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July 2014

1. SIE O lt m IE m gt L Ro as 78 w O m 12 For Home Health and Hospice Providers MM8684 Claim Status Category and Claim Status Codes Update The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8684 Related Change Request CR CR 8684 Related CR Release Date May 23 2014 Effective Date October 1 2014 Related CR Transmittal R2967CP Implementation Date October 6 2014 Provider Types Affected This MLN Matters article is intended for physicians providers and suppliers submitting claims to Medicare administrative contractors MACs including durable medical equipment Medicare administrative contractors DME MACs and home health amp hospice MACs HH amp H MACs for services to Medicare beneficiaries BIE lt m IE m gt T Ro T 0A I O m Provider Action Needed This article is based on CR 8684 which informs the MACs of the changes to Claim Status Category Codes and Claim Status Codes Make sure that your billing personnel are aware of these changes Background The Health Insurance Portability and Accountability Act HIPAA requires all health care ben
2. A Valuable Educational Resource a 9 MLN Connects Provider e News 9 MM8456 Rescinded Modifying the Daily Common Working File CWF to Medicare Beneficiary Database MBD File to Include Diagnosis Codes on the Health Insurance Portability and Accountability Act Eligibility j m edi Transaction System HETS 270 271 Transactions 9 l Le r MM8664 Revised April Update to the Calendar n t Year CY 2014 Medicare Physician Fee Schedule e Database MPFSDB 10 Official CMS Information for MM8684 Claim Status Category and Claim Medicare Fee For Service Providers Status Codes Update 13 http www cms gov MLNGenInfo MM8764 July 2014 Integrated Outpatient Code Editor VOCE Specifications Version 15 2 0 14 Bold italicized material is excerpted from the American Medical Association Current Procedural Terminology CPT codes Descriptions and other data only are copyrighted 2009 American Medical Association All rights reserved Applicable FARS DFARS apply MEDICARE BULLETIN GR 2014 07 JULY 2014 ADIdSOH HLIVAH AWOH For Home Health Providers Submit the Correct Document Control Number DCN When Requesting an Ordering Referring Denial Reopening CGS has seen an increase in provider telephone inquiries regarding ordering referring denial reopening adjustments that have gone to the Return to Provider RTP file because the incorrect DCN was submitted on the hardcopy adjustment UB 04 claim XX
3. index html on the CMS website The summary of key changes for providers is in the following table Effective Date Modification Modify the effective begin date for edit 86 from 10 1 2013 to 10 1 2014 to be applied for claims with 10 1 2014 ane hospice bill types 81X and 82X 4 1 2014 Modify the logic for packaged laboratory services If packaged laboratory services are submitted on a 13X bill type with modifier L1 change the Status Indicator SI from N to A 7 4 2014 Make Healthcare Common Procedure Coding System HCPCS Ambulatory Payment Classification APC SI changes as specified by CMS data change files 7 1 2014 Implement version 20 2 of the NCCI as modified for applicable institutional providers 1 1 2014 Add new modifier L1 Separately payable lab test to the valid modifier list 7 1 2014 Add new modifier SZ Habilitative services to the valid modifier list Updated documentation in Appendix F a and Appendix L to include bill type 13x for laboratory services 1 1 2014 ce reported with modifier L1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at E T A 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 14 Effective Date Modification Documentation change only modified Appendix N List B PHP Services t
4. 8664 which amends the payment files that were issued to Medicare contractors based upon the CY 2014 MPFS Final Rule and passage of the Protecting Access to Medicare Act of 2014 which the President signed on April 1 2014 Make sure that your billing staffs are aware of these changes Background The Social Security Act Section 1848 c 4 see http www ssa gov OP_Home ssact title18 1848 htm on the Internet authorizes CMS to establish ancillary policies necessary to implement relative values for physicians services In order to reflect appropriate payment policy as included in the CY 2014 MPFS Final Rule the MPFSDB has been updated with April changes and those necessitated by Protecting Access to Medicare Act of 2014 which the President signed on April 1 2014 This law extends the 0 5 update through December 31 2014 Since the Act extends the MPFSDB policies to all of CY 2014 the April update payment files that were previously created to be effective from January 1 2014 to March 31 2014 can now be used by MACs to be effective from January 1 2014 to December 31 2014 Note Medicare contractors will not search their files to either retract payment for claims already paid or to retroactively pay claims However contractors will adjust claims brought to their attention CR 8664 Summary of Changes The summary of changes for the April 2014 update consists of the following 1 Short Description Correction
5. J15 Home Health and Hospice PO Box 957124 St Louis MO 63195 7124 In addition send the original CMS 838 Certification with a copy of the check to the following address J15 HHH Correspondence CGS Administrators LLC PO Box 20014 Nashville TN 37202 Credit Balance Reports Certification Adjustment Submitted If you have or will be submitting an adjustment please send the CMS 838 to the following address J15 HHH Correspondence CGS Administrators LLC PO Box 20014 Nashville TN 37202 If you have any Credit Balance related questions or are unable to access our website at http Awww cgsmedicare com hhh financial CMS 588 html to obtain a paper copy of the CMS 838 form please contact the Medicare Credit Balance telephone line at 1 866 590 6703 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 8 For Home Health and Hospice Providers Medicare Learning Network A Valuable Educational Resource The Medicare Learning Network MLN offered by the Centers for Medicare amp Medicaid Services CMS includes a variety of educational resources for health care providers Access Web based training courses national provider conference calls
6. WY w O m 21 Table 6 Updated Payment Rates for Certain HCPCS Codes Effective January 1 2014 through March 31 2014 Corrected Corrected Minimum HCPCS Code Status Indicator APC Short Descriptor Payment Rate Unadjusted Copayment J0775 K 1340 Collagenase clost hist inj 38 49 7 70 Operational Change to Billing Lab Tests for Separate Payment As delineated in MLN Matters Special Edition Article SE 1412 issued on March 5 2014 see http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads SE1412 pdf effective July 1 2014 OPPS hospitals should begin using modifier L1 on type of bill TOB 13X when seeking separate payment for outpatient lab tests under the Clinical Laboratory Fee Schedule CLFS in the following circumstances 1 A hospital collects specimen and furnishes only the outpatient labs on a given date of service or 2 A hospital conducts outpatient lab tests that are clinically unrelated to other hospital outpatient services furnished the same day Unrelated means the laboratory test is ordered by a different practitioner than the practitioner who ordered the other hospital outpatient services for a different diagnosis Hospitals should no longer use TOB 14X in these circumstances CMS is providing related updates to the Medicare Claims Processing Manual Publication 100 04 Chapter 2 Section 90 and Chapter 16
7. article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles htm MLN Matters Number MM8664 Revised Related Change Request CR CR 8664 Related CR Release Date April 4 2014 Effective Date January 1 2014 Related CR Transmittal R2923CP Implementation Date April 7 2014 Note This article was revised on April 8 2014 to reflect the revised CR 8664 issued on April 4 The CR was revised to reflect the President signing into law the Protecting Access to Medicare Act of 2014 on April 1 2014 thus averting the expiration of the 0 5 update to the physician fee schedule conversion factor and the 1 0 work floor GPCI which will now remain in effect until December 31 2014 Similar changes were made to this article The CR release date and the Web address for accessing the CR are revised All other information remains the same Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers who submit claims to Medicare claims administration contractors carriers fiscal intermediaries Fls A B Medicare administrative contractors MACs home health and hospices HH amp Hs MACs and or regional HH intermediaries RHHIs for services provided to Medicare beneficiaries Provider Action Needed This article is based on CR
8. as of July 1 2014 CY 2014 CPT Code CY 2014 Long Descriptor July 2014 OPPS Status Indicator July 2014 OPPS APC 0349T Radiologic examination radiostereometric analysis RSA upper extremity ies includes shoulder elbow and wrist when performed X 0261 0350T Radiologic examination radiostereometric analysis RSA lower extremity ies includes hip proximal femur knee and ankle when performed 0261 0351T Optical coherence tomography of breast or axillary lymph node excised tissue each specimen real time intraoperative N A 0352T Optical coherence tomography of breast or axillary lymph node excised tissue each specimen interpretation and report real time or referred N A 0353T Optical coherence tomography of breast surgical cavity real time intraoperative N A 0354T 0355T Optical coherence tomography of breast surgical cavity interpretation and report real time or referred Gastrointestinal tract imaging intraluminal e g capsule endoscopy colon with interpretation and report N A 0142 0356T Insertion of drug eluting implant including punctal dilation and implant removal when performed into lacrimal canaliculus each 0698 0358T Bioelectrical impedance analysis whole body composition assessment supine position with interpretation and report Q1 0340 0359T 0360T Behavior identification assessment by the phy
9. corrected payment rate is listed in Table 5 below and it has been installed in the July 2014 OPPS Pricer effective for services furnished on October 1 2013 through December 31 2013 Your MAC will adjust any claims incorrectly processed if you bring those claims to the attention of your MAC Table 5 Updated Payment Rates for Certain HCPCS Codes Effective October 1 2013 through December 31 2013 Corrected Corrected Minimum HCPCS Code Status Indicator APC Short Descriptor Payment Rate Unadjusted Copayment J2788 K 9023 Rho d immune globulin 50 mcg 25 15 5 03 f Updated Payment Rates for Certain HCPCS Codes Effective January 1 2014 through March 31 2014 The payment rate for one HCPCS code was incorrect in the January 2014 OPPS Pricer The corrected payment rate is listed below in Table 6 and it has been installed in the July 2014 OPPS Pricer effective for services furnished on January 1 2014 through March 31 2014 Your MAC will adjust any claims incorrectly processed if you bring those claims to the attention of your MAC This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 SIE Z m IE m gt L Ro T O
10. health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 SE lt m IE m gt T Ro T 0A I O m 15 further modified by section 101 of the Protecting Access to Medicare Act of 2014 on April 1 2014 for MPFS rates to be effective January 1 2014 to December 31 2014 The summary of Healthcare Common Procedure Coding System HCPCS Code additions for the July 2014 update are shown in the following table HCPCS Short Descriptor Procedure Status Q9970 Inj Ferric Carboxymaltos 1mg E Q9974 Morphine epidural intratheca E 0144 Inj Propofol 10mg 1034 Art pancreas system 1035 Art pancreas inv disp sensor 1036 Art pancreas ext transmitter 1037 Art pancreas ext receiver 0347T Ins bone device for rsa C 0348T Rsa spine exam C 0349T Rsa upper extr exam C 0350T Rsa lower extr exam C 0351T Intraop oct brst node spec C 0352T Oct brst node i amp r per spec C 0353T Intraop oct breast cavity C 0354T Oct breast surg cavity i amp r C 0355T Gi tract capsule endoscopy C 0356T Insrt drug device for iop C 0358T Bia whole body C 0359T Behavioral id assessment C 036
11. 0T Observ behav assessment C 0361T Observ behav assess addl C 0362T Expose behav assessment C 0363T Expose behav assess addl C 0364T Behavior treatment C 0365T Behavior treatment addl C 0366T Group behavior treatment C 0367T Group behav treatment addl C 0368T Behavior treatment modified C 0369T Behav treatment modify addl C 0370T Fam behav treatment guidance C 0371T Mult fam behav treat guide C 0372T Social skills training group C 0373T Exposure behavior treatment C 0374T Expose behav treatment addl C All the additional codes listed in the above table are effective as of July 1 2014 For full details on the above codes including on descriptors place of service codes co surgery indicators etc see the tables in CR 8773 The Web address for CR 8773 is in the Additional Information section below In addition to the codes that were added codes J2271 Morphine SO4 injection 100mg and J2275 Morphine sulfate injection have a change in their procedure status code from E to l effective July 1 2014 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 16 Also Section 651 of Medicare Mode
12. 7 These reopening adjustments are being submitted for claims that originally denied in the Fiscal Intermediary Standard System FISS with reason code 37236 or 37237 To determine the correct DCN to report on the hardcopy UB 04 claim e From the FISS Main Menu select 01 Inquiries From the Inquiry Menu select 12 Claim Summary From the Claim Summary Inquiry screen enter your National Provider Identifier NPI in the NPI field and the beneficiary s Medicare number in the HIC field Enter 329 in the TOB type of bill field Enter the dates of service From Date and To Date of the denied claim BIE lt m IE m gt T Ro T 0A I O m Select the denied claim Go to Page 02 and press F2 to access MAP171D The DCN of the denied claim will appear in the upper left corner of MAP171D in the DCN field This is the number that must be entered into Document Control Number DCN field on the Medicare HHH Reopening Adjustment Request Form For additional information refer to the Reopenings Web page at http www cgsmedicare com hhh appeals Reopenings html on the CGS website For Home Health Providers Widespread Home Health Probe Results Utah Home Health Providers In the October 2013 CGS Home Health amp Hospice Medicare Bulletin available at http www cgsmedicare com hhh pubs mb_hhh 2013 10_2013 PDFs HHH_Bulletin Oct13 pdf CGS published the article Widespre
13. CD10 2015 ICD 10 PCS and GEMs html The mappings can be used to convert policies from ICD 9 CM to ICD 10 codes The GEMs provide both forward ICD 9 CM to ICD 10 and backward ICD 10 to ICD 9 CM mappings There are no new revised or deleted ICD 10 CM or ICD 10 PCS codes This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 23 For Home Health and Hospice Providers The Interactive Voice Response IVR 1 877 220 6289 is available for assistance in obtaining patient eligibility information claim and deductible information and general information For information about the IVR access the IVR User Guide at http www cgsmedicare com hhh help pdf IVR_User_Guide pdf on the CGS website In addition CGS Internet portal myCGS is available to access eligibility information through the Internet For additional information go to http www cgsmedicare com hhh index html and click the myCGS button on the left side of the Web page BIE Provider Contact Center PCC e Availability and the July 4th Holiday lt m Medicare is a continuously changing program a
14. HH MACs for services provided to Medicare beneficiaries Provider Action Needed This article is based on CR 8773 which amends the payment files that were issued to MACs based upon the CY 2014 MPFS Final Rule as modified by the Pathway for SGR Reform Act of 2013 Section 101 passed on December 18 2013 and further modified by section 101 of the Protecting Access to Medicare Act of 2014 on April 1 2014 Make sure your billing staffs are aware of these changes Background The Social Security Act Section 1848 c 4 available at http www socialsecurity gov OP_Home ssact title18 1848 htm authorizes CMS to establish ancillary policies necessary to implement relative values for physicians services In order to reflect appropriate payment policy based on current law and the Calendar Year CY 2014 Medicare Physician Fee Schedule MPFS Final Rule the MPFS Database MPFSDB has been updated using the 0 5 percent update conversion factor effective January 1 2014 to December 31 2014 Payment files were issued to MACs based upon the CY 2014 MPFS Final Rule published in the Federal Register on December 10 2013 which is available at http www cms gov Medicare Medicare Fee for Service Payment PhysicianFeeSched PFS Federal Regulation Notices Items CMS 1600 FC html and as modified by section 101 of the Pathway for SGR Reform Act of 2013 passed on December 18 2013 and This newsletter should be shared with all
15. JULY 2014 gt WWW CGSMEDICARE COM Medicare Bulletin Jurisdiction 15 Reaching Out to the Medicare Community CELERIAN GROUP COMPANY 2014 Copyright CGS Administrators LLC O lt m JE m gt L Ro ag O N U O m Medicare Bulletin Jurisdiction 15 HOME HEALTH PROVIDERS MM8773 July Update to the Calendar Year CY 2014 Medicare Physician Fee Schedule Submit the Correct Document Control Database MPFSDB guudea babwieeva na Sa E T iene see 15 Number DCN When Requesting an MMB8776 July 2014 Update of the Hospital Ordering Referring Denial Reopening 3 Outpatient Prospective Payment System OPPS 17 Widespread Home Health Probe Results News Flash Messages from the Centers Utah Home Health Providers ooo 3 for Medicare amp Medicaid Services CMS 23 Provider Contact Center PCC Availability HOSPICE PROVIDERS and the July 4th Holiday l 24 Provider Contact Center Reminders wo 24 New Hospice Denial Fact Sheet Quick Resource Tool 5 Quarterly Provider Update oo cece 25 Reason Code 34952 Service Facility NPI is Required _ 5 Stay Informed and Join the CGS ListServ Notification Service 25 HOME HEALTH amp Submit Your Redetermination Requests HOSPICE PROVIDERS through the myCGS Web Portal 26 CGS Website Updates 6 eOffset Using myCGS Clarification of Valid Requests ooo eee 7 Medicare Credit Balance Quarterly Reminder 7 Medicare Learning Network
16. PCS code G9361 will be added to your Medicare contractor s systems HCPCS Code G9361 Procedure Status M Short Descriptor Doc comm risk calc Effective Date 01 01 2014 Work RVU 0 Full Non Facility PE RVU 0 Full Non Facility NA Indicator blank Full Facility PE RVU 0 Full Facility NA Indicator blank Malpractice RVU 0 Multiple Procedure Indicator 9 Bilateral Surgery Indicator 9 Assistant Surgery Indicator 9 Co Surgery Indicator 9 Team Surgery Indicator 9 PC TC 9 Site of Service 9 Global Surgery XXX Pre 0 00 Intra 0 00 Post 0 00 Physician Supervision Diagnostic Indicator 09 Diagnostic Family Imaging Indicator 99 Non Facility PE used for OPPS Payment Amount 0 00 Facility PE used for OPPS Payment Amount 0 00 MP Used for OPPS Payment Amount 0 00 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 11 Type of Service 9 Medical indication for induction Documentation of reason s for elective delivery or early induction e g hemorrhage and placental complications hypertension preeclampsia and eclampsia rupture of membranes premature prolonged maternal conditions com
17. Phys Diag Supv Correction TC 02 01 01 2014 72157 1C oe Nae Mise ie a Supt 02 01 01 2014 72158 TC ele ca w o amp widye Phys Diag Supv 02 01 01 2014 72191 TC a ae wlo amp widye Phys Diag Supv 02 01 01 2014 74174 TC 3 aa w o amp w dye Phys Diag Supv 02 01 01 2014 74175 TC P ott i eg oun 02 01 01 2014 93880 TC Extracranial bilat study Phys Diag Supv Correction TC 01 01 01 2014 93882 TC Extracranial uni ltd study Phys Diag Supv Correction TC 01 01 01 2014 77001 TC Fluoroguide for vein device Phys Diag Supv Correction TC 03 01 01 2014 77002 TC Needle localization by xray Phys Diag Supv Correction TC 03 01 01 2014 77003 TC Fluoroguide for spine inject Phys Diag Supv Correction TC 03 01 01 2014 Additional Information The official instruction CR 8664 issued to your MAC regarding this change may be viewed at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2923CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014
18. Providers New Hospice Denial Fact Sheet Quick Resource Tool CGS has developed a new hospice fact sheet to assist hospice clinical staff in avoiding medical review denials The fact sheet SPPOC Plan of Care is available at http cgsmedicare com hhh education materials hospice_qrt html on the Hospice Quick Resource Tools Web page In addition the fact sheet is also accessible from the Hospice Denial Reason Codes Web page at hitp cgsmedicare com hhh medreview HOS _DRC html on the CGS website e 5PPOC Plan of Care http cgsmedicare com hhh education materials pdf hospice_5PPOC_factsheet pdf For Hospice Providers Reason Code 34952 Service Facility NPI is Required BIE lt m IE m gt T Ro T 0A I O m CGS has identified a new reason code in our Claim Submission Error CSE data for May 2014 The reason code 34952 indicates that a service facility National Provider Identifier NPI is required on the claim but was not reported As a reminder per Change Request 8358 effective for dates of service on after April 1 2014 hospice providers are now required to report a service facility NPI when billing any of the following place of service HCPCS codes e Q5003 hospice care provided in nursing long term care facility LTC or non skilled nursing facility NF Q5004 hospice care provided in skilled nursing facility SNF Q5005 hospice care provided in inpatient hosp
19. Sections 30 3 40 3 and 40 3 1 which are included as an attachment to CR 8766 Clarification of Payment for Certain Hospital Part B Inpatient Labs As recently provided in CR 8445 Transmittal 2877 published on February 7 2014 see http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8445 pdf on the CMS website and CR 8666 Transmittal 182 published on March 21 2014 see hitp www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8666 pdf on the CMS website hospitals may only bill for a limited set of Part B inpatient services when beneficiaries who have Part B coverage are treated as hospital inpatients and 1 They are not eligible for or entitled to coverage under Part A or 2 They are entitled to Part A but have exhausted their Part A benefits CMS is clarifying its general payment policy that for hospitals paid under the OPPS these Part B inpatient services are separately payable under Part B and are excluded from OPPS packaging if the primary service with which the service would otherwise be bundled is not a payable Part B inpatient service CMS has adjusted its claims processing logic to make separate payment for Laboratory services paid under the CLFS pursuant to this policy that would otherwise be OPPS packaged beginning in 2014 Hospitals should consult their MAC for reprocessing of any 12X TOB claims with dates o
20. ad Home Health Probe Utah Home Health Providers page 12 which notified home health agencies in Utah about a new statewide service specific probe The edit 5012W selected 100 claims billed with 10 or more therapy visits from October to November 2013 This probe was initiated based on analysis of billing data which identified greater aberrancies among home health providers in the state of Utah in comparison to the universe of CGS providers in the following areas e Average reimbursement per claim Average total visits e Average total therapy visits e Percent of claims with therapy services and e Percent of claims with 20 therapy visits This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 3 In addition an OIG report titled Inappropriate and Questionable Billing by Medicare Home Health Agencies http oig hhs gov oei reports oei 04 11 00240 pdf identified I the state of Utah as one of eight states that had high percentages of agencies with questionable billing practices lt CGS has completed its analysis of this probe which resulted in a 79 error rate based m on the dollar amount denied Below i
21. ailure to pass these edits will result in the claim being returned to the provider New Brachytherapy Source Payment The Social Security Act Section 1833 t 2 H see hitp www socialsecurity gov OP_Home ssact title18 1833 htm mandates the creation of additional groups of covered outpatient department OPD services that classify devices of brachytherapy consisting of a seed or seeds or radioactive source brachytherapy sources separately from other services or groups of services The additional groups must reflect the number isotope and radioactive intensity of the brachytherapy sources furnished Cesium 131 chloride solution is a new brachytherapy source The HCPCS code assigned to this source as well as payment rate under OPPS are listed in Table 1 below Table 1 New Brachytherapy Source Code Effective July 1 2014 Effective Minimum Unadjusted HCPCS date SI APC Short Descriptor Long descriptor Payment Copayment Brachytx Brachytherapy source C2644 7 01 2014 U 2644 cny cesium 131 chloride solution 18 97 3 80 cesium 131 chloride eee per millicurie Category III Current Procedural Terminology CPT Codes The American Medical Association AMA releases Category lIl CPT codes twice per year 1 in January for implementation beginning the following July and 2 in July for implementation beginning the following January For the July 2014 update CMS
22. aims processing times and avoid payment delays by ensuring this information is reported on the claim when required For additional information about billing hospice claims refer to the Hospice Claims Filing Web page at http Awww cgsmedicare com hhh education materials Hospice CF htm on the CGS website For Home Health and Hospice Providers CGS Website Updates CGS has recently made updates to their website giving providers additional resources to assist with billing Medicare covered services appropriately Please review the following updates The Ordering Referring Denial Reopenings section of the Reopenings Web page at http www cgsmedicare com hhh appeals Reopenings html was updated to include information to ensure the correct Document Control Number DCN is submitted on the HHH Reopening Adjustment Request Form BIE lt m IE m gt T Ro T 0A I O m The ICD 10 CM PCS Web page at http www cgsmedicare com hhh claims 5010 html was updated to include information about the new ICD 10 compliance date of September 30 2015 and the cancellation of the July ICD 10 end to end testing during the week of July 21 through July 25 2014 The ICD 10 CM PCS Frequently Asked Questions at http www cgsmedicare com hhh education faqs ICD 10 html were also updated to reflect this information The Home Health amp Hospice 2014 Holiday Training Closure Schedule at htt
23. at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R2967CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 13 For Home Health and Hospice Providers MM8 764 July 2014 Integrated Outpatient Code Editor I OCE Specifications Version 15 2 The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http Awww cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8764 Related Change Request CR CR 8764 Related CR Release Date May 16 2014 Effective Date July 1 2014 Related CR Transmittal R2957CP Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers submitting claims to Medicare administrative contractors MACs inc
24. ate Preservative Free For N A N Epidural Or Intrathecal Use 10 mg HCPCS code C9441 Injection ferric carboxymaltose 1 mg will be deleted and replaced with HCPCS code Q9970 effective July 1 2014 HCPCS code J2275 Injection morphine sulfate preservative free sterile solution per 10 mg and will be replaced with HCPCS code Q9974 effective July 1 2014 The SI for HCPCS code J2275 will change to E Not Payable by Medicare effective July 1 2014 d Revised Sls for HCPCS Codes J2271 and Q2052 Effective July 1 2014 the SI for HCPCS code J2271 Injection morphine sulfate 100mg will change 1 From SI N Paid under OPPS payment is packaged into payment for other services Therefore there is no separate APC payment 2 To SI E Not paid by Medicare when submitted on outpatient claims any outpatient bill type Effective April 1 2014 the SI for HCPCS code Q2052 Services supplies and accessories used in the home under the Medicare intravenous immune globulin IVIG demonstration will change 1 From SI N Paid under OPPS payment is packaged into payment for other services Therefore there is no separate APC payment 2 To SI E Not paid by Medicare when submitted on outpatient claims any outpatient bill type e Updated Payment Rates for Certain HCPCS Codes Effective October 1 2013 through December 31 2013 The payment rate for one HCPCS code was incorrect in the October 2013 OPPS Pricer The
25. ate of Initial Determination Claim DCN i i Denied Services Remove Clear All Is there an Overpayment Appeal Cyes No Step 7 Reasons Rationale Click to validate the haracters left information entered Validate NOTE The Attachments section of the Redetermination form allows you to attach documentation e g medical records notes orders etc you would like CGS to consider when processing your redetermination request You can attach up to 5 documents up to 5 MB each At least one document is required The documents must be in a PDF format 8 To add an attachment select the Browse button and a window will open allowing you to locate the document on your computer that you wish to attach Repeat this process to attach each additional document Step 8 Click on Browse to locate and select the document that you wish to attach Attachments Please attach all documentation up to 5 MB each that you would lik ou should also include any documentation to support your redetermination request xamples of supporting documentation would include Attachment 1 Step 9 Type the name of the person completing the form 08 23 2013 Step 10 And click the Submit button Subrnit Clear 9 Below the attachments section complete the Name field by typing the name of the person who completed the f
26. avior treatment by protocol administered by technician 0367T face to face with two or more patients each additional 30 minutes of N N A technician time List separately in addition to code for primary procedure Adaptive behavior treatment with protocol modification administered by 0368T physician or other qualified health care professional with one patient first 30 S 0322 minutes of patient face to face time 0369T 0370T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient each N additional 30 minutes of patient face to face time List separately in addition to code for primary procedure NIA Family adaptive behavior treatment guidance administered by physician or other qualified health care professional without the patient present 9 ase Multiple family group adaptive behavior treatment guidance administered by 0371T physician or other qualified health care professional without the S 0324 patient present 0372T Adaptive behavior treatment social skills group administered by physician or other qualified health care professional face to face with multiple patients ae Exposure adaptive behavior treatment with protocol modification requiring 0373T two or more technicians for severe maladaptive behavior s first 60 minutes S 0323 of technicians time face to face with patient 0374T E
27. d at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2974CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8776 July 2014 Update of the Hospital Outpatient Prospective Payment System OPPS The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8776 Related Change Request CR CR 8776 Related CR Release Date May 23 2014 Effective Date July 1 2014 Related CR Transmittal R2971CP Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for providers and suppliers who submit claims to Medicare administrative contractors MACs including home health and hospice MACs for services provided to Medicare beneficiaries Provider Action Needed This article is based on CR 8776 which describes changes to and billing instructions for various payment policies implemented in the July 2014 Outpatient Prospective Payment System OPPS update Make sure your billing staffs are awa
28. d drop down box select Secure Forms The Secure Forms page will display Step 2 Select Secure Forms You have 29 unread message s and 0 alerts Help Go To page Secure Forms Welcome to secure forms You can now submit forms to CGS Administrators securely through myCGS You may attach up to five PDF attachments to each form Each attachment can be up to SMB in size The forms and attachments are automatically entered into our workflow This makes form processing more efficient and cost effective NOTE The Select a Topic field on the Secure Forms page defaults to Appeals The Select a Type field defaults to First level appeal on a Medicare Claim 3 Redetermination requests must be submitted within 120 days of the initial determination i e date on the Medicare remittance advice If you need to verify that the redetermination request is timely click on the Appeals Calculator link This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 26 Get Status Secure Forms You have 29 unread message s and 0 a
29. efit payers to use only Claim Status Category Codes and Claim Status Codes approved by the national Code Maintenance Committee in the X12 276 277 Health Care Claim Status Request and Response format adopted as the standard for national use e g previous HIPAA named versions included 004010X093A1 more recent HIPAA named versions These codes explain the status of submitted claim s Proprietary codes may not be used in the X12 276 277 to report claim status The National Code Maintenance Committee meets at the beginning of each X12 trimester meeting February June and October and makes decisions about additions modifications and retirement of existing codes The codes sets are available at http www wpc edi com reference codelists healthcare claim status category codes and http www wpc edi com reference codelists healthcare claim status codes on the Internet All code changes approved during the June 2014 committee meeting will be posted on these sites on or about July 1 2014 Included in the code lists are specific details including the date when a code was added changed or deleted These code changes will be used in the editing of all X12 276 transactions processed on or after the date of implementation and are to be reflected in X12 277 transactions issued on and after the date of implementation of CR 8684 Additional Information The official instruction CR 8684 issued to your MAC regarding this change is available
30. et This feature allows registered users to submit electronic authorizations to offset from pending overpayments that are owed to CGS This option allows providers to request an immediate offset each time a demanded overpayment is received or authorize a permanent request for all future demanded overpayments To use the eOffset function for an immediate offset the provider must have received an overpayment demand letter from CGS The letter will include a number in the upper right corner of the letter An eOffset may be requested by using this number or the account receivable AR number located on the attachment to the demand letter MEDICARE CMS aR lt m IE m gt T Ro T 0A I O m CENTERS FOR MEDICARE amp MEDICAID SERVICES CGS is aware that some providers are attempting to use the eOffset feature to submit a voluntary refund However the eOffset function does not support voluntary refunds To make a voluntary refund follow the instructions provided on the Overpayment Web page and use the appropriate Voluntary Refund form available on the CGS website e Part A http www cgsmedicare com parta overpay index html e Part B Ohio http www cgsmedicare com ohb forms overpayment html e Part B Kentucky http www cgsmedicare com kyb forms overpayment html e Home Health amp Hospice http www cgsmedicare com hhh financial Overpay html Note Part A providers including home hea
31. f service on or after January 1 2014 that were denied and should be paid under this policy Coverage Determinations The fact that a drug device procedure or service is assigned a HCPCS code and a payment rate under the OPPS does not imply coverage by the Medicare program but indicates only how the product procedure or service may be paid if covered by the program This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 SE lt m IE m gt T Ro T 0A I O m 22 MACs determine whether a drug device procedure or other service meets all program requirements for coverage For example Medicare contractors determine that it is reasonable and necessary to treat the beneficiary s condition and whether it is excluded from payment Additional Information The official instruction CR 8776 issued to your MAC regarding this change is available at http www cms gov Regulations and Guidance Guidance Transmittals Downloads R2971CP pdf on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hos
32. hments By clicking on the Ok button you are signing the authorized to submit the information Cancel 12 Once submitted a message will display in your myCGS inbox with the Subject indicating Secure Form Received Refer to the Messages Tab instructions found on the myCGS User Manual Web page at hitp www cgsmedicare com mycgs manual html for additional information about the messages received in myCGS BIE lt m IE m gt T Ro T 0A I O m This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 29
33. ick Resource Tool http www cgsmedicare com hhh education materials pdf ADR_QRT pdf To educate home health agencies on the top denials by medical review and to prevent future denials CGS has developed several Home Health Denial Fact Sheets Below is a list of those currently available along with the link to access these critical resources e 5FFTF Missing Incomplete Untimely Face to Face Encounter http www cgsmedicare com hhh education materials pdf HH_5SFFTF_FactSheet pdf SHHBD Homebound Status http www cgsmedicare com hhh education materials pdf hh_5Shhbd_factsheet pdf SHMED Medical necessity http www cgsmedicare com hhh education materials pdf HH_5HMED_FactSheet pdf SHNOA No OASIS http Awww cgsmedicare com hhh education materials pdf hh_5hnoa_factsheet pdf SHPLN SHORD Missing plan of care or orders http www cgsmedicare com hhh education materials pdf HH_5HPLN 5HORD_FactSheet pdf Please share this information with your staff If you have any questions contact the CGS Provider Contact Center at 1 877 299 4500 Option 1 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 4 For Hospice
34. ification for each individual PTAN which is available at htto www cms gov Medicare CMS Forms CMS Forms downloads CMS838 pdf The report must be postmarked by the date indicated above If the report is received with a postmark date later than the date indicated above we are required to withhold 100 percent of all payments being sent to your facility This withholding will remain in effect until the reporting requirements are met If no credit balance exists for your facility during a quarter a signed Medicare Credit Balance Report certification is still required Please include your Medicare provider number on the certification form Refer to the Medicare Credit Balance Report CMS 838 form for complete instructions However for additional assistance in completing the form refer to the Tips on Completing a Credit Balance Report Form CMS 838 Web page at https www cgsmedicare com hhh financial 838_form_tips html on the CGS website To ensure timely receipt and processing please send to the appropriate address listed below Credit Balance Reports CMS 838 Certification with Checks If you are sending a check with the CMS 838 to repay the credit balance amount please send the check payable to Medicare Fund with either a copy of the CMS 838 or a letter indicating that the check is associated with the CMS 838 to the following address BIE lt m IE m gt T Ro T 0A I O m CGS
35. is implementing in the OPPS 27 Category Ill CPT codes that the AMA released in January 2014 for implementation on July 1 2014 Of the 27 Category III CPT codes shown in Table 2 below 17 of the Category III CPT codes are separately payable under the hospital OPPS The Sls and APCs for these codes are shown in Table 2 below Payment rates for these services can be found in Addendum B of the July 2014 OPPS Update that is posted at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS Addendum A and Addendum B Updates htm on the CMS website Table 2 27 Category Ill CPT Codes Implemented as of July 1 2014 CY 2014 July 2014 OPPS July 2014 CPT Code CY 2014 Long Descriptor Status Indicator OPPS APC 0347T Placement of interstitial device s in bone for radiostereometric Q2 0420 analysis RSA Radiologic examination radiostereometric analysis RSA spine includes 0348T X 0261 cervical thoracic and lumbosacral when performed This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T WY I O m 18 Table 2 27 Category Ill CPT Codes Implemented
36. ital Q5007 hospice care provided in long term care hospital LTCH Q5008 hospice care provided in inpatient psychiatric facility The service facility NPI must be reported in Loop 2310E when billing in the 5010 electronic claim format or the SERV FAC NPI field in the Fiscal Intermediary Standard System FISS on Claim Page 03 MAP1713 CGS J15 MAC HHH REGION ACPFA052 MM DD YY AXB1234 SC INST CLAIM ENTRY C201423P HH MM SS HIC TOB 811 S LOC S B0100 PROVIDER NDC CODE OFFSITE ZIPCD CD ID PAYER OSCAR RI AB EST AMT DUE A B C DUE FROM PATIENT MEDICAL RECORD NBR COST RPT DAYS NON COST RPT DAYS DIAG CODES 01 02 03 04 05 06 07 08 09 END OF POA IND ADMITTING DIAGNOSIS E CODE HOSPICE TERM ILL IND IDE PROCEDURE CODES AND DATES 01 02 03 04 05 06 ESRD HOURS ADJUSTMENT REASON CODE REJECT CODE NONPAY CODE ATT PHYS NPI L F M SC OPR PHYS NPI L F M Sc OTH OPR NPI L F M sc REN PHYS NPI L F M sc REF PHYS NPI L F M SC This newsletter should be shared with all health care practitioners and managerial members of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 5 Claims that do not include an NPI in the SERV FAC NPI field when required will be sent to the returned to the provider RTP file status location T B9997 for correction Providers can reduce cl
37. ith interpretation and report administered by physician or other qualified health care professional with the assistance of one or more technicians each additional 30 minutes of technician s time face to face with the patient List separately in addition to code for primary procedure N A 0364T 0365T Adaptive behavior treatment by protocol administered by technician face to face with one patient first 30 minutes of technician time Adaptive behavior treatment by protocol administered by technician face to face with one patient each additional 30 minutes of technician time List separately in addition to code for primary procedure 0322 N A 0366T Group adaptive behavior treatment by protocol administered by technician face to face with two or more patients first 30 minutes of technician time 0325 This newsletter should be shared with all health care practitioners and managerial members of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 RETURN TO TABLE OF CONTENTS JULY 2014 zie lt m IE m gt ale Ro T O WY I O m 19 Table 2 27 Category Ill CPT Codes Implemented as of July 1 2014 CY 2014 July 2014 OPPS July 2014 CPT Code CY 2014 Long Descriptor Status Indicator OPPS APC Group adaptive beh
38. lerts Heip Go To page Select Form 7 Welcome to secure forms You can now submit forms to CGS Administrators securely throug Step 3 five PDF attachments to each form Each attachment can be up to 5MB in size The forms a Is the redetermination entered into our workflow This makes form processing more efficient and cost effective i request timely To begin please select an answer to the questions from the drop down selections below Bal each of the questions the available form s will appear at the bottom of this box At this available Select a Topic Appeals gt Select a Type First level appeal on a Medicare Claim x To verify you are within timely filing requirements for this Appeal please use our Appeals Calculat Step 4 Select Yes if the redetermination request is timely Is your appeal late over 120 days for a redetermination or over 365 days for a reopening No Redetermination 1 Level Appeal EA J15 HHH 1000 Once you have determined that your request is timely select Yes from the drop down menu If your appeal is untimely you cannot submit your redetermination request via the myCGS portal Click on the Redetermination 1st Level Appeal link to access the online Redetermination Form Select a Type First level appeal on a Medicare Claim gt St ep 5 To verify you are within timely filing requirements f Click to access the o
39. lth and hospices are strongly encouraged to electronically adjust claims to correct overpayments rather than submit a refund via the Voluntary Refund Request form If you have additional questions about using the eOffset feature please contact the CGS EDI Department using the appropriate number below e Part A 1 866 590 6703 Option 2 e Part B Kentucky and Ohio 1 866 276 9558 Option 2 e Home Health amp Hospice 1 877 299 4500 Option 2 You may also refer to the eOffset Job Aid located at htip www cgsmedicare com pdf eOffsetsJobAid pdf For Home Health and Hospice Providers Medicare Credit Balance Quarterly Reminder This article is a reminder submit the Quarterly Medicare Credit Balance Report The next report is due in our office postmarked by July 30 2014 for the quarter ending June 30 2014 A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 Y Each provider must submit a quarterly Medicare Credit Balance Report CMS 838 and cert
40. luding the home health and hospice MACs for outpatient services provided to Medicare beneficiaries and paid under the Outpatient Prospective Payment System OPPS and for outpatient claims from any non OPPS provider not paid under the OPPS and for claims for limited services when provided in a home health agency HHA not under the Home Health Prospective Payment System HH PPS or claims for services to a hospice patient for the treatment of a non terminal illness BIE lt m IE m gt T Ro T 0A I O m Provider Action Needed This article is based on CR 8764 which informs MACs about the changes to the I OCE instructions and specifications for the I OCE that is used under the OPPS and Non OPPS for hospital outpatient departments community mental health centers all non OPPS providers and for limited services when provided in a HHA not under the HH PPS or to a hospice patient for the treatment of a non terminal illness Make sure your billing staffs are aware of these changes Background This instruction informs the MACs that the I OCE is being updated for July 1 2014 The I OCE routes all institutional outpatient claims which includes non OPPS hospital claims through a single integrated OCE which eliminates the need to update install and maintain two separate OCE software packages on a quarterly basis The full list of OCE specifications is available at http www cms gov Medicare Coding OutpatientCodeEdit
41. materials from past conference calls MLN articles and much more To stay informed about all of the CMS MLN products refer to hitp www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts Downloads MailingLists FactSheet pdf and subscribe to the CMS electronic mailing lists Learn more about what the CMS MLN offers at http www cms gov Outreach and Education Medicare Learning Network MLN MLNGenInfo index html on the CMS website For Home Health and Hospice Providers MLN Connects Provider e News BIE lt m IE m gt T Ro T 0A I O m The MLN Connects Provider e News contains a weeks worth of Medicare related messages issued by the Centers of Medicare amp Medicaid Services CMS These messages ensure planned coordinated messages are delivered timely about Medicare related topics The following provides access to the weekly messages Please share with appropriate staff If you wish to receive the ListServv directly from CMS please contact CMS at LearnResource L cms hhs gov e May 22 2014 http go cms gov 1jVHzTn e May 29 2014 hitp go usa gov 8PgC e June 5 2014 http go cms gov S8OnGR e June 12 2014 http go usa gov 8ugz For Home Health and Hospice Providers MM8456 Rescinded Modifying the Daily Common Working File CWF to Medicare Beneficiary Database MBD File to Include Diagnosis Codes on the Health Insurance Portability and Accou
42. nd it is important that we provide correct IE and accurate answers to your questions To better serve the provider community the m Centers for Medicare amp Medicaid Services CMS allows the provider contact centers gt the opportunity to offer training to our customer service representatives CSRs The list below indicates when the home health and hospice PCC at 1 877 299 4500 will be JE closed for training go Date PCC Closed Thursday July 10 2014 PCC Closed 8 00 a m 10 00 a m ET T Thursday July 24 2014 PCC Closed 8 00 a m 10 00 a m ET 2 I O m July 4th Holiday The CGS office will be closed on Friday July 4 2014 Our data center has informed us that the Fiscal Intermediary Standard System FISS and access to the eligibility screens ELGA ELGH will not be available on July 4th In addition the system will not cycle that night which means that claims will not be sent to the Common Working File CWF on July 4 2014 Medicare Remittance Advices Electronic Remittance Advices ERAs Medicare paper checks and Electronic Funds Transfer EFTs will no be produced July 4 2014 For your reference access the Home Health amp Hospice 2014 Holiday Training Closure Schedule at http www cgsmedicare com hhh help pdf Holiday_Schedule pdf for a complete list of PCC closures For Home Health and Hospice Providers Provider Contact Center Reminders Your questions are important to us and CGS s Provide
43. nical billing and administrative who interact with Medicare topics register individually This will help to facilitate the internal distribution of critical information and eliminates delay in getting the necessary information to the proper staff members To subscribe to the CGS ListServ Notification Service go to hitp www cgsmedicare com medicare_dynamic is O01 asp and complete the required information For Home Health and Hospice Providers Submit Your Redetermination Requests through the myCGS Web Portal It s fast easy and cost effective Redeterminations the first level of appeal and supporting medical records can be submitted through the myCGS Web portal This allows providers to save the cost of printing and mailing paper documents Once submitted providers have the ability to monitor the status of these redeterminations within myCGS Redetermination requests are submitted through the Forms tab If you do not have access to the Forms tab but believe you should talk with your myCGS Provider Administrator for your agency organization and they can update your security If your agency organization has not yet registered for myCGS visit the myCGS registration Web page at http cgsmedicare com mycgs index html today Submitting a Redetermination Request using myCGS 1 Select the Forms tab Step 1 Click Forms You have 0 unread message s and 0 alerts co 2 From the Go To page fiel
44. nline Redetermination Form Is your appeal late over 120 days for a redetermina Redetermination 1 Level Appeal EA J15 HHH 1000 The myCGS Redetermination 1st Level Appeal form will appear There are four sections 1 Beneficiary Information 2 Provider Information 3 Claims Information and 4 Attachments Complete the required fields which are marked with a red asterisk Refer to the Forms Tab instructions found on the myCGS User Manual Web page at http www cgsmedicare com mycgs manual himl for additional information Once all the information is entered click Validate myCGS will validate the information entered If information is missing or invalid a message will display indicating the information that must be corrected If information entered is complete and correct the message Your entries have been validated Please attached the required documents input your name and click Submit will display This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 SIE lt m IE m gt T Ro T 0A I O m 21 Claims Information Service Date From Service Date To D
45. ntability Act Eligibility Transaction System HETS 270 271 Transactions The Centers for Medicare amp Medicaid Services CMS has rescinded the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8456 Rescinded Related Change Request CR CR 8456 Related CR Release Date May 16 2014 Effective Date October 1 2014 Related CR Transmittal R1386OTN Implementation Date October 6 2014 Note This article was rescinded on May 20 2014 as a result of a revision to CR 8456 issued on May 16 The CR revision eliminated the need for provider education As a result this article is rescinded This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 9 For Home Health and Hospice Providers MM8664 Revised April Update to the Calendar Year CY 2014 Medicare Physician Fee Schedule Database MPFSDB The Centers for Medicare amp Medicaid Services CMS has revised the following Medicare Learning Network MLN Matters
46. o note the add on codes 7 1 2014 in a separate list as part of PHP List C referred to in Appendix C a Partial Hospitalization Logic effective v10 0 Additional Information The official instruction CR 8764 issued to your MAC regarding this change is available at http Awww cms gov Regulations and Guidance Guidance Transmittals Downloads R2957CP pdi on the CMS website If you have any questions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers MM8773 July Update to the Calendar Year CY 2014 Medicare Physician Fee Schedule Database MPFSDB The Centers for Medicare amp Medicaid Services CMS has issued the following Medicare Learning Network MLN Matters article This MLN Matters article and other CMS articles can be found on the CMS website at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles 2014 MLN Matters Articles html MLN Matters Number MM8773 Related Change Request CR CR 8773 Related CR Release Date June 6 2014 Effective Date July 1 2014 Related CR Transmittal R2974CP Implementation Date July 7 2014 Provider Types Affected This MLN Matters article is intended for physicians other providers and suppliers who submit claims to Medicare administrative contractors MACs including home health and hospice H
47. orm 10 Click the Submit button to submit your redetermination requests to CGS You will receive a message in your myCGS inbox You can access the message by either clicking on the Messages tab or clicking the link displayed in the Message bar 11 An e signature box will appear asking you to verify that the information entered and attachments are correct This ensures the signature requirement for all redetermination requests has been met If the information was entered correctly and all desired attachments were included click OK to submit the Redetermination form and all attachments This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 28 If any information needs to be corrected or if any attachments need to be added or deleted click Cancel to return to the form e Signature Is this information correct Please review your information and attachments carefully If they are correct please ppe Step 11 submit If not press Cancel Click OK to submit Step 11 Click Cancel to correct information or add or remove attac
48. p www cgsmedicare com hhh help pdf Holiday_Schedule pdf was updated to show the Provider Contact Center PCC training day change from Tuesday to Thursday The Hospice Quick Resource Tools Web page at hiip cgsmedicare com hhh education materials hospice_grt htm was updated to include a link to the new SPPOC Plan of Care denial fact sheet hittp cgsmedicare com hhh education materials pdf hospice_5PPOC_factsheet pdf The Fiscal Intermediary Standard System FISS Guide Chapter Three Inquiry Menu which is available at http www cgsmedicare com hhh education materials pdt Chapter3_ Inquiry Menu pdf was updated The updated information shows in red font The Centers for Medicare amp Medicaid Services CMS Educational Resources Web page at http www cgsmedicare com hhh education CMS_Resources html has been updated to include links that allow providers to subscribe to CMS electronic mailing lists This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 6 For Home Health and Hospice Providers eOffset Using myCGS Clarification of Valid Requests In May CGS announced a new feature in the myCGS Web Portal eOffs
49. pice Providers News Flash Messages from the Centers for Medicare amp Medicaid Services CMS e Products from the Medicare Learning Network MLN REVISED Advance Payment Accountable Care Organization Fact Sheet ICN 907403 downloadable at http www cms gov Medicare Medicare Fee for Service Payment sharedsavingsprogram Downloads ACO_Advance_Payment_Factsheet ICN907403 pdf NEW Information on the National Physician Payment Transparency Program Open Payments Podcast ICN 908961 downloadable only at http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts MLN Multimedia ltems ICN908961 Podcast html Want to stay connected about the latest new and revised Medicare Learning Network MLN products and services Subscribe to the MLN Educational Products electronic mailing list For more information about the MLN and how to register for this service visit http www cms gov Outreach and Education Medicare Learning Network MLN MLNProducts downloads MLNProducts_ListServ pdf and start receiving updates immediately 2015 GEMs Reimbursement Mappings and ICD 10 Files Now Available The 2015 General Equivalence Mappings GEMs Reimbursement Mappings ICD 10 CM files and ICD 10 PCS files are now available on the 2015 ICD 10 CM and GEMs Web page at http www cms gov Medicare Coding ICD10 2015 ICD 10 CM and GEMs htm and 2015 ICD 10 PCS and GEMs Web page at hitp www cms gov Medicare Coding I
50. plicating pregnancy delivery fetal conditions complicating pregnancy delivery malposition and malpresentation of fetus late pregnancy prior uterine Long Descriptor surgery or participation in clinical trial 4 Correct the Physician Supervision of Diagnostic Procedures indicator for the TC s of the following codes effective January 1 2014 Physician Supervision of HCPCS Diagnostic Procedures Effective Code Phys Diag Supv Date 70450 TC Ct head brain w o dye Phys Diag Supv Correction TC 01 01 01 2014 70460 TC Ct head brain widye Phys Diag Supv Correction TC 02 01 01 2014 70551 TC Mri brain stem w o dye Phys Diag Supv Correction TC 01 01 01 2014 70552 TC Mri brain stem w dye Phys Diag Supv Correction TC 02 01 01 2014 70553 TC Mri brain stem w o amp w dye Phys Diag Supv Correction TC 02 01 01 2014 72141 TC Mri neck spine w o dye Phys Diag Supv Correction TC 01 01 01 2014 72142 TC Mri neck spine widye Phys Diag Supv Correction TC 02 01 01 2014 72146 TC Mri chest spine w o dye Phys Diag Supv Correction TC 01 01 01 2014 72147 TC__ Mri chest spine w dye Phys Diag Supv Correction TC 02 01 01 2014 72148 TC Mri lumbar spine w o dye Phys Diag Supv Correction TC 01 01 01 2014 72149 TC Mri lumbar spine w dye Phys Diag Supv Correction TC 02 01 01 2014 72156 TC Mri neck spine w o amp w dye
51. r Contact Centers PCCs strive to provide the most accurate and consistent information to our provider community There may be times when we receive a question that requires additional research before an accurate response can be provided by the Customer Service Representative Please be advised that every effort is taken to research your questions and to return your call as soon as possible However the Centers for Medicare amp Medicaid Services CMS does allow PCCs up to 10 business days to research and return your call This information can be found in the CMS Medicare Contractor Beneficiary and Provider Communications Manual Pub 100 09 Chapter 6 Section 60 2 5 htip www cms gov Regulations and Guidance Guidance Manuals Downloads com109c06 pdf This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 24 As a reminder CGS offers the Interactive Voice Response IVR Unit and the myCGS Web portal for eligibility claim status information e IVR User Guide http www cgsmedicare com hhh help pdf IVR_User_Guide pdf e myCGS http www cgsmedicare com hhh myCGS index html For Home Health and Hospice Providers Quarterly Provider Update The Quarte
52. re of these changes Background CR 8776 describes changes to and billing instructions for various payment policies implemented in the July 2014 OPPS update The July 2014 Integrated Outpatient Code Editor I OCE and OPPS Pricer will reflect the Healthcare Common Procedure Coding System HCPCS Ambulatory Payment Classification APC HCPCS Modifier This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 17 Status Indicator SI and Revenue Code additions changes and deletions identified in CR 8776 The July 2014 revisions to I OCE data files instructions and specifications are provided in the forthcoming CR 8764 The MLN Matters article related to CR 8764 is available at http www cms gov Outreach and Education Medicare Learning Network MLN MLNMattersArticles Downloads MM8764 pdf on the CMS website Key changes to and billing instructions for various payment policies implemented in the July 2014 OPPS update are as follows Changes to Device Edits for July 2014 The most current list of device edits is available under Device and Procedure Edits at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS on the CMS website F
53. rly Provider Update is a comprehensive resource published by the Centers for Medicare amp Medicaid Services CMS on the first business day of each quarter It is a listing of all nonregulatory changes to Medicare including transmittals manual changes and any other instructions that could affect providers Regulations and instructions published in the previous quarter are also included in the update The purpose of the Quarterly Provider Update is to Inform providers about new developments in the Medicare program e Assist providers in understanding CMS programs and complying with Medicare regulations and instructions e Ensure that providers have time to react and prepare for new requirements e Announce new or changing Medicare requirements on a predictable schedule and e Communicate the specific days that CMS business will be published in the Federal Register To receive notification when regulations and program instructions are added throughout the quarter go to https www cms gov Regulations and Guidance Regulations and Policies QuarterlyProviderUpdates CMS Quarterly Provider Updates Email Updates htm to sign up for the Quarterly Provider Update electronic mailing list We encourage you to bookmark the Quarterly Provider Update website at https www cms gov Regulations and Guidance Regulations and Policies QuarterlyProviderUpdates index html and visit it often for this valuable information If you have any q
54. rnization Act MMA required the Secretary of Health and Human Services to conduct a demonstration for up to 2 years to evaluate the feasibility and advisability of expanding coverage for chiropractic services under Medicare The demonstration expanded Medicare coverage to include A care for neuromusculoskeletal conditions typical among eligible beneficiaries and B diagnostic and other services that a chiropractor is legally authorized to perform by the state or jurisdiction in which such treatment is provided The demonstration which ended on March 31 2007 was required to be budget neutral as section 651 f 1 B of MMA mandates the Secretary to ensure that the aggregate payments made by the Secretary under the Medicare program do not exceed the amount which the Secretary would have paid under the Medicare program if the demonstration projects under this section were not implemented The costs of this demonstration were higher than expected and CMS has been recovering costs by deducting 2 percent from payments for chiropractic services Since CMS has determined that the costs are fully recovered the July update eliminates the 2 percent reduction for CPT codes 98940 98941 and 98942 that was utilized for the first half of CY 2014 effective July 1 2014 Additional Information BIE lt m IE m gt T Ro T 0A I O m The official instruction CR 8773 issued to your MAC regarding this change may be viewe
55. s Through Status Effective July 1 2014 HCPCS Code Long Descriptor APC Status Indicator c9022 Injection elosulfase alfa 1mg 1480 G 9134 Factor XIII antihemophilic factor recombinant Tretten per 10 i u 1481 G J1446 Injection tbo filgrastim 5 micrograms 1447 G Note The HCPCS codes identified with an indicate that these are new codes effective July 1 2014 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at TABLE OF CONTENTS http www cgsmedicare com 2014 Copyright CGS Administrators LLC MEDICARE BULLETIN GR 2014 07 JULY 2014 zie lt m IE m gt a Ro T WY w O m 20 c New HCPCS Codes Effective July 1 2014 for Certain Drugs and Biologicals Two new HCPCS codes have been created for reporting certain drugs and biologicals other than new pass through drugs and biological listed in Table 4 in the hospital outpatient setting for July 1 2014 These codes are listed below in Table 4 and they are effective for services furnished on or after July 1 2014 Table 4 New HCPCS Codes for Certain Drugs and Biologicals Effective July 1 2014 HCPCS Code Long Descriptor APC Status Indicator Effective 7 1 14 Q9970 Injection ferric carboxymaltose 1 mg 9441 G Q9974 Injection Morphine Sulf
56. s a table showing the denial reasons and volume of IE claims denied for each reason m Denial Reason Code Denial Reason of Claims Denied a 5FFTF Missing incomplete untimely face to face encounter 37 5HMED Medical necessity not supported in medical record 23 IE 5HORD Missing incomplete untimely orders 8 Ro 56900 No timely response to ADR 5 T 5HNOA No OASIS assessment submitted to the state 4 5HPLN Missing incomplete untimely plan of care 3 Tp 5HHBD Homebound status not supported in the record 3 U 5HRHC 5HRHD HIPPS code reduced clinical domain Incorrect 2 O 5HRHF or 5HSUP diagnosis functional domain or non routine supplies m 5HDOC Services were not documented 1 As a result of the high error rate CGS will be implementing a service specific edit for home health providers in Utah that selects claims with at least 10 therapy visits Provider Action to Prepare and Reduce Risk of Future Denials Home health agencies HHAs should take action now to ensure that they have procedures and processes in place to appropriately identify and respond to claims that are selected for Medical Review by this edit Providers may access the following resources to ensure they are prepared in the event that a claim is selected for an additional development request ADR Additional Development Request ADR Process Web page http www cgsmedicare com hhh medreview adr_process html Additional Development Request ADR Qu
57. s for HCPCS codes G0416 G0419 This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 10 HCPCS Code Old Short Description Revised 2014 Short Description I G0416 Sat biopsy prostate 1 20 spc Biopsy prostate 10 20 spc G0417 Sat biopsy prostate 21 40 Biopsy prostate 21 40 lt G0418 Sat biopsy prostate 41 60 Biopsy prostate 41 60 m G0419 Sat biopsy prostate gt 60 Biopsy prostate gt 60 JE 2 Adjust the Facility and Non Facility PE RVUs for HCPCS code 77293 Global gt and 77293 TC via CMS update files an Non Facility Facility HCPCS Mod Status Description PE RVUs PE RVUs Global T 77293 A Respietonmaten ogg NA 722 Jan 1 to March 31 2014 Ro mgmt simul Respirator motion an 77293 ITC JA mgmt simul 9 16 NA ZZZ Jan 1 to March 31 2014 O Reiri mation Correction April 1 2014 RVU Y 77293 A pra 10 72 NA ZZZ change effective January 1 to U mgmt simul December 31 2014 O Respirator mation Correction April 1 2014 RVU m T293 TC A fa a ml 9 92 NA ZZL change effective January 1 to 9 December 31 2014 3 HC
58. sician or other qualified health care professional face to face with patient and caregiver s includes administration of standardized and non standardized tests detailed behavioral history patient observation and caregiver interview interpretation of test results discussion of findings and recommendations with the primary guardian s caregiver s and preparation of report Observational behavioral follow up assessment includes physician or other qualified health care professional direction with interpretation and report administered by one technician first 30 minutes of technician time face to face with the patient 0632 0632 0361T Observational behavioral follow up assessment includes physician or other qualified health care professional direction with interpretation and report administered by one technician each additional 30 minutes of technician time face to face with the patient List separately in addition to code for primary service N A 0362T Exposure behavioral follow up assessment includes physician or other qualified health care professional direction with interpretation and report administered by physician or other qualified health care professional with the assistance of one or more technicians first 30 minutes of technician s time face to face with the patient 0632 0363T Exposure behavioral follow up assessment includes physician or other qualified health care professional direction w
59. uestions please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1 877 299 4500 and choose Option 1 For Home Health and Hospice Providers Stay Informed and Join the CGS ListServ Notification Service The CGS ListServ Notification Service is the primary means used by CGS to communicate with home health and hospice Medicare providers This is a free email notification service that provides you with prompt notification of Medicare news including policy benefits claims submission claims processing and educational events Subscribing for this service means that you will receive information as soon as itis available and plays a critical role in ensuring you are up do date on all Medicare information Consider the following benefits to joining the CGS ListServ Notification Service It s free There is no cost to subscribe or to receive information e You only need a valid e mail address to subscribe This newsletter should be shared with all health care practitioners and managerial members RETURN TO of the provider supplier staff Newsletters are available at no cost from our website at http www cgsmedicare com 2014 Copyright CGS Administrators LLC TABLE OF CONTENTS MEDICARE BULLETIN GR 2014 07 JULY 2014 BIE lt m IE m gt T Ro T 0A I O m 25 e Multiple people e mail addresses from your facility can subscribe We recommend that all staff cli
60. xposure adaptive behavior treatment with protocol modification requiring two or more technicians for severe maladaptive behavior s each additional 30 minutes of technicians time face to face with patient List separately in NA addition to code for primary procedure Billing for Drugs Biologicals and Radiopharmaceuticals a Drugs and Biologicals with Payments Based on Average Sales Price ASP Effective July 1 2014 In the CY 2014 OPPS ASC final rule with comment period CMS stated that payments for drugs and biologicals based on ASPs will be updated on a quarterly basis as later quarter ASP submissions become available In cases where adjustments to payment rates are necessary based on the most recent ASP submissions CMS will incorporate changes to the payment rates in the July 2014 release of the OPPS Pricer The updated payment rates effective July 1 2014 will be included in the July 2014 update of the OPPS Addendum A and Addendum B which will be posted at http www cms gov Medicare Medicare Fee for Service Payment HospitalOutpatientPPS Addendum A and Addendum B Updates html on the CMS website Drugs and Biologicals with OPPS Pass Through Status Effective July 1 2014 Three drugs and biologicals have been granted OPPS pass through status effective July 1 2014 These items along with their descriptors and APC assignments are identified below in Table 3 Table 3 Drugs and Biologicals with OPPS Pas

July 2014

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