01/23/2019

CMS-Medicare

Recent Oncology Related Articles

Medicare:
Voluntary and Mandatory Episode-Based Payment Models and Their Participants
GAO-19-156, December 21

**Note - Article includes information on the Oncology Care Model

Hospice Election Statements Lack Required Information or Have Other Vulnerabilities — Reminder

After a stratified random sample review of hospice election statements and certifications of terminal illness, the Office of the Inspector General (OIG) reports that more than one-third of hospice General Inpatient (GIP) stays lack required information or had other vulnerabilities.

• Hospice election statements did not always mention – as required – that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative
• In 14 percent of GIP stays, the physician did not meet requirements when certifying that the beneficiary was terminally ill and appeared to have limited involvement in determining that the beneficiary’s condition was appropriate for hospice care

Hospices should improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care. Resources:

• Hospices Should Improve Their Election Statements and Certifications of Illness OIG Report,
  September 2016.
• Hospice Payment System Booklet: Includes a section on the hospice election statement
• Documentation Requirements for the Hospice Physician Certification/Recertification MLN Matters
  Article
• Sample Hospice Election Statement MLN Matters Special Edition Article

Comparative Billing Report Webinar on Intensity-Modulated Radiation Therapy Webinar — January 24

Thursday, January 24 from 3 to 4 pm ET

Register for this webinar.

Join us for a discussion of the Comparative Billing Report (CBR) on Intensity-Modulated Radiation Therapy (CBR201901), an educational tool for providers who submit Medicare Part B claims for these services. See the CBR website for more information.

New Electronic System for Provider Reimbursement Review Board Appeals Call — February 5

Tuesday, February 5 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

Do you want to file or manage a Provider Reimbursement Review Board (PRRB) appeal? Learn how to use the new Office of Hearings Case and Document Management System (OH CDMS) to submit new appeals, transfer issues, file position papers, and manage all aspects of your PRRB appeals. For more information, visit the PRRB OH CDMS webpage.

During this call, PRRB staff discuss:

• How to access the system
• Detailed overview of the system and its capabilities
• Frequently asked questions

A question and answer session follows the presentation; however, attendees may email questions in advance to PRRB@cms.hhs.gov with “Office of Hearings Case and Document Management System Conference Call” in the subject line. These questions may be addressed during the call or used for other materials following the call.

Target Audience: All PRRB appeal stakeholders.

NCCI PTP Edits: Quarterly Update MLN Matters Article — New

A new MLN Matters Article MM11126 on Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 25.1 Effective April 1, 2019 is available. Learn about Medicare claims processing updates. 

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

A revised MLN Matters Article MM11005 on International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) is available. Learn about coding changes.

Local Coverage Determinations MLN Matters Article — Revised

A revised MLN Matters Article MM10901 on Local Coverage Determinations (LCDs) is available. Learn about updates to the Medicare Program Integrity Manual.

Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims — Reminder

A 2017 Office of the Inspector General (OIG) report noted that, in some cases, pharmacies incorrectly billed Medicare Part B for claims using the KX modifier for immunosuppressive drugs. It is estimated that Medicare paid $4.6 million for these claims that did not comply with Medicare requirements.

In response to this report, CMS clarified manual instructions on the use of the KX modifier to help pharmacies document the medical necessity of organ transplant and eligibility for Medicare coverage. Resources for pharmacies:

• Pharmacy Billing of Immunosuppressive Drugs MLN Matters® Article
• Clarification of the Billing of Immunosuppressive Drugs MLN Matters Article
• Change Request 10235
• OIG Report on the proper use of the KX modifier for Part B immunosuppressive drug claims

Hospital OPPS: January 2019 Update MLN Matters Article — New

A new MLN Matters Article MM11099 on January 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS) is available. Learn about changes and billing instructions for various payment policies.

Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training Course — Revised

With Continuing Education Credit

A revised Medicare Billing: Form CMS-1500 and the 837 Professional Web-Based Training (WBT) course is available through the Learning Management System. Learn about:

• Key aspects and requirements for electronic and paper claims
• Information required when submitting claims
• Important claims processing actions

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

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

• Proof of Delivery Documentation Requirements (SE 19003)
• International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) (Revised MM 11005)
• Local Coverage Determinations (LCDs) (Revised MM 10901)
• Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 25.1 Effective April 1, 2019 (MM 11126)