Updated Current Procedural Terminology Codes for 2019

Updated Current Procedural Terminology Codes for 2019

INSIGHTS

Updated Current Procedural Terminology Codes for 2019

The Current Procedural Terminology (CPT) code changes for 2019 are here! The American Medical Association (AMA) has announced the release of the 2019 CPT Code Set. The changes include 335 codes in the new CPT edition in an effort to capture the latest scientific trends and advances. The code changes include new remote patient monitoring codes and new internet consultation codes. These New CPT category I codes are effective for reporting as of Jan. 1, 2019.

Below are three tabs that include the new, deleted and revised CPT codes. Please remember to inactivate any 2018 codes that have been deleted. Included with the deleted codes are possible replacement codes for use if applicable.

AMA Releases 2019 CPT Code Set. September 5, 2018. Retrieved November 27, 2018 from https://www.ama-assn.org/ama-releases-2019-cpt-code-set 

RECENT POSTS

2019 Payroll Update

There are several important updates and considerations related to wages and year-end payroll duties. Please review the included topics and contact us if you have any questions…

read more

Norby Joins Lutz Financial

Lutz, a Nebraska-based business solutions firm, welcomes Bailey Norby to the Lutz Financial division in the Omaha office. Bailey joins the team as a Client Service Associate. She is responsible for the preparation and filing of client data…

read more

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OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850

Cost Report Corner

Cost Report Corner

INSIGHTS

Cost Report Corner

Certified Registered Nurse Anesthetist (CRNA)

Have you ever heard the saying “The devil is in the details”? Well, in the case of CRNA services provided by a critical access hospital (CAH), you’d be correct.

Annually, CAHs must ensure that they meet the CMS criteria for cost-based reimbursement, submitting the appropriate data to their Medicare Administrative Contractor (MAC) in a timely fashion. This yearly exercise of submitting annualized procedure data to the MAC and attesting to the various CRNA qualification criteria may seem mundane to do every year – and that may be the case. However, if you ever miss a year of filing the appropriate paperwork AND/OR receiving the MAC approval letter, you will never forget this mundane task again. The reimbursement differential of having to bill all CRNA services on a CMS-1500 with fee schedule reimbursement versus UB billing with cost reimbursement for an entire calendar year will sharpen your memory and focus.

Do not procrastinate

When you receive the CRNA letter from your MAC, analyze, complete, review and submit the information in a timely fashion and ensure you receive the approval letter from the MAC. File this letter appropriately in your facility and provide a copy to your cost report preparer, so that you have the documentation should the need arise.

Questions you should ask yourself

If your CAH contracts for CRNA services, have you reviewed the contract lately with your cost report preparer? Are there provisions in your negotiated CRNA contract that unknowingly impact reimbursement? Have you received multiple bids for your CRNA contract to demonstrate you comply with the CMS prudent buyer principle? One of CMS’ current focus areas is to ensure the prudent buyer principle is being followed and can be verified.

At the time (and that time is now), all of these activities may seem mundane and unnecessary, but you will be glad you did when you get that “star” on your cost report during the MAC audit and ensure your facility receives correct reimbursement for CRNA services.

 

RECENT POSTS

2019 Payroll Update

There are several important updates and considerations related to wages and year-end payroll duties. Please review the included topics and contact us if you have any questions…

read more

Norby Joins Lutz Financial

Lutz, a Nebraska-based business solutions firm, welcomes Bailey Norby to the Lutz Financial division in the Omaha office. Bailey joins the team as a Client Service Associate. She is responsible for the preparation and filing of client data…

read more

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © 2018 Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850

Medicare Provider Enrollment

Medicare Provider Enrollment

INSIGHTS

Medicare Provider Enrollment

KIRK DELPERDANG, HEALTHCARE MANAGER

The Medicare provider and supplier enrollment process is a continuous process in which the provider community must focus their attention, lest you be impacted by an interruption in reimbursement.

Here are just a couple of the more popular items that providers find themselves contending with regarding their Medicare enrollments:

 

Changes of Information

Changes of information to your CMS-855 enrollments should be submitted if you are changing, adding, or deleting information under your current tax identification number.  The CMS Provider Integrity Manual or PIM Chapter 15 is the guide to follow when you have questions regarding requirements for your Medicare enrollment.  Additionally, specifically for changes of information, in accordance with 42 C.F.R. 424.516(e), unless otherwise noted below, changes in your existing enrollment data must be reported to CMS within 90 days of the effective date of the change.

Information changes to be reported include (but are not limited to):

  • Legal business name or doing business as (dba) name
  • Change of ownership – all sections must be submitted and must be reported within 30 days of the effective date of the change
  • Adverse history – must be reported within 30 days of the effective date
  • Main practice location change, to add an additional location or to delete a location – must be reported within 30 days of the effective date
  • Ownership interest or managing control information
  • Billing agency information
  • Authorized or delegated officials

 

An individual or entity (group) reporting a change of information may be required to submit a complete CMS-855I or CMS-855B to update their Medicare enrollment information. If the required CMS-855I or CMS-855B is not submitted within 60 days of the request, the change of information will not be processed, and the provider’s Medicare enrollment will be subject to revalidation requirements per 42 CFR § 424.515.

 

Revalidations

If you have spent any time in Medicare enrollment over the last decade, you know what revalidations are and the pitfalls that can befall you if you are not prepared.  CMS began the second round of revalidations in 2016 and will continue this process through the completion of Round 2.

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers/suppliers to revalidate their Medicare enrollment information.  CMS has completed its initial round of revalidations and has resumed regular revalidation cycles in accordance with 42 CFR §424.515.

In an effort to help providers/suppliers in this second round of revalidations, CMS has provided multiple resources for your reference purposes.  A few of these can be found via these references.

Revalidation Resources1

Other assistance provided by CMS includes:

  • End-of-month due dates
  • The ability to  revalidate an enrollment up to 6 months before it is due
  • Early notifications via the PECOS Revalidation Notification Center

Therefore, with all of these tools at your disposal, as well as the Lutz enrollment team, you should be able to keep your Medicare enrollment in good standing with CMS.  We don’t want any preventable enrollment issue to negatively impact your reimbursement.

 

1 - As provided on the WPS GHA Provider Enrollment website

ABOUT THE AUTHOR

402.496.8800

kdelperdang@lutz.us

LINKEDIN

KIRK DELPERDANG + HEALTHCARE MANAGER

Kirk Delperdang is a Healthcare Manager at Lutz with over 25 years of experience. He provides accounting and consulting services to healthcare and related organizations.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association - Nebraska Chapter, Member
  • Nebraska Society of Certified Public Accountants, Member
EDUCATIONAL BACKGROUND
  • BA in Accounting, University of Northern Iowa, Cedar Falls, IA
COMMUNITY SERVICE
  • St. Vincent de Paul, Knights of Columbus, Member
  • Active in various youth sports leagues: Aldrich Elementary, Millard Athletic Association, Millard North Schools, Omaha FC, Skutt Catholic High School and YMCA

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © 2018 Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850

Year-End Audit and Cost Report Planning, Preparation and Tips

Year-End Audit and Cost Report Planning, Preparation and Tips

INSIGHTS

Year-End Audit and Cost Report Planning, Preparation Tips

JULIANNE KIPPLE, HEALTHCARE DIRECTOR

The few months after a facilities fiscal year end are always challenging. From closing the books, to preparing for the external audit process, to providing information for and completing the Medicare cost report, there is never enough time in the day to get everything done. We have all been through the experience– at the time we have all said “next year will be better” and “we will fix the bottlenecks”.

Whether or not your facility has had success or not making progress in this area, the items below serve as a checklist of ways to plan, prioritize, and complete items throughout the year and before the audit. The goal is to make the year-end process easier for staff, more efficient for auditors and cost report preparers, and make your facility less prone to large audit adjustments and/or make costly mistakes in reimbursement.

 

Month End Close & Financial Statements

One of the best ways to avoid bottlenecks at year-end is to review your monthly close and financial statement preparation process. If not monthly, at least quarterly, a facility should reconcile all material balance sheet items back to a supporting schedule. Ideally, try to complete your monthly reconciliation schedule in the auditor’s preferred format so you avoid having to take your reconciliations and input them into the auditors’ format at year end.

Facilities should also prepare a Medicare and Medicaid interim cost report template at least quarterly. This will help a facility manage cash flow throughout the year by requesting Medicare interim rate changes and settlements as needed and avoid large auditor adjusting journal entries.

Another material estimate is the accounts receivable allowance for contractuals and doubtful accounts. This schedule should be reviewed in detail and throughout the year and the contractual allowance and doubtful accounts percentages from payors should be estimated and updated as needed.

Managing your close process monthly will enable your staff to complete the needed reconciliations and financial statements. Are the monthly board meetings being held at the appropriate time and/or day of the month? How long does it take to close accounts receivable, payroll, and accounts payable? Do we have a month end close schedule created that includes the closing schedule and gives the accounting staff time to prepare financial statements? Management should have at least three or four business days to review the prepared financials before presenting them at the monthly board meeting. This allows management to ask questions upon review and gives staff the time to make corrections as needed.

 

External Financial Statement Audit and Cost Report Process

If your facility has followed the recommendations for the monthly close and financial statement process, the external audit preparation time hopefully will already be reduced. However, gathering other information for the audit and for the Medicare cost report can still be overwhelming. Other recommendations to prioritize work and time during the external audit and Medicare cost report process include:

  1. Upon receiving the request for information from the auditor, meet with staff to identify responsibilities and due dates.
  2. Organize, review and send non-financial information as soon as you can after year-end close. This information should not change after the end of the fiscal year so there is no reason to wait to pull this information together as time permits. This includes:
    • Monthly statistical reports
    • Board of Director Meeting Minutes
    • Accounts Receivable Reports
    • Payroll Reports
    • Chargemaster and Revenue Usage Reports
    • Internal control checklists
    • Charity Care information
    • New or amended contracts, debt agreements, capital lease contracts, etc.
    • Medicare and Medicaid Correspondence received throughout the year
    • Medicare cost report statistics and information
      1. Statistics, including observation hours, rural health clinic visits, and 96-hour compliance log for critical access hospitals
      2. Payroll information and FTE’s
      3. B-1 Square Footage Summary with detail support including updates for changes during the fiscal year
      4. A-8-3 Contracted Therapy Invoices and Information
      5. Emergency Room Time Studies
      6. Rural Health Clinic Time Studies
      7. Rural Health Clinic Vaccine information and invoices
      8. Any other B Series allocation statistics that will not change such as:
        • Laundry pounds
        • Dietary Meals
        • Housekeeping Time Study

 

As you can see, if you are able to complete the list above well in advance of the scheduled audit date, it should help reduce stress and bottlenecks, allowing staff to focus on finalizing the correct year-end trial balance. If you are able to put the time in to review research and correct accounts as needed, you can put the facility in a better position to reduce any surprise auditor adjusting journal entries that can have a material impact to your bottom line and cash flow.

ABOUT THE AUTHOR

julianne kipple

402.827.2075

jkipple@lutz.us

LINKEDIN

JULIANNE KIPPLE + HEALTHCARE DIRECTOR

Julianne Kipple is a Healthcare Director at Lutz with over 10 years of professional experience in the healthcare industry. Her expertise is in accounting and consulting services for healthcare facilities, including outsourced CFO services, Medicare and Medicaid reimbursement, and Medicaid Disproportionate Share Surveys (DSH).

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association, Member
  • American Institute of Certified Public Accountants, Member
  • Nebraska Society of Certified Public Accountants, Member
  • Certified Public Accountant
  • Certified Healthcare Financial Professional
EDUCATIONAL BACKGROUND
  • BSBA in Accounting, with high distinction, Creighton University, Omaha, NE
  • MBA, Creighton University, Omaha, NE

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © 2018 Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850

Tis the (Flu) Season

Tis the (Flu) Season

INSIGHTS

Tis the (Flu) Season

CATHY BOJANSKI, HEALTHCARE MANAGER
AMY EVANICH, SENIOR HEALTHCARE CONSULTANT

With summer quickly winding down a topic of conversation for many is the upcoming flu season, particularly vaccinations. The high severity of the 2017-2018 season leaves healthcare institutions wondering what is in store for the 2018-2019 season. While the proper care of these patients remains the top priority, another aspect that should be analyzed annually is proper coding and billing for immunizations such as the flu shot.

Effective for claims processed with Dates of Service (DOS) on or after January 1, 2019, Medicare Change Request (CR) 10871 provides instructions for payment regarding influenza virus vaccine code 90689 (Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25mL dosage, for intramuscular use) will be payable by Medicare. The short descriptor is VACC IIV4 NO PRSRV 0.25ML IM. This new code will be included on the 2019 Medicare Physician Fee Schedule Database file update and the annual Healthcare Common Procedure Coding System (HCPCS) update. The new influenza virus vaccine code 90689 is not retroactive to August 1, 2018. No claims should be accepted for influenza virus vaccine code 90689 between the DOS August 1, 2018, and December 31, 2018.

 

Inpatient Immunization Billing Tips:

  • Condition code A6 is used to indicate services not subject to deductible and coinsurance
  • All providers that bill the intermediary for influenza and pneumococcal vaccines report the administration under revenue code 771
  • Medicare hospitals bill for the vaccines under bill type 12x for their inpatients and SNFs bill for the vaccines under bill type 22x

 

Outpatient Immunization Billing Tips:

  • Bill types 131 or 851
  • Revenue code 636 for the vaccine and 771 for the administration

 

Medicare Rural Health Clinic (RHC)/Federally Qualified Health Center (FQHC) Immunization Billing Tips:

  • The costs of influenza and pneumococcal vaccines and their administration are separately reimbursed at annual cost settlement on the Medicare Cost Report
  • There is a separate worksheet on the cost report to report the cost of these vaccines and their administration
  • The patient pays no Part B deductible or coinsurance for these services
  • When an RHC practitioner sees a patient for the sole purpose of administering these vaccinations, the RHC may not bill for a visit; however, the costs of the vaccines and their administration are included on the annual cost report and reimbursed at cost settlement

 

Mass immunizations (Flu shot clinic) Billing Tips:

  • Must be enrolled with Medicare as a mass immunizer
  • Outpatient services can be billed on a roster
  • Roster billing is used if multiple beneficiaries are immunized on the same day
  • Entities that submit claims on roster bills must accept assignment and may not collect any “donation” or other cost sharing of any kind from Medicare beneficiaries; however, they may bill Medicare for the amount not subsidized from their own budget.
  • Rosters are submitted with a 1500 claim form

 

Take the time now to ensure your billing department is ready in order to confirm proper reimbursement. If you have questions, reach out to get them answered before the busy season of billing for vaccinations begins. It will be here before we know it – Tis the (Flu) Season!

 

 

References

Department of Health and Human Services (DHHS) (2018, August 3). Quarterly Influenza Virus Vaccine Code Update – January 2019. Retrieved August 9, 2018, from https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R4100CP.pdf

Department of Health and Human Services (DHHS) (2018, January).  Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B. Retrieved August 8, 2018 from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf

 

 

ABOUT THE AUTHOR

402.827.2366

cbojanski@lutz.us

CATHY BOJANSKI + HEALTHCARE MANAGER

Cathy Bojanski is a Healthcare Manager at Lutz with over 25 years of experience. Her primary responsibilities include preparation and review of Hospital and Clinic Chargemaster (CDM) reviews for healthcare clients, as well as assisting with coding and billing services.

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Association for Rural Health Professional Coding, Member
  • Certified Billing Specialist

402.769.7055

aevanich@lutz.us

LINKEDIN

AMY EVANICH + HEALTHCARE CONSULTING SENIOR

Amy Evanich is a Healthcare Consulting Senior at Lutz with over 10 years of professional experience in the Healthcare industry. She specializes in the areas of medical chart reviews, appeal preparation, Medicare regulation guidance, interpretation and education, and healthcare billing policies and procedures.

AREAS OF FOCUS
  • Healthcare Reimbursement
  • Audit Response Assistance and Appeal Preparation
  • Medical Chart Review Including Medical Necessity
  • Healthcare Billing
AFFILIATIONS AND CREDENTIALS
  • Registered Nurse (RN)
EDUCATIONAL BACKGROUND
  • Bachelor of Science in Nursing (BSN), Clarkson College, Omaha, NE
  • Master of Science in Nursing Health Care Administration (MSN), Clarkson College, Omaha, NE
COMMUNITY SERVICE
  • Nebraska Action Coalition, Leadership Team
THOUGHT LEADERSHIP

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © 2018 Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850

Attention Kansas CAHs – Upcoming DSH Surveys

Attention Kansas CAHs – Upcoming DSH Surveys

INSIGHTS

Attention Kansas CAH’s – Upcoming DSH Surveys

JULIANNE KIPPLE, HEALTHCARE DIRECTOR

For all Kansas Critical Access Hospitals (CAH), the SFY 2019 Disproportionate Share (DSH) and Uncompensated Care (UCC) payment survey is expected to be sent by the end of May. If a CAH has not completed this survey in the past, this is an opportunity for hospitals to receive a DSH payment for serving a disproportionate share of Medicaid or uninsured patients. There are a few qualifications, such as serving a certain percentage of Medicaid patients and also having two physicians with staff privileges at the hospital to perform non-emergency obstetric procedures.

If you have not reviewed whether or not you would qualify in the last few years, we would highly encourage hospitals to review the DSH survey and qualifications. If you complete a DSH survey, we would also recommend looking at the various reports, including the uninsured data, to make sure you are claiming all valid uncompensated care costs.

If you have questions about the survey or the qualification requirements, please contact us.

ABOUT THE AUTHOR

julianne kipple

402.827.2075

jkipple@lutz.us

LINKEDIN

JULIANNE KIPPLE + HEALTHCARE DIRECTOR

Julianne Kipple is a Healthcare Director at Lutz with over 10 years of professional experience in the healthcare industry. Her expertise is in accounting and consulting services for healthcare facilities, including outsourced CFO services, Medicare and Medicaid reimbursement, and Medicaid Disproportionate Share Surveys (DSH).

AREAS OF FOCUS
AFFILIATIONS AND CREDENTIALS
  • Healthcare Financial Management Association, Member
  • American Institute of Certified Public Accountants, Member
  • Nebraska Society of Certified Public Accountants, Member
  • Certified Public Accountant
  • Certified Healthcare Financial Professional
EDUCATIONAL BACKGROUND
  • BSBA in Accounting, with high distinction, Creighton University, Omaha, NE
  • MBA, Creighton University, Omaha, NE

SIGN UP FOR OUR NEWSLETTERS!

We tap into the vast knowledge and experience within our organization to provide you with monthly content on topics and ideas that drive and challenge your company every day.

Toll-Free: 866.577.0780  |  Privacy Policy

All content © 2018 Lutz & Company, PC

OMAHA

13616 California Street, Suite 300

Omaha, NE 68154

P: 402.496.8800

HASTINGS

747 N Burlington Avenue, Suite 401

Hastings, NE 68901

P: 402.462.4154

GRAND ISLAND + NORTH 

403 Lexington Circle

Grand Island, NE 68803

P: 308.384.9910

LINCOLN 

601 P Street, Suite 103

Lincoln, NE 68508

P: 531.500.2000

GRAND ISLAND + SOUTH

2722 S Locust Street

Grand Island, NE 68801

P: 308.382.7850