05/07/2019

CMS-Medicare

Recent Oncology Related Articles

Open Payments: Review and Dispute Data by May 15

Pre-publication review and dispute for program year 2018 Open Payments data is available through May 15. CMS will publish program year 2018 data and updates to the previous program years’ data in June. Physician and teaching hospital review of the data is voluntary, but strongly encouraged:

• Records eligible for review and dispute: All records submitted during the submission period of the
  current calendar year, including newly edited, submitted, and re-attested records from previous
  calendar years; See the Physician and Teaching Hospital Review and Dispute Tutorial
• Disputes must be initiated by May 15: See the Review and Dispute Timing and Data Publication Quick Reference Guide
• We do not meditate or facilitate disputes: Work directly with reporting entities to resolve disputes
• Registration in the Open Payments system is required: Visit the Registration for Physicians & Teaching Hospitals webpage for instructions

If you are already registered, log in to review your data:

• If you have not accessed your account in 60 days or more, you will need to unlock your account in the CMS Portal
• If you have not accessed your account in 180 days or more, your account has been deactivated, and you will need to contact the Open Payments Help Desk to reinstate your account

For More Information:

• Open Payments website
• Materials from March 13 Medicare Learning Network call
• Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or 855-326-8366; TTY 844-649-2766

Medicare Overpayments — Revised

A revised Medicare Overpayments Medicare Learning Network Fact Sheet is available. Learn about:

• Definition of an overpayment
• Collection tools and processes
• Payment options

Medicare Offers To Partially Raise Payment For Cancer CAR-Ts

(Reuters) Apr 23, 2019 - The U.S. Centers for Medicare and Medicaid Services will slightly increase coverage for expensive CAR-T cell therapies administered at certain large hospitals, and is considering other ways to pay more for the cancer treatments, the agency said on Tuesday.  READ ARTICLE  

CMS Reopens National Coverage Determination for NGS Testing in Advanced Cancer

(GenomeWeb) May 1, 2019 – The Centers for Medicare & Medicaid Services have officially reopened its national coverage determination for next-generation sequencing for advanced cancer patients in order seek public comments on germline testing. READ ARTICLE (free registration required) 

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities

In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.

All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:

• MLN Matters Special Edition Article
• Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet
• Acute Care Hospital Inpatient Prospective Payment System Fact Sheet: See payment information on page 3
• Items and Services Not Covered Under Medicare Booklet, Page 12
• Medicare Claims Processing Manual, Chapter 3, Section 10.4
• Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided To
  Beneficiaries Who Were Inpatients of Other Facilities OIG Report, September 2017

Medicare Billing: CMS Form CMS-1450 and the 837 Institutional — Reminder

The Medicare Billing: CMS Form CMS-1450 and the 837 Institutional Medicare Learning Network Booklet is available. Learn:

• When Medicare will accept a hard copy claim form
• Filing requirements
• How to submit and code claims

Medicare Billing: CMS Form CMS-1500 and the 837 Professional — Reminder

The Medicare Billing: CMS Form CMS-1500 and the 837 Professional Medicare Learning Network Booklet is available. Learn:

• When Medicare will accept a hard copy claim form
• Filing requirements
• How to submit and code claims

Quality Payment Program: MIPS 2019 Call for Measures/Activities Ends July 1

You can submit Promoting Interoperability measures and Improvement Activities for consideration for future years of the Merit-based Incentive Payment System (MIPS) through July 1. CMS is currently accepting submissions for:

• Electronic health record measures for the Promoting Interoperability performance category
• Activities for the Improvement Activities performance category

For More Information:

• Call for Measures and Activities: Fact sheet and materials
• Resource Library webpage
• Webinar Library webpage

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

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
• OIG Report on the proper use of the KX modifier for Part B immunosuppressive drug claims

2019 MIPS Group Participation

CMS posted a Merit-based Incentive Payment System (MIPS) 2019 Group Participation Guide, covering the following topics:

• Eligibility and participation
• Group registration for CMS Web Interface and CAHPS® for MIPS Survey
• Data collection and submission for each MIPS performance category
• Scoring and payment adjustments

PECOS for Physicians and NPPs — Revised

A revised The Provider Enrollment, Chain, and Ownership System (PECOS) for Physicians and Non-Physician Practitioners (NPPs) Medicare Learning Network Booklet is available. Learn how to:

• Register in the system
• Obtain a National Provider Identifier
• Enter enrollment information
• Respond to Medicare Administrative Contractor requests

Provider Minute Video: The Importance of Proper Documentation

Why is proper documentation important to you and your patients? Find out how it affects items/services, claim payment, and medical review in the Provider Minute: The Importance of Proper Documentation video. Learn about:

• Top five documentation errors
• How to submit documentation for a Comprehensive Error Rate Testing review
• How your Medicare Administrative Contractor can help

A revised Telehealth Services Medicare Learning Network Booklet is available.

Learn about:

• Requirements
• Distant site practitioners
• Billing and payment for the originating site facility 

Quality Payment Program Merit-based Incentive Payment System (MIPS): Quality Performance Category in 2019 Web-Based Training Course — Revised

With Continuing Medical Education Credit

A revised Quality Payment Program Merit-based Incentive Payment System (MIPS): Quality Performance Category in 2019 Web-Based Training Course is available through the Medicare Learning Network Learning Management System. Learn about:

• Reporting requirements
• Identifying data submission and collection types
• Scoring and benchmark methodology, and helpful resources

Recent LearnResource & MedLearn Matters Articles

• Appeals of Claims Decisions - Revisions
• New Waived Tests
• Implementation to eMDR for Registered Providers via the esMD System — Reissued