09/05/2018

CMS-Medicare

Recent Oncology Related Articles

 Patients Over Paperwork: Medicare Physician Fee Schedule Proposed Rule Presentation

CMS posted a 2019 Medicare Physician Fee Schedule proposed rule presentation. Visit the Patients Over Paperwork webpage to learn how CMS is putting patients first by reviewing and streamlining our regulations. 

Quality Payment Program: Design Examples for CY 2019 Proposed Rule

The Quality Payment Program created a set of design examples that illustrate key concepts in the CY 2019 proposed rule. See the proposed rule to submit comments by September 10. 

CMS Proposes 50 Percent Reduction in Claims Submitted with Modifier 25 
By Shannon DeConda CPC, CPC-I, CEMC, CMSCS, CPMA®

By now I am sure that everyone is well aware that the Centers for Medicare & Medicaid Services (CMS) has proposed modifications to the reimbursement model for the outpatient/office evaluation and management (E&M) code sets, as well as the anticipated documentation relaxation accompanying the proposal. Read the full story →

MIPS Targeted Review Request: Deadline October 1 

If you participated in the Merit-based Incentive Payment System (MIPS) in 2017, your MIPS final score and performance feedback are available on the Quality Payment Program website. The payment adjustment you receive in 2019 is based on this final score. If you believe there is an error in your 2019 MIPS payment adjustment calculation, request a targeted review until October 1 at 8 pm.

For More Information:

• How to Request a Targeted Review Video
• Targeted Review of 2019 MIPS Payment Adjustment User Guide
• Targeted Review of 2019 MIPS Payment Adjustment Fact Sheet
• Contact the Quality Payment Program at 866-288-8292 (TTY: 877-715-6222) or QPP@cms.hhs.gov

2019 eCQM Flows for EPs

CMS posted 2019 performance period electronic Clinical Quality Measure (eCQM) flows for eligible clinicians and Eligible Professionals (EPs) on the eCQI Resource Center for the following programs:

• Quality Payment Program: Merit-based Incentive Payment System and Advanced Alternative Payment Models
• Comprehensive Primary Care Plus
• Promoting Interoperability Program

CMS plans to publish flows for eligible hospital and critical access hospital eCQMs in September. Send
questions to the ONC eCQM Issue Tracker.

2016 PQRS and 2018 Value Modifier Experience Reports

Find data from the Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier Programs. 2018 payment adjustments are based on 2016 data.

• 2018 Value-Based Payment Modifier Program Experience Report (2015 – 2018) and 2018 Results Fact Sheet
• 2016 PQRS Reporting Experience Including Trends (2007-2016) and Appendix

 Provider Minute: Laboratory and Diagnostic Services Billing Video

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

• Importance of legible signed orders
• Signed orders versus intent to order services
• Documentation of medical necessity

 Claims for Biosimilar Drug Code Q5108

Medicare will pay for a new biosimilar drug (code Q5108) provided on or after July 12. You may submit claims for this drug starting October 1. See the HCPCS Drug/Biological Code Changes MLN Matters® Article for more information. 

 Next Generation ACO Model 2019 Benefit Enhancement MLN Matters Article — New

A new MLN Matters Article MM10824 on Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement is available. Learn about implementing one new Benefit Enhancement for program year three.

 Diagnosis Coding: Using the ICD-10-CM Web-Based Training Course — Revised

With Continuing Education Credit

A revised Diagnosis Coding: Using the ICD-10-CM Web-Based Training course is available through the
Learning Management System. Learn about:

• Structure, format, and features
• How to find correct codes
• ICD-10-CM/PCS coding tips, information, and resources

 Medicare Enrollment for Physicians, NPPs, and Other Part B Suppliers Booklet — Reminder

The Medicare Enrollment for Physicians, Non-Physician Practitioners (NPPs), and Other Part B Suppliers Booklet is available. Learn about:

• Who are Part B suppliers
• Enrolling in the Medicare Program
• Determining if you want to be a participating provider

CMS NEWS - FOR IMMEDIATE RELEASE
August 29, 2018

CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees

The Centers for Medicare & Medicaid Services (CMS) issued a memo today to Medicare Part D plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, offering plans new tools and flexibility to expand choices and lower drug prices for patients. READ MORE

Recent LearnResource & MedLearn Matters Articles

• International Classification of Diseases, Tenth Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) (MM 10859)
  
• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2018 Update (MM 10834)
• Quarterly Influenza Virus Vaccine Code Update - January 2019 (MM 10871)
• Quarterly Update to the Medicare Physician Fee Schedule Database (MPFSDB) - October 2018 Update (MM 10898)
• Outpatient Code Editor (OCE) Quarterly Release Files
• I/OCE Specifications Version 19.3: October 2018 MLN Matters Article
• Claim Status Category and Claim Status Codes Update (MM 10925)
• Healthcare Provider Taxonomy Codes (HPTCs) October 2018 Code Set Update (MM 10857)
• Next Generation Accountable Care Organization (ACO) Model 2019 Benefit Enhancement (MM 10824)