Novitas Solutions Medicare Part A and B Presents: …

1 Novitas Solutions Medicare part A and B Presents: Medicare Updates NJ AAHAM Semi Annual Billing Seminar March 19, 2015 Disclaimer All Current Procedural Terminology (CPT) only copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable Federal Acquisition Regulation/ Defense Federal Acquisition Regulation (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 information enclosed was current at the time it was presented.

2 Medicare policy changes frequently; links to the source documents have been provided within the document for your reference. This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. Novitas Solutions employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. This presentation is a general summary that explains certain aspects of the Medicare program, but is not a legal document.

3 The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Novitas Solutions does not permit videotaping or audio recording of training events. Novitas Solutions Education specific to providers in Medicare Administrative Contractor (MAC) Jurisdiction L (JL) include: Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania Education specific to providers in Medicare Administrative Contractor Jurisdiction H (JH) include: Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas This education contains specific contractor guidance If you are not a provider in JL or JH, please contact your Medicare contractor for specific guidance Agenda Quarterly Updates Preventive Services Novitas Initiatives Comprehensive Error Rate Testing Program (CERT)

4 Self-Service Objectives Identify and understand the current Medicare changes Learn how to apply the new guidelines Identify and utilize the educational resources and information Acronym List Acronym Definition CMS Centers of Medicare & Medicaid Services EDI Electronic Data Interchange LCD Local Coverage Determination MLN Medicare Learning Network IPPS Inpatient Prospective Payment System OPPS Outpatient Prospective Payment System Quarterly Updates Update to Medicare Deductible, Coinsurance, and Premium Rates for 2015 Change Request # 8982 oEffective: January 1, 2015 oImplementation: January 5, 2015 Key Points o2015 part A Hospital Insurance Deductible: $1, o2015 part B Medical Insurance Deductible: $ Standard Premium: $ Reference Sequestration Update Mandatory Payment Reduction of 2% Continues through March 31, 2016, for the Medicare Fee For Service Program For more information Frequently Asked Questions oJL Medicare Fee-For-Service International Classification of Diseases, 10th Edition (ICD-10) Testing Approach Special Edition # SE1409 oEffective: October 1, 2015 oRevised: December 8, 2014 Key Points oCMS internal testing of its claims processing system oProvider initiated Beta testing tools oAcknowledgement testing oEnd-to -end testing January 26-30, 2015 April 27-May 1, 2015 July 20-14, 2015 Reference FAQs International Classification of Diseases, 10th Edition (ICD-10) Acknowledgement Testing and End-to-End Testing Special Edition # SE1501 oRevised.

5 January 6, 2015 Key Points oFrequently Asked Questions (FAQs) for those participating in acknowledgement testing and those selected to participate in ICD-10 end-to -end testing weeks Reference Updates to International Classification of Diseases, 10th Edition (ICD-10) Local Coverage Determinations Special Edition SE1421 Key Points oAdvises how to access International Classification of Diseases, 10th Edition (ICD-10) Local Coverage Determinations (LCDs) in the Centers for Medicare & Medicaid Services (CMS) Medicare Coverage Database (MCD) Reference Institutional Services Split Claims Billing Instructions for Fee-For-Service Claims that Span the ICD-10 Implementation Date Special Edition SE1325 Key Points oClarifies the policy for processing institutional claims spanning the October 1, 2015, ICD-10 start date oRelated to SE1408 Reference Special Edition SE1325 Key Points Key Points oOnly claims that span this single implementation date (October 1, 2015) will be impacted oSplit claims for an encounter spanning the ICD-10 implementation date, maintain all charges with the same Line Item Date of Service (LIDOS) on the correct corresponding claim for the encounter oSingle item services whose time-frame cross over midnight on September 30, 2015 ( , Emergency Room Visits and Observation)

6 , are not split into 2 separate charges, rather the single item service should be placed in the claim based upon the LIDOS Reference Incorporation of Certain Provider Enrollment Policies in CMS-4159-F into Pub. 100-08, Program Integrity Manual (PIM), Chapter 15 Change Request # 8901 oEffective: March 18, 2015 oImplementation: March 18, 2015 Key Points oCMS-855 approval of Reactivation Application or Reactivation Certification Package for part B non-certified suppliers effective date will be the date the MAC received the application and a new Provider Transaction Access Number (PTAN) will be issued oCMS may deny or revoke a physician s or eligible professional s CMS-855 enrollment application if Physician s or eligible professional s DEA Certificate of Registration to dispense a controlled substance is currently suspended or revoked Applicable state licensing or administrative body has suspended or revoked the physician s ability to prescribe drugs if it is in effect during the application process oCMS may revoke a physician s or eligible professional s enrollment if there is a pattern or practice of prescribing part D drugs that falls into one of the listed categories below Pattern or practice is abusive or represents a threat to the health and safety of Medicare beneficiaries or both Pattern or practice of prescribing fails to meet Medicare requirements.

7 Reference Notice of New Interest Rate for Medicare Overpayments and Underpayments 2nd Qtr. Notification for FY 2015 Change Request # 9089 oEffective: January 21, 2015 oImplementation: January 21, 2015 Key Points oMedicare contractors will use an interest rate of for both overpayments and underpayments Reference Therapy Cap Values for Calendar Year (CY) 2015 Change Request # 8970 oEffective: January 1, 2015 oImplementation: January 5, 2015 Key Points oTherapy caps for outpatient therapy services $1,940 Physical and Speech Language Pathology $1,940 Occupational Therapy Reference 2015 Annual Update to The Therapy Code List Change Request # 8985 oEffective: January 1, 2015, oImplementation: January 5, 2015 Key Points oThis CR updates the therapy code list with two "sometimes therapy" codes and deletes two current codes for CY 2015 as follows.

8 OSometimes therapy codes Add: 97607 Delete: G0456 Note: 97607 replaces current code G0456 effective 1/1/2015 Add: 97608 Delete: G0457 Note: 97608 replaces current code G0457 effective 1/1/2015 Report GN, GO, or GP when performed by a therapist specialty Reference Current Procedural Terminology (CPT) only copyright 2014 American Medical Association. All rights reserved Ambulance Inflation Factor for 2015 Change Request # 8895 oEffective: January 1, 2015 oImplementation: January 5, 2015 Key Points oThe ambulance inflation factor for 2015 is percent oDeductible and coinsurance requirements apply to payments under the Ambulance Fee Schedule References Remittance Advice Remark and Claims Adjustment Reason Code and Medicare Remit Easy Print and PC Print Update Change Request #9004 Effective: April 1, 2015 Implementation.

9 April 6, 2015 Key Points oRecurring update to the CARC and RARC lists oInstructions to update MREP and PC Print Reference Correct Coding for Venipuncture Collection New England Benefit Integrity Support Center (NEBISC), program safeguard contractor, reported an increase in venipuncture coding errors CPT code 36415 oCollection of venous blood by venipuncture oCommonly referred to as routine venipuncture CPT code 36410 oVenipuncture, performed on an individual over 3 years of age, that requires a physician's skill oMust be supported in the medical documentation Findings oCode 36410 Improperly billed instead of code 36415 Documentation does not support use Pays a higher rate than code 36415 IOM 100-04 Chapter 16 Section 60 Current Procedural Terminology (CPT) only copyright 2014 American Medical Association.

10 All rights reserved Specific Modifiers for Distinct Procedural Services Change Request # 8863 oEffective: January 15, 2015 oImplementation: January 5, 2015 Key Points oFour new modifiers to define specific subsets of the -59 modifier XE Separate Encounter XS Separate Structure XP Separate Practitioner XU Unusual Non-Overlapping Service Reference Continued Use of Modifier 59 after January 1, 2015 Special Edition # SE1503 oEffective: January 1, 2015 oImplementation: January 5, 2015 Key Points oProviders may continue to use Modifier 59 when appropriate oModifiers XE, XP, XS or XU may be used in place of Modifier 59 oAdditional guidance and education forthcoming from CMS oInquiries about the new X modifiers Reference Modifier 59 and New Modifiers XE, XS, XP, XU Until CMS provides official guidance, Novitas offers suggestions in this article for the use of the -X {EPSU} modifiers, should you decide to use them Article with examples Revised Modification to the Medically Unlikely Edit (MUE) Program Change Request # 8853 oEffective: January 1, 2015 oImplementation.