01/03/2019

CMS-Medicare

Recent Oncology Related Articles

Billing for Stem Cell Transplants — Reminder

In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services.

Use the following resources to bill correctly and avoid overpayment recoveries:

• Medicare Did Not Pay Selected Inpatient Claims for Bone Marrow and Stem Cell Transplant
  Procedures in Accordance with Medicare Requirements OIG Report, February 2016
• OIG Report: Stem Cell Transplantation MLN Matters® Article
• CMS Transmittal 1805

Laboratory Date of Service Exception Policy: Enforcement Discretion Exercised until July 1

CMS will exercise enforcement discretion until July 1, 2019, for the laboratory date of service exception policy for advanced diagnostic laboratory tests and molecular pathology tests excluded from the Medicare hospital outpatient prospective payment system packaging policy. Visit the Laboratory Date of Service Policy webpage for more information.

In Case You Missed It: Watch ASCO’s Webinar on 2019 Medicare Reimbursement Changes

(ASCO in Action) Dec 11, 2018 - ASCO recently hosted a webinar outlining important changes to Medicare reimbursement starting Jan. 1, 2019.  READ ARTICLE

CMS Physician Fee Schedule Call: Audio Recording and Transcript

An audio recording and transcript are available for the November 19 call on the Physician Fee Schedule Final Rule. During this call, CMS experts cover three provisions:

• Streamlining Evaluation and Management (E/M) payment and reducing clinician burden
• Advancing virtual care
• Continuing to improve the Quality Payment Program to reduce burden and offer flexibilities to help clinicians successfully participate

CLICK HERE for this information

CY 2019 MPFS Final Rule: Summary of Policies MLN Matters Article — New

A new MLN Matters Article MM11063 on Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List is available. Learn about policy changes.

2019 Medicare Part D Opioid Policies: Training Materials

CMS will implement new opioid policies for Medicare drug plans on January 1. The new policies include:

• Improved safety alerts when patients fill opioid prescriptions at the pharmacy
• Drug management programs for patients at-risk for misuse or abuse of opioids or other drugs

CMS posted new training materials, including slide decks and tip sheets for:

• Prescribers
• Pharmacists
• Patients

CMS also recently released an MLN Matters® Article: A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019. Visit the Reducing Opioid Misuse webpage for more information on CMS’ overall strategy.

MLN Catalog: December 2018 – Revised

A revised MLN Catalog – December 2018 is available. Learn about free:

• Products and services that can be downloaded
• Web-based training courses; some offer continuing education credits
• Helpful links, tools, and tips

Quarterly Provider Update

The Quarterly Provider Update is a comprehensive resource published by the Centers for Medicare & Medicaid Services (CMS) on the first business day of each quarter. It is intended to make it easier for providers, suppliers, and the general public to understand the changes CMS is proposing or making.
 
CMS publishes this update to inform the public about the following: 

• Regulations and major policies completed or cancelled.
• New/Revised manual instructions

The Quarterly Provider Update can be accessed on the CMS website.
 
We encourage you to bookmark this web page and visit it often for this valuable information. To receive notification when regulations and program instructions are added throughout the quarter, sign up for the Quarterly Provider Update Listserv.

Quality Payment Program: 2019 Resources

CMS posted new resources to help you prepare for the 2019 performance year of the Merit-based Incentive Payment System (MIPS):

• Medicare Part B Claims Measure Specifications and Supporting Documents: Descriptions of the claims measures for the Quality performance category
• Clinical Quality Measure Specifications and Supporting Documents: Descriptions of the clinical quality measures for the Quality performance category
• CMS Web Interface Measure Specifications and Supporting Documents: Descriptions of the CMS Web Interface measures for the Quality performance category
• Cross-Cutting Quality Measures: List of cross-cutting Quality measures that are broadly applicable to all clinicians regardless of their specialty
• Quality Measure Benchmarks: Lists and explains benchmarks used to assess performance in the
  Quality performance category
• Promoting Interoperability Measure Specifications: Overview of the requirements for the Promoting Interoperability performance category objectives and measures
• Cost Measure Code Lists: Details the cost measure code lists for each of the 8 episode-based cost measures that are new for the Cost performance category
• Cost Measure Information Forms: Details the measure methodology for each episode-based measure for the Cost performance category
• MIPS: Summary of Cost Measures: Summary of cost measures
• Improvement Activities Inventory: List of the improvement activities and descriptions
• Qualified Clinical Data Registries (QCDRs) and Qualified Registries Qualified Postings: List of CMSapproved QCDRs and Qualified Registries and the performance categories and measures they support
• MIPS Participation and Eligibility Fact Sheet: Overview of the eligibility criteria
• Quality Performance Category Fact Sheet: Includes an overview of quality measures and how to collect and submit quality data
• Cost Performance Category Fact Sheet: Includes details on the episode-based measures

For More Information:

• Resource Library webpage
• Quality Payment Program website
• Reach out to your local technical assistance organization
• Contact QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

Quality Payment Program: Webinar Library

CMS moved Quality Payment Program (QPP) webinar resources to the newly redesigned QPP Webinar Library webpage. Search for the webinars and accompanying recordings, transcripts, and presentation slides by performance year, reporting track, performance category, and webinar type. For questions, contact QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222). 

Recent LearnResource & MedLearn Matters Articles

• January 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS) (MM 11099)
• Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (MM 11076)
• Claim Status Category and Claim Status Codes Update (MM 11073)
• January 2019 Integrated Outpatient Code Editor (I/OCE) Specifications Version 20.0 (MM 11068)