10/02/2018

CMS-Medicare

Recent Oncology Related Articles

QRURs and PQRS Feedback Reports: Access Ends December 31

The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016 and the final payment adjustment year is 2018. Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports will no longer be available after the end of 2018. If you need these reports, download them through December 31, 2018. Visit the How to Obtain a QRUR webpage for more information.

For access to PQRS Taxpayer Identification Number or National Provider Identifier reports from program year 2013 or earlier, contact the QualityNet Help Desk. They are no longer available from the QualityNet Secure Portal.

The Merit-based Incentive Payment System (MIPS) under the Quality Payment Program replaced the Value Modifier and PQRS programs. Visit the Quality Payment Program website to learn more. Note: QRURs and PQRS Feedback Reports are not same as the MIPS Performance Feedback.

For More Information:

• PQRS Analysis and Payment webpage: Information on PQRS Feedback Report
• Value-Based Payment Modifier webpage: Information on QRURs
• For assistance with Enterprise Identity Management or PQRS Feedback Reports , contact the
  QualityNet Help Desk
• For assistance with the QRURs or Value Modifier, contact the Physician Value Help Desk at
  pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 4)

MIPS Targeted Review Request: Deadline Extended to October 15

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available on the Quality Payment Program website. The payment adjustment you receive in 2019 is based on this final score. If you believe there is an error in your 2019 MIPS payment adjustment calculation, request a targeted review until October 15 at 8 pm ET.

For More Information:

• How to Request a Targeted Review Video
• Targeted Review of 2019 MIPS Payment Adjustment User Guide
• Targeted Review of 2019 MIPS Payment Adjustment Fact Sheet
• Contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov

Quality Payment Program: MIPS Resources

CMS posted new Merit-based Incentive Payment System (MIPS) resources:

• 2019 Virtual Groups Toolkit: Includes an overview fact sheet, an election process fact sheet, a sample virtual group election submission email, and a virtual group agreement template
• 2018 Cost Performance Category Fact Sheet (updated): Includes information on how the cost
  performance category is weighted and scored
• 2018 Claims Data Submission Fact Sheet: Provides details on how to submit Quality performance category data
• 2018 MIPS Specialty Measures Guides for Anesthesiologists and Certified Registered Nurse
  Anesthetists, Cardiologists, and Radiologists: Highlights a list of measures and activities for the Quality, Cost, Improvement Activities and Promoting Interoperability performance categories
• MIPS Data Validation Criteria: Includes an overview fact sheet and the 2018 criteria used to audit and validate data submitted in the Quality, Improvement Activities, and Promoting Interoperability performance categories
• 2018 Eligible Measure Applicability (EMA) Resources: Provides an overview of the EMA process and lists individual quality measures for both registry and claims data submission

For More Information:

• 2018 Resources webpage
• Contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient IntensityModulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.

Use the following resources to bill correctly:

• IMRT Planning Services Editing MLN Matters® Article
• Medicare Improperly Paid Hospitals Millions of Dollars for IMRT Planning Services OIG Report, August 2018
• Medicare Claims Processing Manual, Chapter 4, Section 200.3.1
• July 2016 Update of the Hospital Outpatient Prospective Payment System MLN Matters Article

Medicare Appeals Council: New Decision Format

Beginning in October, the Medicare Appeals Council at the HHS Departmental Appeals Board is changing the look and format of its decisions, including a different font style and simplified layout. Email questions about the new format to DABStakeholders@hhs.gov. 

ASP Pricing Files and Coverage for Drugs

The Average Sales Price (ASP) files include payment amounts for Medicare Part B drugs. These files are not intended indicate whether a drug or biological is covered under Part B:

• The absence or presence of a HCPCS code and payment allowance limit does not indicate whether Medicare covers the drug
• The inclusion of a payment allowance limit within a specific column (for example clotting factor) does not indicate whether Medicare covers the drug in that specific category

Remember: Medicare Part B drug coverage determinations are made by your Medicare Administrative
Contractor.

ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised

A revised MLN Matters Article MM10859 on International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) is available. Learn about coding updates.

Open Payments: Key Thresholds for Program Year 2019 Reporting

Open Payments key (de minimis) thresholds for reporting are adjusted based on the consumer price index. Small payments or transfers of value of less than $10.79 do not need to be reported, except when the total annual value of payments or other transfers of value to a covered recipient exceeds $107.91 for Program Year 2019 (data collected from January 1 through December 31, 2019).

For More Information:

• Open Payments website
• For questions, contact the Help Desk at openpayments@cms.hhs.gov or 855-326-8366, (TTY 844-649-2766)

Open Payments: Program Year 2019 Teaching Hospital List

The Open Payments Program Year 2019 teaching hospital list is available in PDF or Excel formats. The list identifies which teaching hospitals are eligible for reporting in Program Year 2019 (data collected from January 1 through December 31, 2019).

For More Information:

• Open Payments website
• For questions, contact the Help Desk at openpayments@cms.hhs.gov or 855-326-8366, (TTY 844-649-2766)

Physician Compare: Public Reporting Webinar Materials

A recording and transcript of the Public Reporting on Physician Compare: What you Need to Know webinar is available on the Physician Compare Initiative website. Contact PhysicianCompare@Westat.com if you have questions.

Annual Clotting Factor Furnishing Fee: 2019 Update MLN Matters Article — New

A new MLN Matters Article MM10918 on Annual Clotting Factor Furnishing Fee Update 2019 is available. Learn about the furnishing fee paid for items and services associated with clotting factor.

Influenza Vaccine Payment Allowances: Annual Update MLN Matters Article — New

A new MLN Matters Article MM10914 on Influenza Vaccine Payment Allowances - Annual Update for 2018-2019 Season is available. Learn about payment allowances for influenza virus vaccines updated on August 1.

Influenza Virus Vaccine Code: January 2019 Update MLN Matters Article — Revised

A revised MLN Matters Article MM10871 on Quarterly Influenza Virus Vaccine Code Update - January 2019 is available. Learn about new influenza virus vaccine code 90689.

Complying with Documentation Requirements for Laboratory Services Fact Sheet — Revised

A revised Complying with Documentation Requirements for Laboratory Services Fact Sheet is available. Learn about:

• Tips for signature requirements
• Services to help avoid errors in claims submission

2016 PQRS and 2018 Value Modifier Experience Reports

Find data from the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier Programs. 2018 payment adjustments are based on 2016 data.

• 2018 Value-Based Payment Modifier Program Experience Report (2015 – 2018) and 2018 Results Fact Sheet
• 2016 PQRS Reporting Experience Including Trends (2007-2016) and Appendix

 Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course — Revised

With Continuing Education Credit

A revised Diagnosis Coding: Using the ICD-10-CM Web-Based Training course is available through the
Learning Management System. Learn about:

• Structure, format, and features
• How to find correct codes
• ICD-10-CM/PCS coding tips, information, and resources

 Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet — Reminder

The Medicare Enrollment for Physicians, Non-Physician Practitioners (NPPs), and Other Part B Suppliers Booklet is available. Learn about:

• Who are Part B suppliers
• Enrolling in the Medicare Program
• Determining if you want to be a participating provider

Recent LearnResource & MedLearn Matters Articles

• 2018-2019 Influenza (Flu) Resources for Health Care Professionals (SE 18015)
• Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2019 (MM 10941)
• New Waived Tests (MM 10958)
• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2018 Update (Revised MM 10834)