08/07/2018

Important Oncology Related News

UnitedHealthcare Reminder: National Drug Code (NDC) Requirement Policy

Effective for dates of service on or after Sept. 1, 2018, there will be an addition to the National Drug Code (NDC) Requirement Policy to include drug-related codes submitted on the CMS UB04 and Electronic Data Interface (EDI) transaction 837i:

• Outpatient claims submitted for reimbursement for unlisted drug-related HCPCS and CPT codes must include the NDC number, quantity and the unit of measure. If the required information is not included, the claim may be denied and you will be notified through a Provider Remittance Advice (PRA) to resubmit the claim with the NDC information.
• The NDC requirement will apply to claims submitted on CMS 1500, 837p, CMS UB04 and 837i claim forms for drug related HCPCS/CPT codes.

For reference, review the August issue of the UnitedHealthcare NetworkBulletin - article beginning on page 22!

CLICK HERE

ASCO Summary of the Proposed Rule for the CY 2019 Medicare Physician Fee Schedule and Quality Payment Program

ASCO has released their summary of the proposed rule and the impact on oncology services.  CLICK HERE

The Proposed 2019 E&M Overhaul: A Preliminary Financial Impact Analysis

Significant – and wildly varying – changes to reimbursement loom ahead.

You don’t have to be a coder to realize what the financial impact of proposed changes from the Centers for Medicare & Medicaid Services (CMS) will be, or to see that there will be winners and losers. Using 2016 data (since data from last year hasn’t yet been released), in the aggregate, winners would have received nearly a billion dollars, while losers would be impacted to the tune of $722 million in losses.  READ MORE

CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS commitment to increasing transparency and lowering drug prices.  On July 25, CMS took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. In addition, as part of the agency’s ongoing efforts to lower drug prices as outlined in the President’s Blueprint, CMS included a Request for Information on how best to develop a model leveraging authority provided to the agency under the Competitive Acquisition Program (CAP) to strengthen negotiations for prescription drugs.

See the full text of this excerpted CMS Press Release (issued July 25).

For More Information:

• Proposed Rule
• Fact Sheet

Radiation Oncology Proposed Rule Summaries by ASTRO

CMS issues 2019 HOPPS Proposed Rule

On Wednesday, July 25, the Centers for Medicare and Medicaid Services (CMS) issued the 2019 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The rule continues the expansion of the Comprehensive Ambulatory Payment Classification system methodology and includes modest changes to the proposed rates for radiation oncology services for 2019. CMS proposes a new device pass through payment for SpaceOAR® and proposes a cap on HOPPS payments tied to fee schedule rates for some services. More information about the rule can be found in ASTRO’s summary of the rule. ASTRO will be preparing comments in response to the rule prior to the September 24 deadline.

Read more about the CMS's proposed changes for the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP).