11/20/2018

CMS-Medicare

Recent Oncology Related Articles

New Proposed Medicare Part B Drug Reimbursement Model Raises Questions

The Centers for Medicare & Medicaid Services (CMS), part of the U.S. Department of Health and Human Services (HHS), announced a new proposed reimbursement model for certain Medicare Part B drugs and biologicals (together, "drugs") on Oct. 25, 2018. READ MORE

Digesting the Medicare Physician Fee Schedule for 2019

The Centers for Medicare & Medicaid Services (CMS) final rule includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (MPFS) on or after Jan. 1, 2019. Read the full story →

Patients Over Paperwork November Newsletter

Read the CMS Patients Over Paperwork November newsletter, part of our ongoing effort to reduce administrative burden and improve the customer experience, while putting patients first. The main article provides an update on how CMS is reducing burden experienced by Medicare beneficiaries during care transitions. In this edition, learn how we are simplifying documentation requirements:

• Physicians acting as suppliers do not need to write orders to themselves
• Physicians do not need to reference page numbers in their certification or recertification statements
• A signature and date is acceptable verification of a medical student’s documentation of an evaluation and management visit performed by a physician

The newsletter also discusses:

• Where we are meeting with stakeholders to talk about burden
• How to provide feedback through Requests for Information and proposed rules

For More Information:

• Patients Over Paperwork website
• Past Newsletters

Quality Payment Program Year 1 Performance Results

CMS released 2017 performance data for the Quality Payment Program. We announced the preliminary data earlier this year, and now we released additional data elements that show significant success and participation in both the Merit-based Incentive Payment System and Advanced Alternative Payment Model tracks. For a complete breakdown of the 2017 performance data, see the blog and infographic.

For More Information:

• Visit the Quality Payment Program website
• Find your local support organization for no-cost technical assistance
• Contact qpp@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222) 

QRURs and PQRS Feedback Reports: Access Ends December 31

The final performance period for the Value Modifier and Physician Quality Reporting System (PQRS) programs was 2016 and the final payment adjustment year is 2018. Quality and Resource Use Reports (QRURs) and PQRS Feedback Reports will no longer be available after the end of 2018. If you need these reports, download them through December 31, 2018, from the CMS Enterprise Portal using an Enterprise Identity Management (EIDM) system account with the correct role. Visit the How to Obtain a QRUR webpage for more information.

For access to PQRS Taxpayer Identification Number or National Provider Identifier reports from program year 2013 or earlier, contact the QualityNet Help Desk. They are no longer available from the QualityNet Secure Portal.

The Merit-based Incentive Payment System (MIPS) under the Quality Payment Program replaced the Value Modifier and PQRS programs. Visit the Quality Payment Program website to learn more. Note: QRURs and PQRS Feedback Reports are not same as the MIPS Performance Feedback.

For More Information:

• PQRS Analysis and Payment webpage: Information on PQRS Feedback Reports
• Value-Based Payment Modifier webpage: Information on QRURs
• For assistance with EIDM or PQRS Feedback Reports , contact the QualityNet Help Desk
• For assistance with the QRURs or Value Modifier, contact the Physician Value Help Desk at pvhelpdesk@cms.hhs.gov or 888-734-6433 (select option 4)

Quality Payment Program: Multi-Payer Other Payer Advanced APMs List

CMS published a list of payment arrangements with CMS Multi-Payer Models that we determined to be Other Payer Advanced Alternative Payment Models (APMs) for the CY 2019 QP Performance Period.

For More Information:

• 2019 QPP Multi-Payer Other Payer Advanced APMs
• APMs Overview webpage
• Contact the Quality Payment Program at QPP@cms.hhs.gov or 866-288-8292 (TTY: 877-715-6222)

Quality Payment Program: Visit the Resource Library Website

Visit the redesigned Quality Payment Program Resource Library webpage. Search for resources by year, reporting track, performance category, and document type.

Medicare Deductible, Coinsurance and Premium Rates: 2019 Update MLN Matters Article — New

A new MLN Matters Article MM11025 on Update to Medicare Deductible, Coinsurance and Premium Rates for 2019 is available. Learn about updating the claims processing system with the new deductible, coinsurance, and premium rates.

ICD-10 and Other Coding Revisions to NCDs MLN Matters Article — Revised

A revised MLN Matters Article MM10859 on International Classification of Diseases, Tenth Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) is available. Learn about coding updates. 

Medicare Billing: CMS Form CMS-1450 and the 837 Institutional Booklet — Revised

A revised Medicare Billing: CMS Form CMS-1450 and the 837 Institutional Booklet is available. Learn:

• When Medicare will accept a hard copy claim form
• Filing requirements
• How to submit and code claims

Medicare Billing: CMS Form CMS-1500 and the 837 Professional Booklet — Revised

A revised Medicare Billing: CMS Form CMS-1500 and the 837 Professional Booklet is available. Learn:

• When Medicare will accept a hard copy claim form
• Filing requirements
• How to submit and code claims

Groups to Sue CMS Over Site-Neutral Payments

(Medscape Medical News) Nov 5, 2018 - The American Society of Clinical Oncology (ASCO) has indicated its extreme dislike of the site-neutral policy. In September comments on the proposed rule, ASCO urged the agency not to employ the payment scheme. READ ARTICLE (free registration required)

Final Rules from CMS Offer Something for Everyone

The Centers for Medicare & Medicaid Services (CMS) has been quite busy these last few weeks, getting approval for and publishing a number of critical final rules that will have an impact on documentation, coding, and payments.    A number of the rules had to do with ways to reduce the prices of drugs and to make changes to the insurance programs operating under the Patient Protection and Affordable Care Act (PPACA). The key topics for our audience were the final rules for the 2019 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP), the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment Policy, and the Home Health Prospective Payment System (PPS) System Update. READ MORE

Medicare and Medicaid Basics Booklet — Revised

A revised Medicare and Medicaid Basics Booklet is available. Learn quick facts, covered services, and other types of common coverage.

Quality Payment Program 2018 MIPS Cost Performance Category Web-Based Training Course — New

With Continuing Education Credit

A new Quality Payment Program in 2018: Merit-based Incentive Payment System (MIPS) Cost Performance Category Web-Based Training Course is available through the Learning Management System. Learn about:

• Data sources used to calculate scores
• Cost score calculation methods
• Beneficiary attribution

Quality Payment Program 2018 MIPS Improvement Activities Performance Category Web-Based Training Course — Revised

With Continuing Education Credit

A revised Quality Payment Program in 2018: Merit-based Incentive Payment System (MIPS) Improvement Activities Performance Category Web-Based Training Course is available through the Learning Management System. Learn about:

• Requirements
• How the category fits in the Quality Payment Program
• Steps to report data
• Basics of scoring

Quality Payment Program 2018 MIPS APMs Web-Based Training Course — Revised

With Continuing Education Credit

A revised Quality Payment Program in 2018: Merit-based Incentive Payment System (MIPS) Alternative Payment Models (APMs) Web-Based Training Course is available through the Learning Management System. Learn:

• How to recognize if you are a part of a MIPS APM
• Benefits of the special APM scoring standard
• Criteria for reporting on performance

Quality Payment Program 2018 Advanced APMs Web-Based Training Course — Revised

With Continuing Education Credit

A revised Quality Payment Program in 2018: Advanced Alternative Payment Models (APMs) Web-Based Training Course is available through the Learning Management System. Learn:

• How to identify Advanced APMs
• How to participate in QPP via an Advanced APM

CMS announces 2019 Medicare Parts A & B premiums and deductibles

On October 12, 2018, the Centers for Medicare & Medicaid Services (CMS) released the 2019 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.  The standard monthly premium for Medicare Part B enrollees will be $135.50 for 2019, a slight increase from $134 in 2018. READ MORE

Recent LearnResource & MedLearn Matters Articles

• New Waived Tests (Revised MM 10958)
• International Classification of Diseases, Tenth Revision (ICD10) and Other Coding Revisions to National Coverage Determinations (NCDs) (Revised MM 10859)
• Medicare Cost Report E-Filing (MCReF) (Revised MM 10611)
• Update to Medicare Deductible, Coinsurance and Premium Rates for 2019 (MM 11025)