04/17/2018

CMS-Medicare

Recent Oncology Related Articles

CMS Transmittal 191 on OCM Bundling Edits

This transmittal formalizes the existing bundling edits on the Oncology Care Model. That is, CMS has increased the codes that may not be billed for the same beneficiary in the same month as the OCM Monthly Enhanced Services (MEOS) payment (G9678). These services include 99358 and 99359 (Prolonged non - face - to - face evaluation and management services); 99487 and 99489 (Chronic Care Management); G0506 (Assessment/care planning for patients requiring CCM services);  CLICK HERE to review the remaining codes and the rest of this Transmittal

2018 MIPS Eligibility Tool

Use the updated MIPS Participation Lookup Tool to check on your 2018 eligibility for the Merit-based Incentive Payment System (MIPS). Just enter your National Provider Identifier to find out whether you need to participate during the 2018 performance year.

To reduce the burden on small practices, CMS changed the eligibility threshold for 2018. Clinicians and groups are now excluded from MIPS if they:

• Billed $90,000 or less in Medicare Part B allowed charges for covered professional services under the Physician Fee Schedule (PFS)
• Furnished covered professional services under the PFS to 200 or fewer Medicare Part B -enrolled beneficiaries

Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs Used in Conjunction

For the 2017 reporting period, the Medicare Fee-For-Service (FFS) improper payment rate for oral anticancer drugs was 43.2 percent, representing a projected improper payment amount of $66.09 million. According to 2016 reporting data, improper payments resulted from:

• Insufficient documentation - 74 percent
• No documentation - 1.8 percent
• Other reasons such as duplicate payment error, non-covered or unallowable service, or ineligible
  Medicare beneficiary - 24.1 percent

Prevent denials by reviewing the Provider Compliance Tips for Oral Anticancer Drugs and Antiemetic Drugs used in Conjunction Fact Sheet for coverage and documentation requirements.

Additional Resources:

• 2017 Medicare FFS Supplemental Improper Payment Data
• Supplementary Appendices for the Medicare FFS 2016 Improper Payments Report
• Local Coverage Determination: Oral Anticancer Drugs
• Local Coverage Article: Oral Anticancer Drugs

New Waived Tests MLN Matters Article — New

A new MLN Matters Article on New Waived Tests is available. Learn about the latest tests approved by the Food and Drug Administration under Clinical Laboratory Improvement Amendments.

Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 MLN Matters Article — Revised

A revised MLN Matters Article on Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 is available. Learn about Medicare fee-for-service claims reprocessing requirements and timeframes.

April 2018 MLN Catalog – Revised 

A revised April 2018 MLN Catalog is available. Learn about:

• Products and services that can be downloaded for free
• Web-based training courses; some offer continuing education credits
• Helpful links, tools, and tips

New Medicare Card Project – Important Updates

CMS started mailing newly-designed Medicare cards with the new Medicare Beneficiary Identifier (MBI), or Medicare Number. People enrolling in Medicare for the first time will be among the first to get the new cards, no matter where they live. Current Medicare beneficiaries will get their new cards on a rolling basis over the coming months. We will continue to accept the Health Insurance Claim Number (HICN) through the transition period.

During our planning, we continuously adjusted and improved our mailing strategy to make sure we are:

• Mailing the new cards to accurate addresses
• Protecting current Medicare beneficiaries and their personal information in every way possible

We are working on making our processes even better by using the highest levels of fraud protection when we mail new cards to current Medicare beneficiaries. Over the next few weeks, we will complete this additional work and begin mailing new cards to current Medicare beneficiaries.

We are committed to mailing new cards to all Medicare beneficiaries over the next year. For more information, visit the New Medicare Card landing and provider webpages.

HCPCS Code Set Modifications

The April update of the HCPCS code set is available on the HCPCS Quarterly Update webpage. Changes are effective on the date indicated in the update.

Institutional Billing for No Cost Items MLN Matters Article — New

A new MLN Matters Article on Institutional Billing for No Cost Items is available. Learn how to report drugs provided at no cost in the hospital outpatient department.

2018 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training Course — Revised

With Continuing Education Credit

A revised 2018 Medicare Part C and Part D Reporting Requirements and Data Validation Web-Based Training (WBT) course is available through the Learning Management System. Learn about:

• Planning and performing data validation activities
• Analyzing results and submission of findings
• Completing the post-data validation activities

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 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

Recent LearnResource & MedLearn Matters Articles

• Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 24.2 Effective July 1, 2018 (MM 10593)
• Claims Processing Actions to Implement Certain Provisions of the Bipartisan Budget Act of 2018 (Revised MM 10531)
  
• Deadline Extension - Low Volume Appeals Expression of Interest