05/01/2018

CMS-Medicare

Recent Oncology Related Articles

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2018 Update

Change Request (CR) 10624 informs MACs of updated drug/biological HCPCS codes. The HCPCS code set is updated on a quarterly basis. The July 2018 HCPCS file includes 4 new HCPCS codes: Q9991, Q9992, Q9993 and Q9995. READ MORE

Open Payments Review and Dispute Data by May 15

Open Payments Program Year 2017 data and any newly submitted records are available for review.
Physicians and teaching hospitals: review, affirm, and, if necessary, dispute these records by May 15. Review of the data is voluntary but strongly encouraged.

Disputes must be initiated during the review and dispute period to be reflected in the June 2018 data
publication. For more information, read the Review and Dispute Quick Reference Guide.

To review your data, register in the Open Payments system. 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
• Contact the Open Payments Help Desk at openpayments@cms.hhs.gov or 855-326-8366; TTY 844-649-2766

CMS Changes Name of the EHR Incentive Programs and Advancing Care Information to “Promoting Interoperability”

CMS is overhauling and streamlining the Electronic Health Record (EHR) Incentive Programs for hospitals as well as for the Advancing Care Information performance category of the Merit-based Incentive Payment System (MIPS), which is one track of the Quality Payment Program. To better reflect this focus, CMS is renaming:

• The EHR Incentive Programs to the Promoting Interoperability Programs for eligible hospitals, critical access hospitals, and Medicaid providers
• The MIPS Advancing Care Information performance category to the Promoting Interoperability
  performance category for MIPS eligible clinicians

Note: this rebranding does not merge or combine the EHR Incentive Programs and MIPS. 

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:

• CMS and Its Claims Processing Contractors Issued Conflicting Guidance on the Proper Use of the KX Modifier for Part B Immunosuppressive Drug Claims OIG Report, August 2017
• Pharmacy Billing of Immunosuppressive Drugs MLN Matters® Article
• Clarification of the Billing of Immunosuppressive Drugs MLN Matters Article

Quality Payment Program: Answering Your Frequently Asked Questions Call — May 16

Wednesday, May 16 from 1:30 to 3 pm ET
Register for Medicare Learning Network events.

April 2018 OPPS Pricer File

The Outpatient Prospective Payment System (OPPS) Pricer webpage is updated with the outpatient provider data for April 2018 under “2nd Quarter 2018 Files.” 

Quarterly Update to the NCCI PTP Edits, Version 24.2 MLN Matters Article — New

A new MLN Matters Article on Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-toProcedure (PTP) Edits, Version 24.2 Effective July 1, 2018 is available. Learn about an update to Chapter 23, Section 20.9 of the Medicare Claims Processing Manual.

Guidelines for Teaching Physicians, Interns, and Residents Booklet — Revised

A revised Guidelines for Teaching Physicians, Interns, and Residents Booklet is available. Learn about:

• Payment for physician services in teaching settings
• Evaluation and Management (E/M) documentation
• Exception for E/M services furnished in certain primary care centers

ICD-10-CM/PCS: The Next Generation of Coding Booklet — Reminder

The ICD-10-CM/PCS: The Next Generation of Coding Booklet is available. Learn about:

• Use of external cause and unspecified codes in ICD-10-CM
• CPT and HCPCS codes
• Similarities and differences between ICD-9-CM and ICD-10-CM
• New features and additional changes in ICD-10-CM

General Equivalence Mappings FAQs Booklet — Reminder

The General Equivalence Mappings FAQs Booklet is available. Learn about:

• Use of external cause and unspecified codes in ICD-10-CM
• Conversion of ICD-9-CM codes to ICD-10-CM/PCS and ICD-10-CM/PCS codes back to ICD-9-CM

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. 

Recent LearnResource & MedLearn Matters Articles

• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2018 Update (MM 10624)