Thursday, March 22, 2018
- Coverage of Next Generation Sequencing Tests Ensures Enhanced Access for Cancer Patients
- IMPACT Act Transfer of Health Measures: Public Comment Period Ends May 3
- Hospice Quality Reporting Program: HART v1.4.0
- Hospital VBP Program FY 2020 Baseline Measures Report
- IMPACT Act and Improving Care Coordination Special Open Door Forum — March 28
- Spinal Orthoses Referring Providers Comparative Billing Report Webinar — April 11
- CMS National Provider Enrollment Conference — April 24 and 25
- April 2018 Update: ASC Payment System MLN Matters Article — New
- Internet Only Manual Update to Correct Errors and Omissions: SNF 2018 MLN Matters Article — New
- SSI/Medicare Beneficiary Data for FY 2016: IPPS Hospitals, IRFs, LTCHs MLN Matters Article — New
- Billing Requirements for OPPS Providers with Multiple Service Locations MLN Matters Article — New
- Reinstating the QMB Indicator in the Medicare FFS Claims Processing System MLN Matters Article — Revised
- Quarterly Update for CLFS and Laboratory Services Subject to Reasonable Charge Payment MLN Matters Article — Revised
- Home Health Prospective Payment System Booklet — Revised
- Federally Qualified Health Center Booklet — Revised
- Medicare Parts A and B Appeals Process Booklet — Reminder
- The Medicare Secondary Payer Provisions Web-Based Training Course — Reminder
- CLIA Program and Medicare Laboratory Services — Reminder
On March 16, CMS took action to advance innovative personalized medicine for Medicare patients with cancer. CMS finalized a National Coverage Determination (NCD) that covers diagnostic laboratory tests using Next Generation Sequencing (NGS) for patients with advanced cancer. CMS believes when these tests are used as a companion diagnostic to identify patients with certain genetic mutations that may benefit from U.S. Food and Drug Administration (FDA)-approved treatments, these tests can assist patients and their oncologists in making more informed treatment decisions. Additionally, when a known cancer mutation cannot be matched to a treatment, results from the diagnostic lab test using NGS can help determine a patient’s candidacy for cancer clinical trials.
This decision was made following the parallel review with the FDA, which granted its approval of the FoundationOne CDx (F1CDx™) test on November 30, 2017. F1CDx is the first breakthrough-designated, NGS-based in vitro diagnostic test that is a companion diagnostic for 15 targeted therapies, as well as can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor. CMS is also covering FDA-approved or cleared companion in vitro diagnostics when the test has an FDA-approved or cleared indication for use in that patient’s cancer and results are provided to the treating physician for management of the patient using a report template to specify treatment options.
“We want cancer patients to have enhanced access and expanded coverage when it comes to innovative diagnostics that can help them in new and better ways,” said Seema Verma, CMS Administrator. “That is why we are establishing clear pathways to coverage, while at the same time supporting laboratories that currently furnish tests to the people we serve.”
For More Information:
See the full text of this excerpted CMS Press Release (issued March 16).
CMS is developing cross-setting post-acute care transfer of health information and care preferences quality measures in alignment with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Submit comments on two draft measure specifications by May 3:
- Medication Profile Transferred to Provider
- Medication Profile Transferred to Patient
Visit the Public Comment webpage for more information.
The Hospice Abstraction Reporting Tool (HART) v1.4.0 is now available. Use this Java-based software application to collect and maintain facility, patient, and Hospice Item Set (HIS) record information for submission to your national data repository. Visit the HIS Technical Information webpage for more details.
Hospital Value-Based Purchasing (VBP) Program FY 2020 Baseline Measures Reports are available through the QualityNet Secure Portal. Monitor your baseline period performance for all domains and measures required for the Hospital VBP Program. To access the report, you must have an active QualityNet account. To run the report, select the Run Reports option from the “My Reports” drop-down on the menu bar.
For More Information:
- How to Read Your FY 2020 Baseline Measures Report
- FY 2020 Domain Weighting Quick Reference Guide
- Questions and Answers Tool
In a February 2016 report, the Office of the Inspector General (OIG) determined that Medicare paid for many stem cell transplants incorrectly. The main finding was that providers billed these procedures as inpatient when they should have been submitted as outpatient services.
Use the following resources to bill correctly and avoid overpayment recoveries:
- Medicare Did Not Pay Selected Inpatient Claims for Bone Marrow and Stem Cell Transplant Procedures in Accordance with Medicare Requirements OIG Report
- OIG Report: Stem Cell Transplantation (PDF) MLN Matters® Article
- CMS Transmittal 1805 (PDF)
Wednesday, March 28 from 2 to 3 pm ET
This Special Open Door Forum provides information and solicits feedback on development and testing of standardized patient assessment data elements mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Learn about the national field test, ongoing stakeholder engagement activities, and ways to remain engaged and informed during the upcoming year. See the announcement (PDF) for more information.
Wednesday, April 11 from 3 to 4 pm ET
Join us for a discussion of the comparative billing report on Spinal Orthoses Referring Providers, an educational tool for referring providers of off-the-shelf and custom-fitted prefabricated spinal orthoses, also known as braces. During the webinar, interact directly with content specialists and submit questions about the report. See the announcement for more information, and find out how to participate.
Tuesday, April 24 and Wednesday, April 25 from 8 am to 5 pm PT
San Diego, California
Register for free by March 30 for the CMS National Provider Enrollment Conference at the San Diego Convention Center. Take advantage of this opportunity to interact directly with CMS and Medicare Administrative Contractor provider enrollment experts.
A new MLN Matters Article on April 2018 Update of the Ambulatory Surgical Center (ASC) Payment System (PDF) is available. Learn about payment rates for separately payable drugs and biologicals and covered surgical and ancillary services.
A new MLN Matters Article on Internet Only Manual Updates to Pub. 100-01, 100-02 and 100-04 to Correct Errors and Omissions (SNF) (2018) (PDF) is available. Learn about updates to the Medicare manuals for Skilled Nursing Facility (SNF) policy.
A new MLN Matters Article on The Supplemental Security Income (SSI)/Medicare Beneficiary Data for Fiscal Year 2016 for IPPS Hospitals, IRFs, and LTCHs (PDF) is available. Learn about updated data for determining the disproportionate share adjustment for Inpatient Prospective Payment System (IPPS) hospitals, the low-income patient adjustment for Inpatient Rehabilitation Facilities (IRFs), and payments for and Long-Term Care Hospital (LTCH) discharges.
A new MLN Matters Special Edition Article on Billing Requirements for OPPS Providers with Multiple Service Locations (PDF) is available. Learn about editing requirements for the Medicare Claims Processing Manual, Chapter 1, and Section 170 which describes payment bases for institutional claims for the Outpatient Prospective Payment System (OPPS).
Reinstating the QMB Indicator in the Medicare FFS Claims Processing System MLN Matters Article — Revised
A revised MLN Matters Article on Reinstating the Qualified Medicare Beneficiary (QMB) Indicator in the Medicare Fee-For-Service (FFS) Claims Processing System from CR9911 (PDF) is available. Learn about the addition of Claim Adjustment Reason Codes (CARCs) 66, 247, and 248 and the updated QMB enrollment numbers.
Quarterly Update for CLFS and Laboratory Services Subject to Reasonable Charge Payment MLN Matters Article — Revised
A revised MLN Matters Article on Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (PDF) is available. Learn about Clinical Lab Fee Schedule (CLFS) rates based on weighted median private payor rates.
A revised Home Health Prospective Payment System Booklet is available. Learn about:
- Consolidated billing requirements
- Criteria that must be met to qualify for services
- Therapy services
- Physician billing and payment
A revised Federally Qualified Health Center Booklet is available. Learn about:
A revised Medicare Parts A and B Appeals Process Booklet is available. Learn about:
- Five levels of claim appeals
- New option for a level three on-the-record review
- Available forms and helpful tips for filing an appeal
With Continuing Education Credit
A revised Medicare Secondary Payer Provisions Web-Based Training course is available through the Learning Management System. Learn about:
- Common situations when Medicare may pay first or second
- When Medicare may make conditional payments
- On-going Responsibility for Medicals provision
- Role of the Benefits Coordination & Recovery Center
The CLIA Program and Medicare Laboratory Services Fact Sheet is available. Learn about:
- Enrolling in the Clinical Laboratory Improvement Amendments (CLIA) program
- Types of laboratory certificates
- CLIA Proficiency Testing and test method categorization
- Medicare laboratory services
This newsletter is current as of the issue date. View the complete disclaimer.
The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).