02/05/2019
CMS-Medicare
Recent Oncology Related Articles
Coding and Billing Date of Service on Professional Claims MLN Matters Article — Reissued
A resissued MLN Matters Article SE17023 on Guidance on Coding and Billing Date of Service on Professional Claims is available. Learn how to identify correct dates of service.
QPP Videos: Create an Account in HARP
On December 19, 2018, CMS transitioned to a new system to create identity management accounts and request access to the Quality Payment Program (QPP) website: The Healthcare Quality Information System (HCQIS) Access Roles and Profile (HARP) system. If you previously created a QPP account in the Enterprise Identity Management (EIDM) system, continue to use your EIDM ID and password to sign-in, view, submit, and manage your data. If you need to make any changes to your ID/password or create a new account, you will do so in the HARP system.
View videos for step-by-step instructions on how to:
- Create a QPP Account - Create a new HARP account
- Connect to an Organization: Practice - View, submit, and manage data on behalf of the practice
- Connect to an Organization: APM Entity - View, submit, and manage data on behalf of the APM
- Connect to an Organization: Registry - Submit data on behalf of your customers
- Connect to an Organization: Virtual Group - View, submit, and manage data on behalf of the virtual group
- Security Officials: Approving Role Requests - Approve and deny requests from staff users
For More Information:
- QPP User Access Guide
- Questions: QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)
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:
Open Payments Data Update
On January 18, CMS updated the Open Payments dataset to reflect changes to the data that took place since the last publication in June 2018. Use the Open Payments Search Tool to view the data. The refreshed dataset includes:
- Record updates: Changes to non-disputed records made on or before November 15
- Disputed records: Updated information for dispute resolutions completed on or before December 31
- Record deletions: Removed records deleted before December 31
The Search Tool is updated with the following features:
- Query builder: Conduct payment searches not tied to an entity. The results organize payments by
program year with the option to download the results for additional analysis. - Entity profile updates: Payment types are converted to tabs to make this data easier to access and navigate. The summary table is consolidated with the top summary section and accessible by a “table” toggle button. The Nature of Payment chart includes a “company filter.”
For More Information:
- Open Payments website
- Resources webpage
- Submit questions to the Help Desk at openpayments@cms.hhs.gov or 855-326-8366 (TTY: 844-649-2766)
New System for PRRB Appeals MLN Matters Article — New
A new MLN Matters Article SE19004 on New Electronic System for Provider Reimbursement Review Board (PRRB) Appeals is available. Learn about the new web-based portal.
ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets Educational Tool — Reminder
The ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Code Sets Educational Tool is available. Learn about:
- Code set definitions
- Payment information
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.
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
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.
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
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
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
- April 2019 Quarterly ASP Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM 11151)
- Guidance on Coding and Billing Date of Service on Professional Claims (Reissued SE 17023)
- Local Coverage Determinations (LCDs) (Revised MM 10901)
- Common Working File (CWF) Provider Queries National Provider Identifier (NPI) and Submitter Identification (ID) Verification (Revised MM 10983)