07/24/2018

CMS-Medicare

Recent Oncology Related Articles

MIPS 2017 Performance Feedback User Guide

CMS posted the 2017 Performance Feedback User Guide to help eligible clinicians and groups understand their 2017 Merit-based Incentive Payment System (MIPS) performance feedback. This User Guide:

• Discusses who can access MIPS performance feedback
• Highlights the differences between preliminary and final performance feedback
• Provides step-by-step instructions for accessing your feedback

For More Information:

• 2017 Performance Feedback Fact Sheet
• 2017 Resources webpage
• Contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

 MIPS Payment Adjustment Targeted Review: Request by October 1

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback is available for review on the Quality Payment Program website. If you believe an error has been made in your 2019 MIPS payment adjustment calculation, you can request a targeted review until October 1.

For More Information:

• Performance Feedback Fact Sheet
• Performance Feedback User Guide
• Targeted Review Fact Sheet
• Targeted Review User Guide
• If you have questions about your performance feedback or MIPS final score, contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov 

MIPS 2019 Payment Adjustment Fact Sheet

CMS posted a Fact Sheet to help eligible clinicians and groups understand their Merit-based Incentive
Payment System (MIPS) 2019 payment adjustment based on their 2017 performance. The fact sheet
highlights how CMS assigns final scores to MIPS eligible clinicians and how payment adjustment factors are applied for 2019 based on 2017 MIPS final scores.

For More Information:

• 2018 Resources webpage
• Contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

New MBI: Get It, Use It MLN Matters® Article — Revised

A revised MLN Matters Article on New Medicare Beneficiary Identifier (MBI) Get It, Use It is available. The MBI does not use the letters S, L, O, I, B, and Z to avoid confusion when differentiating between some letters and numbers (e.g., between “0” and “O”). 

 Chronic Care Management Services: Changes for 2017 Fact Sheet — Reminder

The Chronic Care Management Services Changes for 2017 Fact Sheet is available. Learn about:

• 2017 coding changes
• Included services
• Key improvements reducing requirements associated with initiating care

 Chronic Care Management Services Fact Sheet — Reminder

The Chronic Care Management Services Fact Sheet is available. Learn about:

• Separately payable services for non-face-to-face coordinated care for beneficiaries with multiple
  chronic conditions
• Physician Fee Schedule billing requirements
• Practitioner and patient eligibility
• Service elements

 Qualified Medicare Beneficiary: Learn about State Medicaid Agency Requirements

Medicare providers may not bill beneficiaries enrolled in the Qualified Medicare Beneficiary (QMB) program for Medicare Parts A and B deductibles, coinsurance, or copays, but state Medicaid programs may pay for those costs. Check with the states where your beneficiaries reside to determine the billing processes that apply.

• For fee-for-service Medicare claims, nearly all states have electronic crossover processes through the Medicare Benefits Coordination and Recovery Center to automatically receive Medicare-adjudicated claims. Different processes may apply for Medicare Advantage services.
• If a claim is crossed over to Medicaid, it is noted on the Medicare Remittance Advice (RA).
• States require providers to enroll in their Medicaid system for claims review, processing, and issuance of Medicaid RAs. Contact the State Medicaid Agency for information on enrollment.

For More Information:

• Contact your State Medicaid Agency; see Medicaid.gov for state contacts
• Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters® Article
• QMB Program webpage

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

Recent LearnResource & MedLearn Matters Articles

• Medical Review of Evaluation and Management (E/M) Documentation (MM 10627)
• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - July 2018 Update (Revised MM 10624)