.

“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”

On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-

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use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).

Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.

The Trump Administration previously expanded telehealth benefits. Over the last two years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.

A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.

Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.

President Trump’s announcement comes at a critical time as these flexibilities will help healthcare institutions across the nation offer some medical services to patients remotely, so that healthcare facilities like emergency departments and doctor’s offices are available to deal with the most urgent cases and reduce the risk of additional infections. For example, a Medicare beneficiary can visit with a doctor about their diabetes management or refilling a prescription using telehealth without having to travel to the doctor’s office. As a result, the doctor’s office is available to treat more people who need to be seen in-person and it mitigates the spread of the virus.

As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect.

Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.


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Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.

This guidance follows on President Trump’s call for all insurance companies to expand and clarify their policies around telehealth.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

This guidance, and earlier CMS actions in response to the COVID-19 virus, are part of the ongoing White House Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19 click here https://protect2.fireeye.com/url?k=1dc3b044-4196b994-1dc3817b-0cc47a6a52de-daff918c3d41b4a0&u=http://www.coronavirus.gov/. For information specific to CMS, please visit the Current Emergencies Website (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page).

CORONAVIRUS (COVID-19) INFORMATION

Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19)

MLN Matters Number: SE20011 Revised Article Release Date: March 18, 2020 Related CR Transmittal Number: N/A Related Change Request (CR) Number: N/A Effective Date: N/A Implementation Date: N/A

Note: We revised this article on March 18, 2020, to include information about the Telehealth waiver. All other information remains the same.

Provider Types Affected This MLN Matters® Special Edition Article is for providers and suppliers who bill Medicare Fee-For-Service (FFS).

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Provider Information Available The Secretary of the Department of Health & Human Services declared a public health emergency (PHE) in the entire United States on January 31, 2020. On March 13, 2020 Secretary Azar authorized waivers and modifications under Section 1135 of the Social Security Act (the Act), retroactive to March 1, 2020.

The Centers for Medicare & Medicaid Services (CMS) is issuing blanket waivers consistent with those issued for past PHE declarations. These waivers prevent gaps in access to care for beneficiaries impacted by the emergency. You do not need to apply for an individual waiver if a blanket waiver is issued.

More Information:

• Current Emergencies (https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page) webpage

• Instructions (https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Requesting-an-1135-Waiver-Updated-11-16-2016.pdf) to request an individual waiver if there is no blanket waiver

Background

Section 1135 and Section 1812(f) Waivers

As a result of this PHE, apply the following to claims for which Medicare payment is based on a “formal waiver” including, but not limited to, Section 1135 or Section 1812(f) of the Act:

1. The “DR” (disaster related) condition code for institutional billing, i.e., claims submitted using the ASC X12 837 institutional claims format or paper Form CMS-1450.

2. The “CR” (catastrophe/disaster related) modifier for Part B billing, both institutional and non-institutional, i.e., claims submitted using the ASC X12 837 professional claim format or paper Form CMS-1500 or, for pharmacies, in the NCPDP format.

Medicare FFS Questions & Answers (Q&As) available on the Waivers and Flexibilities webpage apply to items and services for Medicare beneficiaries in the current emergency. These Q&As are displayed in two files:

o Q&As that apply without any Section 1135 (https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Consolidated_Medicare_FFS_Emergency_QsAs.pdf) or other formal waiver.

o Q&As apply only with a Section 1135 waiver (https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/MedicareFFS-EmergencyQsAs1135Waiver.pdf) or, when applicable, a Section 1812(f) waiver.


15 04/2020

Blanket Waivers Issued by CMS You do not need to apply for the following approved blanket waivers:

Skilled Nursing Facilities (SNFs)

• Section 1812(f): This waiver of the requirement for a 3-day prior hospitalization for coverage of a SNF stay provides temporary emergency coverage of SNF services without a qualifying hospital stay, for those people who are evacuated, transferred, or otherwise dislocated as a result of the effect of disaster or emergency. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes renewed SNF coverage without first having to start a new benefit period (Blanket waiver for all impacted facilities).

• 42 CFR 483.20: This waiver provides relief to SNFs on the timeframe requirements for Minimum Data Set assessments and transmission (Blanket waiver for all impacted facilities).

Home Health Agencies

• 42 CFR 484.20(c)(1): This waiver provides relief to Home Health Agencies on the timeframes related to OASIS Transmission (Blanket waiver for all impacted agencies).

• To ensure the correct processing of home health emergency related claims, Medicare Administrative Contractors (MACs) are allowed to extend the auto-cancellation date of Requests for Anticipated Payment (RAPs).

Critical Access Hospitals This action waives the requirements that Critical Access Hospitals limit the number of beds to 25, and that the length of stay be limited to 96 hours. (Blanket waiver for all impacted hospitals)

Housing Acute Care Patients in Excluded Distinct Part Units CMS has determined it is appropriate to issue a blanket waiver to inpatient prospective payment system (IPPS) hospitals that, as a result of the emergency, need to house acute care inpatients in excluded distinct part units, where the distinct part unit’s beds are appropriate for acute care inpatient. The IPPS hospital should bill for the care and annotate the patient’s medical record to indicate the patient is an acute care inpatient being housed in the excluded unit because of capacity issues related to the emergency. (Blanket waiver for all IPPS hospitals located in the affected areas that need to use distinct part beds for acute care patients.)

Care for Excluded Inpatient Psychiatric Unit Patients in the Acute Care Unit of a Hospital CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient psychiatric units that, as a result of the emergency, need to relocate inpatients from the excluded distinct part psychiatric unit to an acute care bed and unit. The hospital should continue to bill for inpatient psychiatric services under the inpatient psychiatric facility prospective payment system for such patients and annotate the medical record to indicate the patient is a psychiatric inpatient being cared for in an acute care bed because of capacity or other exigent

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circumstances related to the emergency. This waiver may be utilized where the hospital’s acute care beds are appropriate for psychiatric patients and the staff and environment are conducive to safe care. For psychiatric patients, this includes assessment of the acute care bed and unit location to ensure those patients at risk of harm to self and others are safely cared for.

Care for Excluded Inpatient Rehabilitation Unit Patients in the Acute Care Unit of a Hospital CMS has determined it is appropriate to issue a blanket waiver to IPPS and other acute care hospitals with excluded distinct part inpatient rehabilitation units that, as a result of the emergency, need to relocate inpatients from the excluded distinct part rehabilitation unit to an acute care bed and unit. The hospital should continue to bill for inpatient rehabilitation services under the inpatient rehabilitation facility (IRF) prospective payment system for such patients and annotate the medical record to indicate the patient is a rehabilitation inpatient being cared for in an acute care bed because of capacity or other exigent circumstances related to the emergency. This waiver may be utilized where the hospital’s acute care beds are appropriate for providing care to rehabilitation patients, and such patients continue to receive intensive rehabilitation services.

IRFs may exclude patients from the hospital’s or unit’s inpatient population for purposes of calculating the applicable thresholds associated with the requirements to receive payment as an IRF (commonly referred to as the “60 percent rule”) if an IRF admits a patient solely to respond to the emergency and the patient’s medical record properly identifies the patient as such. In addition, during the applicable waiver time period, we would also apply the exception to facilities not yet classified as IRFs, but that are attempting to obtain classification as an IRF.

Care for Patients in Long-Term Care Acute Hospitals (LTCH)s CMS has determined it is appropriate to issue a blanket waiver to long-term care hospitals (LTCHs) to exclude patient stays where an LTCH admits or discharges patients in order to meet the demands of the emergency from the 25-day average length of stay requirement which allows these facilities to be paid as LTCHs.

Emergency Durable Medical Equipment, Prosthetics, Orthotics, and Supplies for Medicare Beneficiaries Impacted by the Emergency CMS has determined it is appropriate to issue a blanket waiver where Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) is lost, destroyed, irreparably damaged, or otherwise rendered unusable or unavailable, contractors have the flexibility to waive replacements requirements such that the face-to-face requirement, a new physician’s order, and new medical necessity documentation are not required. Suppliers must still include a narrative description on the claim explaining the reason why the equipment must be replaced and are reminded to maintain documentation indicating that the DMEPOS was lost, destroyed, irreparably damaged or otherwise rendered unusable or unavailable as a result of the emergency.

For more information refer to the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies for Medicare Beneficiaries Impacted by an Emergency or Disaster fact sheet at https://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/Emergency-DME-Beneficiaries-Hurricanes.pdf.


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Medicare Advantage Plan or other Medicare Health Plan Beneficiaries CMS reminds suppliers that Medicare beneficiaries enrolled in a Medicare Advantage or other Medicare Health Plans should contact their plan directly to find out how it replaces DMEPOS damaged, lost, or unavailable in an emergency. Beneficiaries who do not have their plan’s contact information can contact 1-800-MEDICARE (1-800-633-4227) for assistance.

Replacement Prescription Fills Medicare payment may be permitted for replacement prescription fills (for a quantity up to the amount originally dispensed) of covered Part B drugs in circumstances where dispensed medication has been lost or otherwise rendered unusable or unavailable due to the emergency.

Telehealth Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Prior to this waiver Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.

There are three main types of virtual services physicians and other professionals can provide to Medicare beneficiaries:

• Medicare telehealth visits

• Virtual check-ins

• e-visits

For more information, review the Medicare Telemedicine Health Care Provider Fact Sheet at: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet and Medicare Telehealth Frequently Asked Questions at: https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf.

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Summary of Medicare Telemedicine Services

TYPE OF SERVICE

WHAT IS THE SERVICE?

HCPCS/CPT CODE Patient Relationship with Provider

MEDICARE TELEHEALTH VISITS

A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include: • 99201-99215 (Office or other outpatient visits) • G0425-G0427 (Telehealth consultations, emergency department or initial inpatient) • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs). For a complete list: https://www.cms.gov/Medicare/Medicare-general-information/telehealth/telehealth-codes

For new* or established patients. *To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

VIRTUAL CHECK-IN

A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

HCPCS code G2012 HCPCS code G2010

For established patients

E-VISITS A communication between a patient and their provider through an online patient portal

• 99431 • 99422 • 99423 • G2061 • G2062 • G2063

For established patients


19 04/2020

Additional Information Review information on the current emergencies webpage at https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Current-Emergencies-page.

If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

Providers may also want to view the Survey and Certification Frequently Asked Questions at https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/index.html.

Document History

Date of Change Description March 18, 2020 We revised this article to include information about the Telehealth waiver. All

other information remains the same. March 16, 2020 Initial article released.

MAC SATISFACTION INDICATOR (MSI) SURVEY INFORMATION

MSI Live Announcement: Evaluate Our Services

The MAC Satisfaction Indicator (MSI) is the best way to share your opinions directly with the Centers for Medicare & Medicaid Services (CMS) about your experience with Palmetto GBA. These survey results will help us gain valuable insights and determine process improvements moving forward.

The survey for The survey for Home Health and Hospice providers is now available (https://www.surveygizmo.com/s3/5439699/?MAC_BRNC=11&MAC=JM-Palmetto)

20 04/2020


HOME HEALTH AND HOSPICE INFORMATION

Ensure Required Patient Assessment Information for Home Health Claims

MLN Matters Number: SE20010 Article Release Date: March 9, 2020 Related CR Transmittal Number: N/A Related Change Request (CR) Number: N/A Effective Date: N/A Implementation Date: N/A

Provider Types Affected This MLN Matters Article is for Home Health Agencies (HHAs) who bill Medicare Administrative Contractors (MACs) for Home Health services provided to Medicare beneficiaries.

Provider Action Needed Special Edition (SE) article SE20010 reminds Home Health Agency (HHA) providers what steps need to be taken to make sure claims match the corresponding Outcome and Assessment Information Set (OASIS) assessment successfully. Be sure your billing staff is aware of this information.

Background For several years, Medicare systems have checked for a corresponding OASIS assessment upon receipt of a final home health claim. This was to ensure the claim met the requirement of Code of Federal Regulations (CFR) 42 CFR 484.210(e) that submission of an OASIS assessment is a condition of payment. This check also validated whether the Health Insurance Prospective Payment System (HIPPS) code on claims was consistent with HIPPS codes calculated in the assessment system.

Home health claims with statement covers “From” dates on or after January 1, 2020, are paid under the Patient-Driven Groupings Model (PDGM). Under the PDGM, matching a claim to the OASIS assessment is more important than ever. HIPPS codes are no longer calculated in the assessment system, known as the Internet Quality Improvement and Evaluation System (iQIES). Instead, iQIES provides the claims system (the Fiscal Intermediary Shared System (FISS)), with the OASIS items used for payment grouping under the PDGM. The HIPPS code is calculated by Medicare’s Grouper program with FISS.

There are steps an HHA can take to make sure claims match to the OASIS assessment successfully.

Refer to OASIS Validation Reports

Before submitting an HH claim to your MAC, HHAs should ensure the OASIS assessment has completed processing and was successfully accepted into iQIES. HHAs can verify this by reviewing their OASIS Final Validation Report (FVR). Additional information concerning OASIS submission and the FVR is available at https://qtso.cms.gov/reference-and-manuals/quick-reference-guide-oasis-submissions-and-final-validation-reports.


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If a claim is submitted and Medicare systems do not find the matching assessment, the claim is Returned to the Provider (RTP) with FISS reason code 37253. Typically, there is no need to call the iQIES help desk for assistance in resolving this reason code.

HHAs should take the following steps:

1. Double-check the FVR to confirm the receipt date shows the OASIS was accepted by iQIES before you submitted your claim. This date is shown on Page 1 of the report, in the field labeled, “Completion Date/Time.” Also, ensure that the assessment has not been inactivated.

• If the OASIS was submitted after the claim, resubmit the claim

• If the assessment was inactivated, resubmit the assessment.

2. Ensure the assessment is one that is used for determining PDGM payments. The Reason for Assessment (RFA) (OASIS Item M0100) must be equal to 01, 03, 04, or 05. Note that RFA 05 is new to the matching process with PDGM.

• If the claim matches an assessment that is for another reason, update the occurrence code 50 date on the claim to correspond to the M0090 date of the applicable assessment and resubmit the claim.

3. Ensure you have submitted occurrence code 50 on any PDGM claims, reporting the assessment completion date (item M0090) as the associated date. This code is new with the PDGM. • If the occurrence code is missing, update the claim and resubmit it.

4. Check the items Medicare systems use to match the claim and OASIS, making sure that they are the same on both submissions. These are:

• Your CMS Certification Number (OASIS item M0010)

• Beneficiary Medicare Number (OASIS item M0063)

• Assessment Completion Date (OASIS item M0090)

• If any of these items do not match, correct the claim or the assessment, then resubmit.

Note: Changes to a beneficiary’s Medicare Beneficiary Identifier (MBI) can affect the match. If an HHA becomes aware of a change to the MBI via the MBI look-up tool and uses the new MBI on their claim when the prior MBI was used on the OASIS, that will cause the claim to be returned with reason code 37253. In these cases, HHAs should update item M0063 on the OASIS and then resubmit the claim.If a claim with correct and matching information continues to RTP, the HHA should reach out to their MAC and provide:

• The claim document control number (DCN)

• The validation report’s Page 1, showing the Completion Date/Time the batch of OASIS assessments was received

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• The validation report’s page for the OASIS assessment in question, showing the RFA, Medicare Number, and M0090 date

• Any other information requested by the MAC to confirm the matching OASIS

This information will enable Medicare to research the issue.

Additional Information If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

Document History

Date of Change Description March 9, 2020 Initial article released.

Accepting Payment from Patients with a Medicare Set-Aside Arrangement

MLN Matters Number: SE17019 Revised Article Release Date: February 19, 2020 Related CR Transmittal Number: N/A Related Change Request (CR) Number: N/A Effective Date: N/A Implementation Date: N/A

Note: We revised this article on February 19, 2020, to add information about submitting electronic attestations via the WCMSAP. This is in the Additional Information Section of the article. We added a note on page 2, regarding WCMSA funds. We also updated the link to an updated version of the WCMSA Reference Guide. All other information remains the same.

Provider Type Affected This MLN Matters Article is for providers, physicians, and other suppliers who are told by patients that they must pay the bill themselves because they have a Medicare Set-Aside Arrangement (MSA).

What You Need To Know This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals, indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a MSA and must pay for their services themselves. This article explains what an MSA is and explains why it is appropriate to accept payment from a patient that has a funded MSA. Please review your billing practices to be sure they are in line with the information provided.


23 04/2020

Background Medicare is always a secondary payer to liability insurance (including self-insurance), no-fault insurance, and workers’ compensation benefits. The law precludes Medicare payment for services to the extent that payment has been made or can reasonably be expected to be made promptly. When future medical care is claimed, or a settlement, judgment, award, or other payment releases (or has the effect of releasing) claims for future medical care, it can reasonably be expected that the monies from the settlement, judgment, award, or other payment are available to pay for future medical items and services which are otherwise covered and reimbursable by Medicare.

Medicare should not be billed for future medical services until those funds are exhausted by payments to providers for services that would otherwise be covered and reimbursable by Medicare.

Medicare should not be billed for future medical services until those funds are exhausted by payments to providers for services that would otherwise be covered and reimbursable by Medicare.

An MSA is a financial arrangement that allocates a portion of a settlement, judgment, award, or other payment to pay for future medical services. The law mandates protection of the Medicare trust funds but does not mandate an MSA as the vehicle used for that purpose. MSAs are the most frequently used formal method of preserving those funds for the Medicare beneficiary to pay for future items or services which are otherwise covered and reimbursable by Medicare and which are related to what was claimed or the settlement, judgment, award, or other payment had the effect of releasing. These funds must be exhausted before Medicare will pay for treatment related to the claimed injury, illness, or disease.

Medicare beneficiaries are advised that before receiving treatment for services to be paid by their MSA, they should advise their health care provider about the existence of the MSA. They are also notified that their health care providers should bill them directly, and that they should pay those charges out of the MSA if:

• The treatment or prescription is related to what was claimed or the settlement, judgment, award, or other payment had the effect of releasing AND

• The treatment or prescription is something Medicare would cover.

The obligation to protect the Medicare trust funds exists regardless of whether or not there is a formal CMS approved MSA amount. A Medicare beneficiary may or may not have documentation they can provide the physician, provider, or supplier from Medicare approving a Medicare Set-Aside amount.

Provider Action Needed Where a patient who is a Medicare beneficiary states that he/she is required to use funds from the settlement, judgment, award, or other payment to pay for the items or services related to what was claimed or which the settlement, judgment, award, or other payment, it is appropriate for you to document your records with that information and accept payment directly from the patient for such services.

Note: Providers should also accept payment from professional administrators holding Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) funds. Providers should not bill Medicare where a third party holds and administers one of these WCMSA funds.

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Note: Providers should also accept payment from professional administrators holding Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) funds. Providers should not bill Medicare where a third party holds and administers one of these WCMSA funds.

Additional Information If you have questions, your MACs may have more information. Find their website at http://go.cms.gov/MAC-website-list.

You can review a related document (Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Downloads/WCMSA-Reference-Guide-Version-3_0.pdf)) published in 2019. Beneficiaries may submit a WCMSA attestation electronically through the WCMSA Portal (WCMSAP), or send by mail, either as paper documents or CD. Using the WCMSAP for a WCMSA submission or attestation is the recommended approach as it is more efficient than mailing this information. For information about how to use the WCMSAP (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/WCMSAP/WCMSA-Portal , please see the WCMSAP page.

Document History

Date of Change Description February 19, 2020 We revised the article to add information about submitting electronic

attestations via the WCMSAP. This is in the Additional Information Section of the article. We added a note on page 2, regarding WCMSA funds. We also updated the link to an updated version of the WCMSA Reference Guide.

July 2, 2019 We revised this article to add a link to the Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide (https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Workers-Compensation-Medicare-Set-Aside-Arrangements/Downloads/WCMSA-Reference-Guide-Version-2_9.pdf)

November 8, 2017 The article was revised to clarify information in the initial release. The title of the article was also changed to better reflect the information.

October 3, 2017 Rescinded September 19, 2017 Initial article issued


25 04/2020

April 2020 Integrated Outpatient Code Editor (I/OCE) Specifications Version 21.1

MLN Matters Number: MM11680 Related CR Release Date: March 6, 2020 Related CR Transmittal Number: R4543CP Related Change Request (CR) Number: 11680 Effective Date: April 1, 2020 Implementation Date: April 6, 2020

Provider Types Affected This MLN Matters Article is for physicians, hospitals, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed CR 11680 provides the Integrated OCE (I/OCE) instructions and specifications for the I/OCE that is being updated for April 1, 2020. Please make sure your billing staff is aware of this update.

Background CR 11680 informs the MACs and the Fiscal Intermediary Shared System (FISS) maintainer that the I/COE is being updated for April 1, 2020. The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated I/OCE.

This I/OCE will be used in the Outpatient Prospective Payment System (OPPS) and for non-OPPS claims for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a Home Health Agency (HHA) not under the HH PPS or to a hospice beneficiary for the treatment of a non-terminal illness.

The I/OCE specifications will be posted on the Centers for Medicare & Medicaid Services website at http://www.cms.gov/OutpatientCodeEdit/.

Table 1: Summary of Quarterly Release Modifications

Type Effective Date Edits Affected

Modification

Logic 04/01/2020 24 Modify the software to maintain 28 prior quarters (7 years) of programs in each release. Remove older versions with each release. The earliest date included for this release is 07/01/2013.

26 04/2020


Logic 01/01/2017 Add new payment method flag of X (Contractor bypass applied to Section 603 service with no reduction applied in OPPS Pricer) to be returned on output to identify a line(s) that have had a Contractor bypass applied to a Section 603 item or service that is not applicable for a reduction in Pricer.

Note: The Contractor Bypass function is a CMS/Contractor related function and is not meant to be used by other end users or providers. See Contractor (MAC) Actions Impacting IOCE Processing for more information.

Logic 01/21/2020 68 Apply mid-quarter edit 68 (Service provided prior to date of NCD approval) to HCPCS 20560, 20561, 97810, 97811, 97813, 97814, if reported before 01/21/2020.

Logic 04/01/2020 1 Update diagnosis code editing for validity, based on the FY 2020 ICD-10-CM code update to include diagnosis code U07.0 (Vaping-related disorder) effective 04/01/2020.

Documentation 04/01/2020 10, 23, 24, 44, 84

Update notes within edit descriptions for edits 10, 23, and 24, 44 and, 84.


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Content 04/01/2020 Make all HCPCS/APC/SI changes as specified by CMS. Updates were made to the following lists (please review the Quarterly Data Table Reports for additional detail). Due to the new table and file structure for January 2020, the tables that are updated which reference a list are specified below. MAP_ADDON_TYPE I

• Addon Type I procedures (edit 106)

MAP_ADDON_TYPE III

• Addon Type III procedures (edit 108)

DATA_HCPCS

• Information Only Service list (edit 112)

• FQHC Non-Covered list

• Device Procedure Edit 92 Bypass list (edit 92)

• Non-covered services lists (SI = E1, for edits 9)

• Non-reportable for OPPS list (SI = B, edit 62)

• Procedure and Sex Conflict list (female only) (edit 8)

• Terminated Device Procedure flag

OFFSET_HCPCS

• Terminated Device Procedure Offset (Retroactively deleted 2 codes from table)

MAP CONFLICT RHC

• RHC CG modifier non-payable conflict

28 04/2020


Content 04/01/2020 Make all HCPCS/APC/SI changes as specified by CMS. Updates were made to the following lists (please review the Quarterly Data Table Reports for additional detail). Due to the new table and file structure for January 2020, the tables that are updated which reference a list are specified below. MAP_ADDON_TYPE I

• Addon Type I procedures (edit 106)

MAP_ADDON_TYPE III

• Addon Type III procedures (edit 108)

DATA_HCPCS

• Information Only Service list (edit 112) • FQHC Non-Covered list • Device Procedure Edit 92 Bypass list (edit 92) • Non-covered services lists (SI = E1, for edits 9) • Non-reportable for OPPS list (SI = B, edit 62) • Procedure and Sex Conflict list (female only) (edit

8) • Terminated Device Procedure flag

OFFSET_HCPCS

• Terminated Device Procedure Offset (Retroactively deleted 2 codes from table)

MAP CONFLICT RHC

• RHC CG modifier non-payable conflict Content 04/01/2020 20, 40 Implement version 26.1 of the NCCI (as modified for

applicable outpatient institutional providers). Additional Information The official instruction, CR 11680, issued to your MAC regarding this change is available at https://www.cms.gov/files/document/r4543CP.pdf.


Document History

Date of Change Description March 6, 2020 Initial article released.


29 04/2020

Claims Payment Issues Log

Palmetto GBA wants to keep you in the know, and one way we do this is by publishing a Claims Payment Issues Log. This log lets you know about any current system-related payment and processing issues. Many of these issues are reported to the Centers for Medicare & Medicaid Services (CMS), as well as the Multi-Carrier System (MCS) or Fiscal Intermediary Shared System (FISS) maintainers.

If this log has an issue that impacts your claims and you’ve read about it on our site, sign up for an email to let you know if the article has been updated and/or the problem has been resolved. To do this, enter your information into the “Article Update Notification” box at the bottom of the individual log, and you’ll receive an email notice every time the log is changed.

To access these logs, please use the following links:

JJ Part A: https://www.palmettogba.com/palmetto/providers.nsf/DocsR/JJ-Part-A~AU2STG2520

JJ Part B: https://www.palmettogba.com/palmetto/providers.nsf/DocsR/JJ-Part-B~AVGL3B4132

JM Part A: https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/JM-Part-A~8X7LPG4107

JM Part B: https://www.palmettogba.com/palmetto/providers.nsf/docsCat/Providers~JM%20Part%20B~Browse%20by%20Topic~Claims%20Processing%20Issues%20Log

JM HHH: https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/JM-Home-Health-and-Hospice~8XMNAE5202

Railroad Medicare (RRB SMAC): https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad-Medicare~9AERC83708

eTicket Enables Providers to Save Time with Every Call

Palmetto GBA continues to develop tools to improve service and efficiency, and our new eTicket is no exception.

eTicket, like the recently introduced ePass, will save you time when contacting the Provider Contact Center (PCC) about a particular issue on multiple occasions. While ePass provides you with a code to bypass authentication on subsequent calls to the PCC during a single day, eTicket enables our representatives to serve you quickly and with greater effectiveness.

When you speak to a customer care representative by phone, a numeric inquiry number or eTicket is generated which provides a reference to the subject matter of your conversation with our PCC. When you call us with additional follow-up questions or for more information specific to a prior call, you can input your eTicket number into the IVR. Upon being transferred to a service representative, your topic of inquiry and data related to your previous call with Palmetto GBA will automatically be presented on the service representative’s screen, expediting their ability to serve you.

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Palmetto GBA welcomes you to eTicket. Look for additional information at www.PalmettoGBA.com, in our Listserv newsletters and on Palmetto GBA’s social media channels.

Never Share Your eServices User ID and Password

Palmetto GBA puts a priority on stability and security as far as our eServices portal is concerned, and your participation in keeping eServices secure is important.

Each eServices user should have his or her separate user ID and password. We prohibit sharing of user IDs and passwords in order to maintain the integrity of the system. Palmetto GBA will delete, without notice, any user names we find that are generic and any accounts that have a shared user ID.

If you are currently not using eServices, (https://www.onlineproviderservices.com/ecx_improvev2/initLogin.do) our user-friendly internet portal, we encourage you to register today. It’s easy and it’s free.


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ePass is Now Available to Ease the Burden of Repeated Authentication When Calling Palmetto GBA’s Provider Contact Center

Authentication is required before Palmetto GBA is authorized to discuss Medicare information with a provider. The ePass is an eight-digit code providers can elect to receive, per each NPI and PTAN combination, following their first-time authentication when they call the Provider Contact Center (PCC). This ePass can then be used for the remainder of the day in order to authenticate. This code will be delivered in one of two ways:

• Through the IVR, follow the first-time authentication steps by selecting Option 5 for ePass and then Option 2 to receive ePass; or

• Request your ePass verbally while speaking with a Customer Service Agent (CSA) following first-time authentication

The goal of the ePass is to ease provider burden by eliminating the need to repeatedly authenticate each time you contact the PCC in a given day. The ePass can then be used for the remainder of that business day in order to authenticate. Simply select Option 5 for ePass and Option 1 to enter your 8-digit ePass number.

This enhancement is in direct response to provider feedback with the goal of improving your provider experience with Palmetto GBA

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Get Your Medicare News Electronically

The Palmetto GBA Medicare listserv is a wonderful communication tool that offers its members the opportunity to stay informed about:

• Medicare incentive programs • Fee Schedule changes• New legislation concerning Medicare • And so much more!

How to register to receive the Palmetto GBA Medicare Listserv:

Go to http://tinyurl.com/PalmettoGBAListserv and select “Register Now.” Complete and submit the online form. Be sure to select the specialties that interest you so information can be sent.

Note: Once the registration information is entered, you will receive a confirmation/welcome message informing you that you’ve been successfully added to our listserv. You must acknowledge this confirmation within three days of your registration.

Medicare Learning Network® (MLN)

Want to stay informed about the latest changes to the Medicare Program? Get connected with the Medicare Learning Network® (MLN) – the home for education, information, and resources for health care professionals.

The Medicare Learning Network® is a registered trademark of the Centers for Medicare & Medicaid Services (CMS) and the brand name for official CMS education and information for health care professionals. It provides educational products on Medicare-related topics, such as provider enrollment, preventive services, claims processing, provider compliance, and Medicare payment policies. MLN products are offered in a variety of formats, including training guides, articles, educational tools, booklets, fact sheets, web-based training courses (many of which offer continuing education credits) – all available to you free of charge!

The following items may be found on the CMS web page at: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.html

• MLN Catalog: is a free interactive downloadable document that lists all MLN products by media format. To access the catalog, scroll to the “Downloads” section and select “MLN Catalog.” Once you have opened the catalog, you may either click on the title of a product or you can click on the type of “Formats Available.” This will link you to an online version of the product or the Product Ordering Page.


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• MLN Product Ordering Page: allows you to order hard copy versions of various products. These products are available to you for free. To access the MLN Product Ordering Page, scroll to the “Related Links” and select “MLN Product Ordering Page.”

• MLN Product of the Month: highlights a Medicare provider education product or set of products each month along with some teaching aids, such as crossword puzzles, to help you learn more while having fun!

Other resources:

• MLN Publications List: contains the electronic versions of the downloadable publications. These products are available to you for free. To access the MLN Publications go to: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/MLN-Publications.html. You will then be able to use the “Filter On” feature to search by topic or key word or you can sort by date, topic, title, or format.

MLN Educational Products Electronic Mailing ListTo stay up-to-date on the latest news about new and revised MLN products and services, subscribe to the MLN Educational Products electronic mailing list! This service is free of charge. Once you subscribe, you will receive an e-mail when new and revised MLN products are released.

To subscribe to the service:

1. Go to https://list.nih.gov/cgi-bin/wa.exe?A0=mln_education_products-l and select the ‘Subscribe or Unsubscribe’ link under the ‘Options’ tab on the right side of the page.

2. Follow the instructions to set up an account and start receiving updates immediately – it’s that easy!

If you would like to contact the MLN, please email CMS at [email protected].

MEDICARE BENEFICIARY IDENTIFIER (MBI) INFORMATION

Medicare Beneficiary Identifier (MBI) Look-up Tool

The Medicare Beneficiary Identifier (MBI) Lookup tool allows providers to use our secure eServices online portal to obtain the new MBI number when patients do not present their Medicare card. If you do not already have access, sign up (https://www.onlineproviderservices.com/ecx_improvev2/initLogin.do) now for access to eServices to use the tool.

As background, the New Medicare Card Project was established in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 which mandates the removal of the Social Security Number (SSN)-based Health Insurance Claim Number (HICN) from Medicare cards by April, 2019. CMS began mailing new Medicare cards with the MBI on April 2, 2018.

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From April 1, 2018, to December 31, 2019, CMS will offer a transition period during which the system will accept both HICNs and MBIs on Medicare transactions (including eligibility requests and claims) for beneficiaries in the Medicare program prior to April 1, 2018 (i.e., those who received an HICN on their Medicare card). The transition period ensures your Medicare patients continue to get care by allowing you to use either the HICN or the MBI for all Medicare transactions. Note: Providers should not submit both numbers on the same transaction.

Beginning in January, 2020, providers may only use MBIs, with limited exceptions,

To submit an inquiry you must do the following:

• Once logged into eServices, click on the MBI LOOKUP tab located in the header of the portal

• Complete the required* fields:

o Beneficiary’s Last Name

o First Name

o Date of Birth

o Social Security Number (Note: the social security number must be in the XXX-XX-XXXX format)

• To meet our CAPTCHA requirements, you must select the I’M NOT A ROBOT checkbox

• Click SUBMIT INQUIRY


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Figure 1: MBI Lookup Tab

Lookup Tool Status ResultsIf the inquiry successfully returns an MBI, the screen will refresh with the data at the bottom.

Figure 2: MBI Lookup Successful Response Screenshot

In the event that your MBI Lookup request does not result in a successful response, eServices will display an error message to assist you. If any required fields are left blank or are not in a proper format, a message will appear advising you which fields to correct.

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Figure 3: MBI Lookup Unsuccessful Response Screenshot

Check the CMS New Medicare Card Project Outreach & Education (https://www.cms.gov/Medicare/New-Medicare-Card/Outreach-and-Education/Outreach-and-education.html) webpage and the Medicare Beneficiary Identifier (MBI) Lookup Tool Clarification article (https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2018-05-17-eNews.pdf) for additional information.

ELECTRONIC DATA INTERCHANGE (EDI) INFORMATION

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

MLN Matters Number: MM11638 Related CR Release Date: February 21, 2020 Related CR Transmittal Number: R4536CP Related Change Request (CR) Number: 11638 Effective Date: July 1, 2020 Implementation Date: July 6, 2020

Provider Types Affected This MLN Matters Article is for physicians, providers, and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed CR 11638 updates the Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) lists and instructs the ViPS Medicare System (VMS) and Fiscal Intermediary Shared System (FISS) maintainers to update Medicare Remit Easy Print (MREP) and PC Print software. Be sure your billing staffs are aware of these changes and obtain the updated MREP and PC Print versions if they use that software.

Background The Health Insurance Portability and Accountability Act of 1996 (HIPAA) instructs health plans to conduct standard electronic transactions adopted under HIPAA using valid standard codes. Medicare policy states that, as appropriate, CARCs and RARCs are required in the remittance advice and coordination of benefits transactions. CARCs and RARCs provide either supplemental explanation for a monetary adjustment or policy information that generally applies to the monetary adjustment.


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The Centers for Medicare & Medicaid Services (CMS) instructs MACs to conduct updates based on the RARC/CARC code update schedule that results in publication three times per year, around March 1, July 1, and November 1.

CMS provides a code update notification indicating when updates to CARC and RARC lists are made available on the Washington Publishing Company (WPC) website. The Medicare system maintainers have the responsibility to implement code deactivation, making sure that any deactivated code is not used in original business messages and allowing the deactivated code in derivative messages. The maintainers must make sure that Medicare does not report any deactivated code on or after the effective date for deactivation as posted on the WPC website. If any new or modified code has an effective date later than the implementation date specified in CR11638, MACs must implement on the date specified on the WPC website, which is http://wpc-edi.com/Reference/.

A discrepancy between dates may arise, as the WPC website is only updated three times per year and may not match the CMS release schedule. MACs and system maintainers must get the complete list for both CARCs and RARCs from the WPC website to obtain the comprehensive lists for both code sets and determine the changes that are included on the code list since the last code update (CR11489).

Additional Information The official instruction, CR 11638, issued to your MAC regarding this change, is available at https://www.cms.gov/files/document/r4536CP.pdf.


Document History

Date of Change Description February 24, 2020 Initial article released.

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ESERVICES INFORMATION

New eServices Appeals Feature

We are live!

Palmetto GBA is pleased to announce that eServices has been enhanced with the addition of new appeals features. Part A and Home Health and Hospice providers that are actively using eServices and have access to the Claims Inquiry tab can get up-to-date appeals status, view and download decision letters, and more. Please contact your eServices administrator for access to the Claims Inquiry tab if you do not already have access.

Do you want to learn about all of the new appeals enhancements? View our on-demand webcast to learn more!

https://event.on24.com/wcc/r/2217457/CFBDBA6C9DAB56A83555A9FFC481B732

eServices Profile Verification Timeframes

eServices Profile Verification has been extended from 90 to 250 days, allowing more time for you to complete this process. During this time, please make sure that all eServices user ID profiles are up to date to avoid interruption or deactivation.

As a result of this change, several additional timeframe alerts have been adjusted.

Pop-ups Pop-ups will be displayed for days 240–249, instead of days 80–89Redirected Accounts will be redirected for days 250–259, instead of days 90–99Deactivated Accounts will be deactivated on day 260, instead of day 100Email Notification

Email Notifications will be sent on day 240 and 250, instead of day 80 and 90


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Do You Have a Question Regarding eServices? We Can Help!

Palmetto GBA has dedicated representatives available to provide technical assistance and answer questions about our secure online portal — eServices. Our Provider Contact Center (PCC) representatives can be reached at 855–567–7271 (Monday – Friday, 8 a.m. to 6 p.m. ET).

To connect with an eServices representative:

• Press/say 1 or EDI

• Press/say 1 or eServices

https://www.palmettogba.com/Palmetto/Providers.Nsf/files/IVR_JJ_Call_Flow.pdf/$File/IVR_JJ_Call_Flow.pdf

How Can We Be Of “eServices” To You!

Do you want to use eServices, but feel you just have too many accounts to keep track of? Palmetto GBA’s portal offer all providers the option to link your provider facilities through our Account Linking feature! Account linking gives users the ability to link their previously assigned eServices user IDs under one default ID. Getting started is simple! Users should log into eServices with the user ID that they wish to designate as their default login ID. This is the user ID that will be used to access the linked accounts. Once the user has successfully logged into eServices, they will select the My Account Tab and then access the Account Linking sub-tab. This will allow the provider to choose the accounts they wish to link.

Note: Providers are only able to link active eServices accounts.Once your accounts are linked you will be able to log in, click a drop down menu that lists all your linked NPI and PTAN combinations attached to your ID, and select the individual account you’d like to view. For complete step-by-step instructions, please view the eServices User Guide (https://www.palmettogba.com/eServicesuserguide).

FEE SCHEDULE INFORMATION

Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - April 2020 Update

MLN Matters Number: MM11661 Revised Related CR Release Date: February 27, 2020 Related CR Transmittal Number: R4540CP Related Change Request (CR) Number: 11661 Effective Date: January 1, 2020 Implementation Date: April 6, 2020

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Note: We revised this article on February 27, 2020, to reflect the revised CR11661 issued on that date. In the article, we changed the MP RVU for code G2013 in Table 2 to 0.28. Also, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

Provider Types Affected This MLN Matters Article is for physicians, providers and suppliers billing Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries and reimbursed using the Medicare Physician Fee Schedule (MPFS).

Provider Action Needed CR 11661 informs you that the Centers for Medicare & Medicaid Services (CMS) issued payment files to the MACs based upon the 2020 MPFS Final Rule, published in the Federal register on November 15, 2019. CR 11661 amends those payment files. Make sure your billing staffs are aware of these changes.

Background Section 1848(c)(4) of the Social Security Act authorizes the Secretary of the Department of Health and Human Services (HHS) to establish ancillary policies necessary to implement relative values for physicians’ services. The updated payment files are effective for services you furnish between January 1, 2020 and December 31, 2020.

Summary of Changes for April 2020 Below is a summary of the changes for the April update to the 2020 MPFS. Unless otherwise stated, these changes are effective for dates of service on and after January 1, 2020.

1. The G codes listed in Table 1 are new codes, effective January 1, 2020.

Table 1: New Codes effective January 1, 2020

Code Action G2168 Status indicator = E; there are no RVUs, payment policy indicators do not apply. G2169 Status indicator = E; there are no RVUs, payment policy indicators do not apply.

Note: For new codes, please refer to the following link for more information: https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update


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2. The HCPCS codes listed in Table 2 have revisions to Relative Value Units, effective for dates of service on and after January 1, 2020.

Table 2: HCPCS Codes with Revisions to Relative Value Units

Code Modifier Action G0105 53 Non-Facility PE RVU change = 2.88, MP RVU change = 0.20 G0121 53 Non-Facility PE RVU change = 2.88, MP RVU change = 0.21 44388 53 Non-Facility PE RVU change = 2.79, MP RVU change = 0.20 45378 53 Non-Facility PE RVU change = 2.88, MP RVU change = 0.21 G2001 MP RVU change = 0.05G2002 MP RVU change = 0.08G2003 MP RVU change = 0.13G2004 MP RVU change = 0.22G2005 MP RVU change = 0.28G2006 MP RVU change = 0.05G2007 MP RVU change = 0.09G2008 MP RVU change = 0.13G2009 MP RVU change = 0.22G2013 MP RVU change = 0.28

3. The HCPCS codes listed in Table 3 have been revised, effective for dates of service on and after January 21, 2020. Please see the following link for more information regarding these codes: https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=295

Table 3: Revised HCPCS codes

Code Action20560 Status code indicator change = A, Multiple Procedure indicator = 0, Bilateral Surgery

indicator = 0, Assistant at Surgery indicator = 1, Co-Surgeons indicator = 0, Team Surgeons indicator = 0, Professional/Technical Component indicator = 0

20561 Status code indicator change = A, Multiple Procedure indicator = 0, Bilateral Surgery indicator = 0, Assistant at Surgery indicator = 1, Co-Surgeons indicator = 0, Team Surgeons indicator = 0, Professional/Technical Component indicator = 0

97810 Status Code indicator change = A, Multiple Procedure indicator = 0, Bilateral Surgery indicator = 0, Assistant at Surgery indicator = 1, Co-Surgeons indicator = 0, Team Surgeons indicator = 0, Professional/Technical Component indicator = 0

97811 Status code indicator change = A, Multiple Procedure indicator = 0, Bilateral Surgery indicator = 0, Assistant at Surgery indicator = 1, Co-Surgeons indicator = 0, Team Surgeons indicator = 0, Professional/Technical component indicator = 0

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The Relative Value Units (RVU) for these codes are listed below.

Code Work RVU Non Facility PE RVU

Facility PERVU

MPRVU

20560 0.32 0.39 0.12 0.0320561 0.48 0.57 0.18 0.0597810 0.60 0.40 0.23 0.0597811 0.50 0.25 0.19 0.0597813 0.65 0.47 0.25 0.0597814 0.55 0.36 0.21 0.05

4. The G code listed in Table 4 is no longer valid on the MPFS effective for dates of service on and after April 01, 2020.

Table 4: G Code No Longer Valid

Code Action G1000 Status Change to I

5. The G codes listed in Table 5 are new codes, effective April 01, 2020. CR 11550 implemented these codes.

Table 5: New G Codes Code Action G1012 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1013 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1014 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1015 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1016 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1017 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1018 Status indicator = X, there are no RVUs, payment policy indicators do not apply G1019 Status indicator = X, there are no RVUs, payment policy indicators do not apply

Please see https://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets/HCPCS-Quarterly-Update for more information on the above new codes.


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Additional Information The official instruction, CR11661, issued to your MAC regarding this change, is available at https://www.cms.gov/files/document/r4540cp.pdf.


Document History

Date of Change Description February 27, 2020 We revised this article to reflect the revised CR11661 issued on that date. In

the article, we changed the MP RVU for code G2013 in Table 2 to 0.28. Also, we revised the CR release date, transmittal number, and the web address of the CR. All other information remains the same.

February 18, 2020 Initial article released.

HOME HEALTH REVIEW CHOICE DEMONSTRATION (RCD) INFORMATION

Need to stay abreast of the newest information regarding the Home Health Review Choice Demonstration (RCD)?

Palmetto GBA has created a special listserv category just for you! This will allow you to receive the most up to date information available.

Already receive Palmetto GBA Listservs?

• Sign into your listserv profile by selecting the Log In external link button on the Email updates page

• Scroll down to Step 3 – Select your Specialties

• Select the JM Home Health and Hospice link on the left side of the screen

• Select the “Home Health Review Choice Demonstration” category

• This new category will show up at the top of your chosen list

• Scroll down and select “Update Profile”

Not registered to receive listservs from Palmetto GBA? Registering is quick, easy and free! Sign up now to receive email updates. If you would like to receive these updates by email, you must register (https://www.palmettogba.com/registration.nsf/newie?OpenForm) and create a customized profile of the documents you would like to receive. Be sure to include the new Home Health Review Choice Demonstration category in your selection.

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LEARNING AND EDUCATION INFORMATION

2020 Medical Review (MR) Hot Topic Targeted Probe and Educate (TPE) Teleconference Schedule

Palmetto GBA will host a series of Medical Review Hot Topic Targeted Probe and Educate (TPE) Teleconferences in 2020. These calls are open to all providers. Please mark your calendars to join our Medical Review Subject Matter Experts as they discuss and answer your questions concerning current TPE process.

Medical Review Hot Topic Targeted Probe and Educate TeleconferenceDate June 1, 2020 September 8, 2020 December 7, 2020Time 2 p.m. - 3 p.m. ET 2 p.m. - 3 p.m. ET 2 p.m. - 3 p.m. ETParticipation Number

(877) 789-3907 (877) 789-3907 (877) 789-3907

Confirmation ID Number

9494605 9527339 3476497

Educational Events Where You Can Ask Questions and Get Answers from Palmetto GBA

Don’t Miss this Wonderful Opportunity!If you are in search of an opportunity to interact with and get answers to your Medicare billing, coverage and documentation questions from Palmetto GBA’s Provider Outreach and Education (POE) department, please see these educational offerings which have a question and answer session.

To access the following information, go to: https://www.palmettogba.com/palmetto/providers.nsf/DocsCat/JM-Home-Health-and-Hospice~AH2JQU8321

Quarterly Ask the Contractor Teleconferences (ACTs)

ACTs are intended to open the communication channels between providers and Palmetto GBA, which allows for timely identification of problems and information-sharing in an informal and interactive atmosphere. These teleconferences will be held at least quarterly via teleconference.

Preceding the presentation, providers are given an opportunity to ask questions both on the topics discussed as well as any other question they may have. While we encourage providers to submit questions prior to the call, this is not required. Just fill out the Ask the Contractor Teleconference (ACT): Submit A Question form). Once the form is completed, please fax it to (803) 935-0140, Attention: Ask-the-Contractor Teleconference


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Quarterly Updates Webcasts The Quarterly Update Webcasts are intended to provide ongoing, scheduled opportunities for providers to stay up to date on Medicare requirements.

Providers are able to type a question and have it responded to by the POE department throughout the webcast. At the end of the presentation the moderator will also read and respond to questions submitted by attendees in order to share the responses with the group at large.

Event Registration Portal Visit our Event Registration Portal to find information on upcoming educational events and seminars.

This is a complete listing of both our face-to-face outreach opportunities as well as our teleconference and webcast listings. Providers are able to dialogue with POE and get answers to their questions at all of these educational events.

If you have a question that you need an answer to today or a claims specific question which requires the disclosure of PII or PHI for response, please contact the Provider Contact Center (PCC) at 1-855-696-0705.

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PROVIDER ENROLLMENT INFORMATION

You Can Track Your Enrollment Application

Palmetto GBA makes it easy for you to track your enrollment application with our Application Status Lookup Tool. This tool provides tracking data for application types 855A, 855B, 855I, 855R and 855O, and Medicare Diabetes Prevention Program. Additionally, the tool will provide updates on submitted CMS 588 (EFT), CMS 460 (Participating Agreement), reconsideration requests, opt-out affidavits, license updates and voluntary terminations requests.

Enrollment Application Status Lookup links: JJA: https://www.palmettogba.com/internet/PCIDN.nsf/R?OpenAgent&DID=BBHR2975&url=yes HHH: https://www.palmettogba.com/internet/PCIDN.nsf/R?OpenAgent&DID=BBHR3825&url=yes JMA: https://www.palmettogba.com/internet/PCIDN.nsf/R?OpenAgent&DID=BBBR3N28&url=yes


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This advisory should be shared with all health care practitioners and managerial members of the provider/supplier staff. Medicare Advisories are available at no cost from the Palmetto GBA website at www.PalmettoGBA.com/hhh.

Address Changes

Have you changed your address or other significant information recently? To update this information, please complete and submit a CMS 855A form. The most efficient way to submit your information is by Internet-based Provider Enrollment, Chain and Ownership System (PECOS). To make a change in your Medicare enrollment information via the Internet-based PECOS, go to https://pecos.cms.hhs.gov on the CMS website. To obtain the hard copy form plus information on how to complete and submit it, visit the Palmetto GBA website (www.PalmettoGBA.com/hhh).

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TOOLS THAT YOU CAN USE

Medicare Secondary Payer (MSP) Coding Module

This module provides a quick reference to the most common condition, occurrence, value, patient relationship, remarks field and primary payer codes associated with Medicare Secondary Payer (MSP) claims.

To access this module and other online training courses, please go to the Self-Paced Learning Section (https://www.palmettogba.com/palmetto/providers.nsf/Docs/Providers~JM%20Home%20Health%20and%20Hospice~Learning%20Education~Self-Paced%20Learning) of the HHH website.


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HELPFUL INFORMATION

Contact Information for Palmetto GBA Home Health and Hospice

Provider Contact Center: 855-696-0705

Email Part A: https://www.palmettogba.com/palmetto/Feedback.nsf/Feedback?OpenForm&SendTo=08

To contact a specific JM HHH department, please select the link below:

https://www.palmettogba.com/palmetto/providers.nsf/cudocs/JM%20Home%20Health%20and%20Hospice?open&Expand=1

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NOTES


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