03/04/2019

CMS-Medicare

Recent Oncology Related Articles

Quality Payment Program: Payment Adjustment Resource

CMS posted a new Merit-based Incentive Payment System (MIPS) resource, addressing frequently asked questions about the application of payment adjustments, which began January 1, 2019. Topics include: 

• Services subject to the 2019 MIPS payment adjustment
• Changes made to remittance advice documents
• Impact of claim assignments on payment adjustments
• Correction of the inclusion of Medicare Part B drugs and certain items and services
• Links to additional resources

For More Information:

• Resource Library webpage
• For questions, reach out to your local technical assistance organization or contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

First Opinion: Medicare Should Stop Blocking Access To Next-Generation Sequencing For People With Hereditary Cancer

(STAT) Mar 1, 2019 - America’s policymakers are rightly concerned about identifying the best ways to provide access to affordable health care. READ ARTICLE 

Data on Geographic Variation in the Medicare Program

CMS posted the annual release of the Geographic Variation Public Use File (PUF) with data for 2007 to 2017. This PUF is a series of downloadable tables and reports with demographic, spending, utilization, and quality indicators for the Medicare fee-for-service population. It presents data at the state, hospital referral region, and county level.

Laboratory Blood Counts: Provider Compliance Tips — Reminder

In 2017, the Medicare fee-for-service improper payment rate for blood counts was 19.2 percent with projected inaccurate payments of $56.6 million. Improper payments resulted from:

• Insufficient documentation - 89 percent
• Incorrect coding - 8.3 percent
• No documentation - 2.7 percent

Prevent denials by reviewing the Provider Compliance Tips for Laboratory Tests – Blood Counts Fact Sheet, which details coverage and documentation requirements.

Open Payments: Transparency and You Call — March 13

Wednesday, March 13 from 1 to 2 pm ET

Register for Medicare Learning Network events.

Reporting entities are submitting data to the Open Payments system on payments or transfers of value made to physicians and teaching hospitals during 2018. Beginning in April, physicians and teaching hospitals have 45 days to review and dispute records attributed to them. During this call, find out how to access the Open Payments system to review the accuracy of the data submitted about you before it is published on the CMS website. A question and answer session follows the presentation.

See the Open Payments Registration webpage for more information. CMS will publish the 2018 payment data and updates to the 2013 through 2016 data by June 30, 2019.

Topics: 

• Overview of the Open Payments national transparency program
• Program timeline
• Registration process
• Critical deadlines for physicians and teaching hospitals to review and dispute data

Target Audience: Physicians, teaching hospitals, and physician office staff.

CMS Updates Consumer Resources for Comparing Hospital Quality

New Data Added to CMS Hospital Compare Website 

February 28, 2019 - Today, the Centers for Medicare & Medicaid Services (CMS) updated hospital performance data on the Hospital Compare website and on data.medicare.gov to empower patients, families, and stakeholders with important information they need to compare hospitals and make informed healthcare decisions.  READ MORE

CMS: Beyond the Policy — New Podcast

On February 19, CMS launched CMS: Beyond the Policy, a new podcast highlighting updates and changes to policies and programs in an easily accessible and conversational format.

“The new Beyond the Policy podcast demonstrates our commitment to transparency and outreach by
presenting CMS-related policies, updates, and innovations on as many platforms as possible,” said CMS Administrator Seema Verma. “This program is a direct response to stakeholders’ suggestions that a podcast would be a modern, user-friendly way to stay informed about CMS.”

The first episode focuses on evaluation and management coding. New episodes of the podcast will be
released periodically.

See the full text of this excerpted CMS Press Release (issued February 19).

CAR T-cell Therapy: CMS Proposes Coverage with Evidence Development

On February 15, CMS proposed to cover U.S. Food and Drug Administration-approved Chimeric Antigen Receptor (CAR) T-cell therapy under “Coverage with Evidence Development.” This is a new form of cancer therapy that uses a patient’s own immune system to fight the disease.

Currently, there is no national Medicare policy for covering CAR T-cell therapy, so local Medicare
Administrative Contractors have discretion over whether to pay for it. The proposed National Coverage
Determination would require Medicare to cover the therapy nationwide when it is offered in a CMS-approved registry or clinical study, in which patients are monitored for at least two years post treatment.

Submit comments on the proposed decision memo by March 17. A final decision will be issued no later than 60 days after the conclusion of the comment period. See the full text of this excerpted CMS Press Release (issued February 15).

Appeals Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the February 5 call on the New Electronic System for Provider Reimbursement Review Board Appeals. Learn how to use the new Office of Hearings Case and Document Management System to submit new appeals, transfer issues, file position papers, and manage your appeals.

How to Use the Medicare National Correct Coding Initiative Tools Booklet — Revised

A revised How to Use the Medicare National Correct Coding Initiative (NCCI) Tools Booklet is available. Learn about:

• Website navigation
• Medicare code pair edits
• Medically unlikely edits
• Coding and billing errors

How to Use the Medicare Coverage Database Booklet — Revised

A revised How to Use The Medicare Coverage Database Booklet is available. Learn about:

• Navigating the database
• Searching indexes
• Downloading reports

Advance Care Planning Fact Sheet — Reminder

The Advance Care Planning Fact Sheet is available. Learn about:

• Provider and patient eligibility information
• How to code and bill services

Medicare Advance Written Notices of Noncoverage Booklet— Revised

A revised Medicare Advance Written Notices of Noncoverage Booklet is available. Learn about:

• Financial liability
• How to issue and complete the forms
• Guidelines for collecting beneficiary payment

Medicare Parts A & B Appeals Process Booklet— Revised

A revised Medicare Parts A & B Appeals Process Booklet is available. Learn about:

• Tips for filing
• The five levels of appeals
• Appointing a representative

QPP Videos: MIPS Data Submission

Learn how to manage and submit your 2018 Merit-based Incentive Payment System (MIPS) data through the Quality Payment Program (QPP) website by April 2 by viewing these brief videos:

• Uploading Files for Data Submission
• Reviewing Overview Data
• Reviewing Quality Category Data
• Reviewing Promoting Interoperability Category Data
• Reviewing Improvement Activities Category Data
• Manual Attestation of the Promoting Interoperability Category
• Manual Attestation of the Improvement Activities Category
• Deleting Submitted Data in the System
• Reviewing and Submitting Data as a Registry
• Navigation to Individual and Group Submission

For More Information:

• Resource Library webpage
• 2018 Data Submission FAQs
• QPP Access User Guide

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

• Evaluation and Management (E/M) When Performed with Superficial Radiation Treatment (Revised MM 11137)
• Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits (MM 11135)
• Medicare Part B Clinical Laboratory Fee Schedule: Revised Information for Laboratories on Collecting and Reporting Data for the Private Payor Rate-Based Payment System (SE 19006)
• Healthcare Provider Taxonomy Codes (HPTCs) April 2019 Code Set Update (MM 11121)
• Implementation to Exchange the List of Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System (Revised MM 11003)
• Local Coverage Determinations (LCDs) (Revised MM 10901)
• Modification of the MCS Claims Processing System Logic for Modifier 59, XE, XS, XP, and XU Involving the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Column One and Column Two Codes (MM 11168)