06/19/2018

CMS-Medicare

Recent Oncology Related Articles

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, February 2016
• OIG Report: Stem Cell Transplantation MLN Matters® Article
• CMS Transmittal 1805

FY 2019 ICD-10-CM Diagnosis Codes

Final FY 2019 ICD-10-CM diagnosis code updates are available on the 2019 ICD-10-CM webpage.

Update of the Hospital OPPS: July 2018 MLN Matters Article — New

A new MLN Matters Article on July 2018 Update of the Hospital Outpatient Prospective Payment System (OPPS) is available. Learn about changes to and billing instructions for various payment policies.

I/OCE Specification Version 19.2: July 2018 MLN Matters Article — New

A new MLN Matters Article on July 2018 Integrated Outpatient Code Editor (I/OCE) Specification Version 19.2 is available. Learn about instructions and specifications.

Transition to New Medicare Numbers and Cards Fact Sheet — Revised

A revised Transition to New Medicare Numbers and Cards Fact Sheet is available. Learn about:

• New Medicare numbers, which will replace Health Insurance Claim Numbers on new Medicare cards
• What you need to do to get ready for the change
• Where to find help

CMS Web Wheel Educational Tool — Revised

A revised CMS Web Wheel Educational Tool is available. Find webpages to learn about:

• Educational resources
• CMS initiatives
• Medicare Administrative Contractor resources 

Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-based Training — Reminder

With Continuing Education Credit

A revised Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians Web-Based Training course is
available through the Learning Management System. Learn about:

• Three types of physician business relationships that may raise fraud and abuse concerns
• Federal laws that combat fraud and abuse
• The "red flags" that could lead to potential liability in law enforcement and administrative actions
• Where to find help 

Remittance Advice Resources and FAQs Booklet — Reminder

A revised Remittance Advice Resources and FAQs Booklet is available. Learn about:

• How to read institutional or professional Remittance Advice (RA)
• Assigned and unassigned claims
• Balancing an RA

View Your MIPS Preliminary Performance Feedback Data

If you submitted 2017 Merit-based Incentive Payment System (MIPS) data through the Quality Payment
Program website, access preliminary performance feedback data with your Enterprise Identity Management (EIDM) credentials. Your final MIPS score and feedback will be available in July. Between now and June 30, your score could change based on:

• Special status scoring considerations
• Final calculations of the All-Cause Readmission Measure for the Quality performance category
• Inclusion of claims measures from 60-day run out period
• Results of the CAHPS for MIPS Survey
• Approval or denial of Promoting Interoperability performance category Hardship Application
• Improvement Activities Study participation and results
• Creation of performance period benchmarks for Quality measures that didn’t have a historical
  benchmark

If you have questions about your data, contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov. 

Physician Compare Downloadable Database: 2016 Performance Scores

Clinicians and group representatives, your 2016 performance scores are available through the Physician
Compare Downloadable Database:

• 2016 Physician Quality Reporting System (PQRS) measures for clinicians and groups
• 2016 Consumer Assessment of Healthcare Providers and Systems for PQRS summary survey
  measures for groups
• 2016 non-PQRS Qualified Clinical Data Registry (QCDR) measures for clinicians and groups
• Subset of 2015 utilization data for clinicians

Recent LearnResource & MedLearn Matters Articles

• Claim Status Category and Claim Status Codes Update (MM 10777)
• Provider/Supplier Reporting of Adverse Legal Actions (MM 10558)