07/03/2019

CMS-Medicare

Recent Oncology Related Articles

CMS Proposes New Electronic Prior Authorization Process to Speed Access to Care

(ASCO in Action) June 25, 2019 - The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule to update and streamline the prior authorization process under Medicare Part D. READ ARTICLE

Two HCPCS Replacement Codes Take Effect July 1

J7208 replaces J7199 when billing from JIVI^® (antihemophilic factor, recombinant [Pegylated-aucl]).

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug JIVI (triamcinolone acetonide extended-release injectable suspension, for intra-articular use).

All services from Aug. 30, 2018, through June 30, 2019, can continue to be reported with J7199. All services performed on and after July 1, 2019, must be reported with J7208.

Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. continues to be covered for FDA-approved indications, which is in the routine prophylactic treatment of hemophilia A in previously treated adults and adolescents age 12 or older.

Q5114 replaces J9999 when billing Ogivri, trastuzumab-dkst, biosimilar.

CMS has an established a permanent procedure code for Ogivri.

All services from Dec. 1, 2017, through June 30, 2019, will continue to be reported with procedure code J9999. All services performed on and after July 1, 2019, must be reported with Q5114.

Ogivri continues to be covered for the approved FDA indications as established on Dec. 1, 2017.

Utilize the link below for additional codes included in the July 2019 Update...

Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2019 Update

Two-Sided Risk in the Oncology Care Model

(AJMC Managed Markets Network) June 18, 2019 - The US healthcare system remains one of the most inefficient healthcare systems in the world.  Read More

MIPS Data Validation and Audit for Performance Years 2017 and 2018

CMS contracted with Guidehouse to conduct data validation and audits of some Merit-based Incentive
Payment System (MIPS) eligible clinicians. Data validation and audits will help ensure MIPS is operating with accurate and useful data. MIPS eligible clinicians, groups, and virtual groups are required by regulation to comply with data sharing requests, providing all data as requested by CMS.

If you are selected for data validation and/or audit, you will receive a request for information from Guidehouse via email or by certified mail. You have 45 calendar days from the date of the notice to provide the requested information.

For More Information:

• 2017 MIPS Data Validation Criteria
• 2018 MIPS Data Validation Criteria
• Direct questions to QPP@cms.hhs.gov or 1-866-288-8292 (TTY 1-877-715- 6222), Monday through Friday from 8am-8 PM ET

FY 2020 ICD-10-CM Diagnosis Code Updates

The FY 2020 ICD-10-CM diagnosis code updates are available on the 2020 ICD-10-CM webpage. 

CMS Proposes to Update e-Prescribing Standards

On June 17, CMS issued a proposed rule that would update the Part D e-prescribing program by adopting standards that ensure secure transmissions and expedite prior authorizations.

“Improving patients’ access to prescription drugs is a top priority for CMS,” said CMS Administrator Seema Verma. “This proposed rule would reduce the time it takes for a patient to receive needed medications and ease the prescriber burden by giving clinicians the flexibility and choice to complete prior authorization transactions electronically.”

Under the proposed change, clinicians would be able to choose to complete prior authorizations online,
reducing burden for providers through a more streamlined process for performing prior authorization for Part D prescriptions. Clinicians who select the electronic option will typically be able to satisfy the terms of a prior authorization in real time and before a prescription is transmitted to a pharmacy, so patients do not arrive at a pharmacy counter to find that their prescription cannot be filled.

The proposed rule would implement new prior authorization transaction standards for the Part D e-Prescribing program as required by the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The proposed standards would begin in January 2021.

See the full text of this excerpted CMS Press Release (issued June 17).

NEW - Quality Payment Program: 2019 Resources

CMS posted new resources on the Quality Payment Program (QPP) Resource Library webpage for 2019 participation:

• Participating in QPP Infographic: Describes how to check your QPP participation status; basic
  requirements for participating in the Merit-based Incentive Payment System (MIPS), Advanced
  Alternative Payment Models (APMs), and MIPS APMs; and key dates
• MIPS Eligibility Decision Tree: Uses a series of questions to help you determine if you are eligible for MIPS
• Qualifying APM Participant (QP) Methodology Fact Sheet: Details how we determine which eligible clinicians are QPs and make predictive QP determinations
• MIPS Specialty Guides: Highlights specific MIPS measures and activities that may apply to clinical psychologists, physical therapists and occupational therapists, speech-language pathologists and audiologists, registered dietitian and nutrition professionals, anesthesiologists and certified nurse anesthetists, and primary care clinicians
• CAHPS for MIPS Approved Survey Vendors: Lists the survey vendors CMS approved to administer the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) for MIPS survey
• MIPS Quality User Guide: Details how to participate in the Quality performance category
• MIPS Cost User Guide: Details how to participate in the Cost performance category

For More Information:

• Check the QPP Participation Status Tool for initial eligibility information
• For questions, contact your local technical assistance organization, QPP@cms.hhs.gov, or 866-288-8292 (TTY: 877-715-6222)

Recent LearnResource & MedLearn Matters Articles

• Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes – July 2019 Update
• Implement Operating Rules - Phase III Electronic Remittance Advice (ERA) Electronic Funds Transfer (EFT): Committee on Operating Rules for Information Exchange (CORE) 360 Uniform Use of Claim Adjustment Reason Codes (CARC), Remittance Advice Remark Codes (RARC), and Claim Adjustment Group Code (CAGC) Rule - Update from Council for Affordable Quality Healthcare (CAQH) CORE