12/01/2018

CMS-Medicare

Recent Oncology Related Articles

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

On November 26, CMS published a proposed rule for Medicare Parts C and D that would strengthen negotiations with prescription drug manufacturers to lower costs and increase transparency for patients. The proposed policies for 2020 would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and CMS is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter. Comment on these proposals and other policies under consideration by January 25.

For More Information:

• Proposed Rule
• Press Release
• Fact Sheet
• Blog

CLICK HERE (to get to this document)

Payment for Outpatient Services Provided to Beneficiaries Who Are Inpatients of Other Facilities — Reminder

In a recent report, the Office of the Inspector General (OIG) determined that Medicare inappropriately paid acute-care hospitals for outpatient services provided to beneficiaries who were inpatients of other facilities, including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. As a result, beneficiaries were unnecessarily charged outpatient deductibles and coinsurance payments.

All items and non-physician services provided during a Medicare Part A inpatient stay must be provided directly by the inpatient hospital or under arrangements with the inpatient hospital and another provider. Use the following resources to bill correctly:

• Medicare Inappropriately Paid Acute-Care Hospitals for Outpatient Services They Provided To Beneficiaries Who Were Inpatients of Other Facilities. OIG Report, September 2017.
• MLN Matters® Special Edition Article
• Provider Compliance Tips for Ordering Hospital Outpatient Services Fact Sheet
• Acute Care Hospital Inpatient Prospective Payment System Fact Sheet: See payment information on page 3
• Items and Services Not Covered Under Medicare Booklet, Page 12
• Medicare Claims Processing Manual, Chapter 3, Section 10.4 

Open Payments: Review Program Year 2017 Data through December 31

On June 29, CMS published Program Year 2017 Open Payments data, along with updated and newly submitted data from previous program years (2013-2016). Physicians and teaching hospitals: This data is available for review and dispute through December 31. Review of the data is voluntary, but strongly encouraged.

For More Information:

• Review and Dispute for Physicians and Teaching Hospitals webpage
• Resources for Physicians and Teaching Hospitals webpage
• Review the data
• Submit questions to openpayments@cms.hhs.gov or by call 855-326-8366

Improper Payment for Intensity-Modulated Radiation Therapy Planning Services — Reminder

In a recent report, the Office of Inspector General (OIG) determined that payments for outpatient Intensity-Modulated Radiation Therapy (IMRT) did not comply with Medicare billing requirements. Specifically, hospitals billed separately for complex stimulations when they were performed as part of IMRT planning. Overpayments occurred because hospitals are unfamiliar with or misinterpreted CMS guidance.

Use the following resources to bill correctly:

• IMRT Planning Services Editing MLN Matters® Article
• Medicare Improperly Paid Hospitals Millions of Dollars for IMRT Planning Services OIG Report, August 2018
• Medicare Claims Processing Manual, Chapter 4, Section 200.3.1
• July 2016 Update of the Hospital Outpatient Prospective Payment System MLN Matters Article

IVIG Demonstration: 2019 Payment Update MLN Matters Article — New

A new MLN Matters Article MM10896 on Intravenous Immune Globulin (IVIG) Demonstration: Payment Update for 2019 is available. Learn about payment rate changes for demonstration services.

RARC, CARC, MREP and PC Print Update MLN Matters Article — New

A new MLN Matters Article MM11038 on Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update is available. Learn about code list changes and software updates.

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: 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.

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

Recent LearnResource & MedLearn Matters Articles

• International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) (MM 11005)
• Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 25.0, Effective January 1, 2019 (MM 11044)