08/07/2018

CMS-Medicare

Recent Oncology Related Articles

As MACRA Heads Toward Third Year, Congress Urged to Consider How Proposed CMS Changes Will Impact Medicare Beneficiaries with Cancer

(ASCO in Action) July 31, 2018 - ASCO submitted a statement to the U.S. House of Representatives Energy and Commerce Committee in conjunction with a subcommittee hearing on implementation of the Merit-Based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act (MACRA).  READ ARTICLE

CMS Grants New Technology Add-On Payment to Vyxeos® (daunorubicin and cytarabine) Liposome for Injection

(Markets Insider) Aug 3, 2018 - Jazz Pharmaceuticals plc today announced that the United States Centers for Medicare and Medicaid Services (CMS) granted approval for a New Technology Add-on Payment (NTAP) for Vyxeos® (daunorubicin and cytarabine) liposome for injection for the treatment of adults with newly diagnosed therapy-related acute myeloid leukemia (t-AML) or AML with myelodysplasia-related changes (AML-MRC), a rapidly progressing and life-threatening blood cancer.
READ ARTICLE

Qualified Medicare Beneficiary Program Billing Requirements FAQs

During the June 6 Medicare Learning Network call, CMS experts discussed Qualified Medicare Beneficiary (QMB) billing requirements and their implications. Updated FAQ are available, including new FAQs on Advance Beneficiary Notices and statutorily excluded services and revised information for Medicare Advantage providers.

For More Information:

• Materials from June 6 call
• Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program MLN Matters Article
• QMB Program webpage

2018 QRDA III Implementation Guide for Eligible Professionals — Updated

CMS updated the 2018 CMS Quality Reporting Document Architecture Category III (QRDA III) Implementation Guide (IG) for Eligible Clinicians and Eligible Professionals.

More Information:

• What changed
• Electronic Clinical Quality Improvement Resource Center - QRDA related resources, current and past IGs
• Questions about QRDA IGs and Schematrons - ONC QRDA JIRA Issue Tracker
• Questions on Quality Payment Program/Merit-Based Incentive Payment System data submissions - Quality Payment Program website; call 1-866-288-8292 (TTY: 1-877-715-6222) or email QPP@cms.hhs.gov 

Physician Fee Schedule Proposed Rule: Understanding 3 Key Topics Listening Session – August 22

Wednesday, August 22 from 1:30 to 3 pm
Register for Medicare Learning Network events.

Proposed changes to the CY 2019 Physician Fee Schedule would increase the amount of time doctors and other clinicians spend with their patients by reducing the burden of Medicare paperwork. During this listening session, CMS experts will briefly cover three provisions from the proposed rule and address your clarifying questions to help you formulate your written comments for formal submission:

• Streamlining Evaluation and Management (E/M) payment and reducing clinician burden
• Advancing virtual care
• Continuing to improve the Quality Payment Program to reduce clinician burden, focus on outcomes, and promote interoperability

We encourage you to review the proposed rule prior to the call, as well as the following materials on the provisions to be covered:

• Quality Payment Program Year 3 (2019) Webinar Recording, Transcript, Presentation, and Comparison Fact Sheet
• Slide presentation on E/M and Advancing Virtual Care
• E/M Coding Reform videos: Introduction, Office Visits and Panel Discussion

Note: feedback received during this listening session will not be considered formal comments on the rule. See the proposed rule for information on submitting these comments by September 10, 2018.

Target Audience: Medicare Part B fee-for-service clinicians; office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.

Provider Minute Video: Physician Orders/Intent to Order Laboratory Services and Other Diagnostic Services - New

Proper physician orders are important to you and your patients. Find out how they affect patient care/services, claim payment, and medical review in the Provider Minute: Physician Orders/Intent to Order Laboratory Services and Other Diagnostic Services. Learn about:

• Importance of legible signed orders
• Signed orders versus Intent to Order Services
• Documentation of Medical Necessity

PECOS Technical Assistance Contact Information Fact Sheet — Reminder

The PECOS Technical Assistance Contact Information Fact Sheet is available. Learn about:

• Common problems and who to contact
• Provider Enrollment, Chain, and Ownership System (PECOS) resources

E/M Coding Reform: Recording of Panel Discussion

CMS proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. We held listening sessions all over the country and heard from thousands of providers and one thing they consistently brought up was how documentation was needlessly burdensome, was not improving patient care, and was actually having a negative impact on patient care. We listened, and in response, we proposed streamlining the documentation requirements for Evaluation and Management (E/M) visits, as well as moving to single payment rates.

Watch CMS Administrator Seema Verma, CMS Chief Medical Officer and Director of CCSQ Kate Goodrich, Dr. Donald Rucker, National Coordinator for Health Information Technology, Dr. Anand Shah, CMMI Chief Medical Office and Dr. Thomas A. Mason, ONC Chief Medical Officer discuss proposed E/M coding changes.

Watch videos on E/M:

• Panel discussion
• Introduction
• Office visits

CLFS and Laboratory Services Payment: Quarterly Update MLN Matters Article — New

A new MLN Matters Article MM10875 on Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment is available. Learn about updates to Chapter 16, Section 20 of the Medicare Claims Processing Manual.

Recent LearnResource & MedLearn Matters Articles

• October 2018 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files (MM 10899)
• Provider Enrollment Requirements for Writing Prescriptions for Medicare Part D Drugs (Rescinded SE 1434)
• System Changes to Implement Epoetin Alfa Biosimilar, Retacrit for End Stage Renal Disease (ESRD) and Acute Kidney Injury (AKI) Claims (MM 10839)