Complete Story
06/05/2018
CMS-Medicare
Recent Oncology Related Articles
ASCO Policy Brief: Quality Payment Program
May 30, 2018 - How QPP is transforming Oncology Practice Reimbursement
CLICK HERE
2016 Physician and Other Supplier PUF
The Physician and Other Supplier Public Use File (PUF) contains summarized information on Part B services and procedures furnished to Medicare beneficiaries by physicians and other healthcare professionals. The 2016 dataset includes:
- Information on utilization, payment, and submitted charges organized by National Provider Identifier, Healthcare Common Procedure Coding System code, and place of service
- Information on more than 1 million distinct health care providers who collectively received $96 billion in
Medicare payments
Provider Minute Video: The Importance of Proper Documentation
Why is proper documentation important to you and your patients? Find out how it affects items/services, claim payment, and medical review in the Provider Minute: The Importance of Proper Documentation video. Learn about:
- Top five documentation errors
- How to submit documentation for a Comprehensive Error Rate Testing review
- How your Medicare Administrative Contractor can help
New Medicare Beneficiary Identifier: Get It, Use It MLN Matters Article — New
A new MLN Matters Article on New Medicare Beneficiary Identifier (MBI) Get It, Use It is available. Learn about three ways you and your office staff can get MBIs.
Quality Payment Program Call: Audio Recording and Transcript — New
An audio recording, transcript, updated presentation, and clarification are available for the May 16 call on the Quality Payment Program. CMS answers frequently asked questions from the 2018 Healthcare Information and Management Systems Society (HIMSS18) Annual Conference & Exhibition and inquiries received by the Quality Payment Program Service Center.
MIPS Promoting Interoperability Performance Category
Recently, CMS announced that we changed the name of the Merit-based Incentive Payment System (MIPS) Advancing Care Information performance category to the Promoting Interoperability performance category:
- This is not a new performance category.
- 2018 requirements are the same as what was finalized for the Advancing Care Information performance category. Review the fact sheet for an overview and participation requirements. We are in the process of updating the 2018 measure specifications to reflect the name change.
- CMS also changed the name of the Electronic Health Record Incentive Programs to the Promoting Interoperability Programs.
For More Information:
- MIPS webpage
- 2018 Resources webpage
- Contact the Quality Payment Program Service Center at QPP@cms.hhs.gov or 866-288-8292 (TTY:877-715-6222)
- Register for the webinar on June 12
Targeted Probe and Educate Video
The CMS Targeted Probe and Educate (TPE) program helps providers and suppliers reduce claim denials and appeals through one-on-one help. Check out a five-minute video that explains the TPE process in more detail, and visit the TPE webpage.
CQM Annual Update
CMS posted the electronic Clinical Quality Measure (eCQM) annual update for:
For More Information:
- eCQI Resource Center website
- Guide to Reading eCQMs
- Value Set Authority Center website
- Visit the eCQM Issue Tracker to provide feedback; an ONC Issue Tracking System account is required
RARC, CARC, MREP, and PC Print Update MLN Matters Article — New
A new MLN Matters Article on Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update is available. Learn about code update notifications when updates to CARC and RARC lists are available.
Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices
On May 15, CMS released a redesigned version of the Drug Spending Dashboards. For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices.
“Under President Trump’s bold leadership, CMS is committed to putting patients first and increasing transparency,” said CMS Administrator Seema Verma. “Publishing how much individual drugs cost from one year to the next will provide much-needed clarity and will empower patients and doctors with the information
they need. As Secretary Azar has repeatedly pointed out, for years Medicare incentives have actually encouraged higher list prices for drugs, and this updated and enhanced dashboard is an important step to bringing transparency and accountability to what has been a largely hidden process.”
The dashboards are interactive online tools that allow patients, clinicians, researchers, and the public to understand trends in drug spending. Data is reported for both Medicare and Medicaid. The new version of the dashboard reports the percentage change in spending on drugs per dosage unit and includes an expanded list of drugs.
Some of the most commonly used drugs across Medicare Part B, Medicare Part D, and Medicaid saw doubledigit annual increases over the last few years. In 2012, Medicare spent 17 percent of its total budget, or $109 billion, on prescription drugs. Four years later in 2016, spending had increased to 23 percent, or $174 billion.
See the full text of this excerpted CMS Press Release (issued May 15), including a list of drugs that accounted for $39 billion in total spending by Medicare and Medicaid in 2016.
Hospital Outpatient Quality Reporting Spring 2018 Newsletter
Read the Hospital Outpatient Quality Reporting Spring 2018 newsletter. Topics include:
- Program tools and resources
- Sampling methods
- Educational events
- Availability of facility-specific reports
- Program support documents
Coding for CAR-T
Last week, the Centers for Medicare and Medicaid Services (CMS) held a public meeting for the Healthcare Common Procedure Coding System (HCPCS). After consulting with members of the ASH Committee on Practice on specific proposals, the Society recommended against the preliminary coding recommendations offered by CMS for two chimeric antigen receptor (CAR) T-cell products. This is the link to DOWNLOAD THE PDF: CLICK HERE.
National Coverage Analysis on CAR-T
On May 16, the Centers for Medicare and Medicaid Services (CMS) released a National Coverage Analysis for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers. CMS will use the National Coverage Analysis (NCA) to create a National Coverage Determination (NCD). NCDs describe the circumstances for Medicare coverage nationwide for a specific medical service, procedure, or device. ASH will submit comments, which are due to the Agency on June 15. ASH staff is in the process of gathering literature that demonstrates that CAR-T is medically necessary and reasonable for both pediatrics and adults. If you have literature you would like to share or comments related to the NCA, please reach out to ASH staff, Leslie Brady (lbrady@hematology.org).
ICD-10 and Other Coding Revisions to National Coverage Determinations MLN Matters Article — New
A new MLN Matters Article on International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) is available. Learn about NCD coding changes, revisions, and feedback.
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
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.
Recent LearnResource & MedLearn Matters Articles
- July 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM 10667)
- New Medicare Beneficiary Identifier (MBI) Get It, Use It (SE 18006)
- Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - July 2018 Update (MM 10644)
- Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (MM 10642)
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