05/21/2019

CMS-Medicare

Recent Oncology Related Articles

Improper Payment for Intensity-Modulated Radiation Therapy Planning Services

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity Modulated 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
• July 2016 Update of the Hospital Outpatient Prospective Payment System MLN Matters Article
• Medicare Claims Processing Manual, Chapter 4, Section 200.3.1
• Medicare Improperly Paid Hospitals Millions of Dollars for IMRT Planning Services OIG Report, August 2018

MIPS Improvement Activities Performance Category in 2019 Webinar — May 23

Thursday, May 23 from 1 to 2 pm ET

Register for this webinar.

During the webinar, CMS experts provide a brief overview of the Merit-based Incentive Payment System (MIPS) and discuss the following Improvement Activities Performance Category topics:

• Basics
• Reporting requirements
• Data submission
• Scoring
• Flexibilities for small and rural practices
• Resources

Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B — Reminder

The Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B Medicare Learning Network Educational Tool is available. Learn:

• Billing information
• Frequently asked questions
• Codes
• Descriptors

Medicare Shared Savings Program: Submit Notice of Intent to Apply Beginning June 11

CMS announced Notice of Intent to Apply (NOIA) and application cycle dates for a January 1, 2020, start date for the Medicare Shared Savings Program – Pathways to Success. Beginning June 11, 2019, CMS will start accepting NOIAs via the Accountable Care Organization (ACO) Management System (ACO-MS). You must submit a NOIA if you intend to apply to the BASIC or ENHANCED track of the Shared Savings Program, apply for a Skilled Nursing Facility 3-Day Rule Waiver, and/or establish and operate a Beneficiary Incentive Program.

NOIA submissions are due no later than June 28 at noon ET. A NOIA submission does not bind your
organization to submit an application; however, you must submit a NOIA to be eligible to apply. Each ACO should submit only one NOIA. ACOs will have an opportunity to make changes to their tracks, repayment mechanisms, and other NOIA-related information during the application submission period. Also, CMS allows ACOs to submit sample documentation (e.g., sample ACO participant agreements) with their NOIA in order to receive feedback from CMS before the application period opens.

The application submission period will be open from July 1 through 29, 2019, at noon ET.

For More Information:

• Shared Savings Program website
• Application Types and Timeline webpage
• Application Toolkit webpage
• For questions email SSPACO_Applications@cms.hhs.gov

Laboratory Blood Counts: Provider Compliance Tips

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. 

Hospital Outpatient Prospective Payment System— Revised

A revised Hospital Outpatient Prospective Payment System Medicare Learning Network Booklet is available. Learn about:

• Ambulatory classifications
• How payment rates are set
• Hospital Outpatient Quality Reporting Program

Recent LearnResource & MedLearn Matters Articles

• International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs)
• Medicare Summary Notice (MSN) Changes to Assist Beneficiaries Enrolled in the Qualified Medicare Beneficiary (QMB) Program
• E/M Services of Teaching Physicians: Documentation
• FISS: Updates for Pricing Drugs Depending on Provider Type
• Medicare Physician Fee Schedule Database File Record Layout
• Clinical Laboratory Fee Schedule: Quarterly Update
• Medicare Physician Fee Schedule Database: Quarterly Update