04/03/2018

CMS-Medicare

Recent Oncology Related Articles

New Q-Code for Yescarta

The new code, Q2041, is defined as “Axicabtagene Ciloleucel, up to 200 million autologous Anti-CD19 CAR T Cells, Including leukapheresis and dose preparation procedures, per infusion.”  This code will be effective April 1, 2018.1
 
YESCARTA® was approved on October 18, 2017, by the US Food and Drug Administration.2 YESCARTA® is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with relapsed or refractory large B-cell lymphoma after two or more lines of systemic therapy, including diffuse large B-cell lymphoma (DLBCL) not otherwise specified, primary mediastinal large B-cell lymphoma, high grade B-cell lymphoma, and DLBCL arising from follicular lymphoma.3 YESCARTA® is not indicated for the treatment of patients with primary central nervous system lymphoma.3

April 1, 2018
*NDC has been “zero‑filled” to ensure creation of an 11‑digit code that meets HIPAA standards. The zero‑fill location is indicated in bold.
HCPCS=Healthcare Common Procedure Coding System; NDC=National Drug Code; CMS=Centers for Medicare and Medicaid Services; HIPAA=Health Insurance Portability and Accountability Act.

HIMSS18 Presentations

CMS recently participated in the 2018 Healthcare Information and Management Systems Society (HIMSS18) Annual Conference & Exhibition. Presentations:

• Meaningful Measures Initiative
• Quality Payment Program Year 2
• Quality Payment Program: Advancing Care Information
• Advanced Alternative Payment Models
• Developer Tools Town Hall

E/M Services Listening Session: Audio Recording and Transcript — New

An audio recording and transcript are available for the March 21 listening session on Evaluation and Management (E/M) services. CMS seeks comments from stakeholders on potential updates to the guidelines to reduce burden and better align coding and documentation with the current practice of medicine. 

Billing for Stem Cell Transplants — Reminder

In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services.

Use the following resources to bill correctly and avoid overpayment recoveries:

• Medicare Did Not Pay Selected Inpatient Claims for Bone Marrow and Stem Cell Transplant
  Procedures in Accordance with Medicare Requirements OIG Report
• OIG Report: Stem Cell Transplantation MLN Matters® Article
• CMS Transmittal 1805

Billing Requirements for OPPS Providers with Multiple Service Locations MLN Matters Article — New

A new MLN Matters Special Edition Article on Billing Requirements for OPPS Providers with Multiple Service Locations is available. Learn about editing requirements for the Medicare Claims Processing Manual, Chapter 1, and Section 170 which describes payment bases for institutional claims for the Outpatient Prospective Payment System (OPPS).

Medicare Parts A and B Appeals Process Booklet — Reminder

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

• Five levels of claim appeals
• New option for a level three on-the-record review
• Available forms and helpful tips for filing an appeal

READ MORE

Early Data Show Positive Trend in Oncology Care ModelCost Savings

In the first presentation of the National Comprehensive Cancer Network (NCCN) Annual Conference (March 21-23, 2018; Orlando, FL) Keynote session, Ron Kline, MD, FAAP, clinical lead on the Oncology Care Model (OCM) and Medicare Care Choices Model at the Center for Medicare & Medicaid Innovation (CMMI), gave an overview of the OCM and an unofficial preview of the preliminary data CMMI has accrued from OCM practices within the first 6 months of implementation.  READ MORE

Recent LearnResource & MedLearn Matters Articles

• Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 (MM 10531)
• Institutional Billing for No Cost Items (MM 10521)
• Adjustments to Qualified Medicare Beneficiary (QMB) Claims Processed Under CR 9911 (MM 10494)
• Prohibition Billing Dually Eligible Individuals Enrolled in the Qualified Medicare Beneficiary (QMB) Program (Revised SE 1128)
• April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1 (Revised MM 10514)
• April 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) (Revised MM 10515)