On June 25, 2018, CMS is holding its annual public meeting to consider the appropriate basis (crosswalking or gapfilling) for establishing payment amounts for new or substantially revised HCPCS codes being considered for payment under the 2019 Medicare clinical laboratory fee schedule (CLFS). The meeting will also address reconsideration requests regarding final determinations made last
Health Care Industry Events
CMS to Host Feedback Session on Medicare Oncology Care Model – May 3
By Debra A. McCurdy on
CMS is inviting stakeholders to provide feedback on its Innovation Center Oncology Care Model (OCM) at a May 3, 2018 public meeting. Under the OCM, 187 practices and 14 payers are testing performance-based Medicare payment for episodes of care surrounding chemotherapy administration to cancer patients.
CMS to Educate Drug Manufacturers on Navigating New ASP Reporting System
By Debra A. McCurdy on
CMS is requiring prescription drug manufacturers that report average sales price (ASP) data to use a new automated system, beginning with the second quarter 2018 ASP data submission (due April 30, 2018). To help manufacturers navigate the new system, CMS is hosting a March 27, 2018 educational call, which will include a question and answer…
CMS Announces Schedule for Public Meetings on Pending HCPCS Applications
By Debra A. McCurdy on
CMS has set the dates for its annual meetings to discuss applications for new and revised HCPCS codes:
May 14-17, 2018: Drugs, Biologicals, Radiopharmaceuticals, Radiologic Imaging Agents
June 5-6, 2018: Durable Medical Equipment and Accessories, Orthotics and Prosthetics, Supplies, Other [note that the Federal Register includes two sets of dates for this session; we…
CMS Wants Physicians to Speak Up on Reducing E/M Services Documentation Burden (March 21)
By Debra A. McCurdy on
CMS is hosting a call on March 21, 2018 to get feedback from physicians and non-physician practitioners on Evaluation and Management (E/M) services. According to the CMS announcement, the agency is looking for information from stakeholders on how the E/M guidelines can be updated “to reduce burden and better align coding and documentation with the…
CMS Update on Low Volume Appeals Settlement Option (March 13)
By Debra A. McCurdy on
CMS is hosting a call on March 13, 2018 to discuss the status of the “Low Volume Appeals” (LVA) settlement process and upcoming submission timeframes. As previously reported, this option is available for appellants with fewer than 500 total Medicare Part A or Part B claim appeals pending at the Office of Medicare…
CMS Plans Q&A Session on Low Volume Appeals Settlement Option (Feb. 13)
By Debra A. McCurdy on
As previously reported, CMS has initiated a “low volume appeals (LVA) settlement” option as part of broader HHS efforts to improve the Medicare appeals process. This option is available for appellants with fewer than 500 total Medicare Part A or Part B claim appeals pending at the Office of Medicare Hearings and Appeals and…
Trump Administration Unveils Its First Bundled Payment Initiative — BPCI Advanced
The Trump Administration has rolled out its first CMS Innovation Center Medicare bundled payment initiative, the Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under the new voluntary model, CMS will test whether bundled payments for 29 inpatient and 3 outpatient clinical episodes will lead to reduced Medicare expenditures while improving quality of care for Medicare beneficiaries. CMS anticipates that the performance period of the BPCI Advanced model will begin on October 1, 2018 and run through December 31, 2023.
BPCI Advanced builds on the ongoing Bundled Payments for Care Improvement (BPCI) initiative, which was launched in 2013 and runs through September 30, 2018. As in the BPCI model, BPCI Advanced seeks to incentivize providers to coordinate care to furnish services more efficiently while maintaining quality. Specifically, participants may either realize a gain or loss depending both on (1) how successfully they manage total Medicare fee-for-service costs of care (with limited exceptions) throughout each 90-day episode of care and (2) performance on specified quality measures.
There are key differences between the original BPCI and BPCI Advanced models, including the following (among others):
Continue Reading Trump Administration Unveils Its First Bundled Payment Initiative — BPCI Advanced
CMS Invites Medicaid Stakeholders to Participate in Call on New Medicare Card Project (Jan. 23)
By Debra A. McCurdy on
CMS is hosting a call on January 23, 2018 to brief state Medicaid agencies, Medicaid providers, managed care organizations, and other Medicaid stakeholders about the new Medicare card project. Under this initiative, CMS is moving away from Social Security Number-based Health Insurance Claim Numbers to new Medicare Beneficiary Identifiers (MBIs).
1/22 update: this call…
CMS Plans Educational Call on Low Volume Appeals Settlement Initiative (Jan. 9)
By Debra A. McCurdy on
On January 9, 2018, CMS is hosting a call to discuss its new low volume appeals settlement option. As previously reported, this option is available for certain Medicare fee-for-service providers, physicians, and other suppliers with fewer than 500 appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council at…
CMS Schedules Feb. 13 Town Hall Meeting on IPPS New Tech Applications
By Debra A. McCurdy on
On February 13, 2018, CMS is holding a public Town Hall meeting to discuss requests for add-on payments for new medical technologies under the Medicare hospital inpatient prospective payment system (IPPS). Registration details are provided in the meeting announcement.
CMS to Help SNFs Prepare for Value-Based Purchasing Program Rules (Nov. 16)
By Debra A. McCurdy on
A November 16, 2017 CMS call will focus on how the Medicare SNF Value-Based Purchasing Program will affect Medicare’s payments to SNFs beginning October 1, 2018. Among other things, the call will cover how CMS will translate SNF performance scores into value-based incentive payments and policies included in the FY 2018 SNF PPS final rule.
Learn What is New Regarding the Medicare Hospital “Primarily Engaged” Requirement (Nov. 2)
By Debra A. McCurdy on
CMS is hosting an educational call November 2, 2017 on new State Operations Manual guidance that discusses the Medicare definition of a hospital, including the requirement for hospitals to be primarily engaged in providing care to inpatients. Registration is required to participate.
Drug Pricing, Drug Costs, and the Opioid Crisis are the Focus of Upcoming Congressional Hearings
By Debra A. McCurdy on
The Energy and Commerce Subcommittee on Health has scheduled an October 11, 2017 hearing to discuss how covered entities use the 340B drug pricing program. A second Subcommittee hearing on October 11 will consider proposals from House members on ways to address the opioid crisis.
On October 17, the Senate Health, Education, Labor, and Pensions…
CMS Call: IMPACT Act and Improving Care Coordination (Sept. 28)
By Debra A. McCurdy on
CMS is hosting an Open Door Forum conference call September 28, 2017 to provide information and solicit feedback on the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Among other things, the call will provide an update on contractor activities and upcoming national field testing.
Upcoming CMS Clinical Diagnostic Lab Test Advisory Panel Meeting to Consider Lab Test Rates
By Debra A. McCurdy on
The Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests (CDLTs) is holding a public meeting on Monday, September 25, 2017. The Panel will discuss calendar year 2018 clinical laboratory fee schedule codes for which CMS received no applicable information to calculate a Medicare payment rate. The list of CDLTs that will be discussed during …
IMPACT Act: Medicare Spending Per Beneficiary Measures Call (Sept. 6)
By Debra A. McCurdy on
CMS is hosting a call on September 6, 2017 to discuss Medicare Spending per Beneficiary Post-Acute Care (PAC) resource use measures, which are mandated by the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The call will focus on the components of each measure and public reporting. The target audience for the call…
Qualified Medicare Beneficiary Program Billing Rules Call
By Debra A. McCurdy on
On September 19, 2017, CMS is hosting a call to explain Qualified Medicare Beneficiary (QMB) billing rules, including upcoming changes to the HIPAA Eligibility Transaction System (HETS) and remittance advice to identify patient QMB status and exemption from cost-sharing.
CMS Summit on Potential Behavioral Health Innovative Payment Model (Sept. 8, 2017)
By Debra A. McCurdy on
The CMS Center for Medicare and Medicaid Innovation is holding a public summit on September 8, 2017 to explore creating a behavioral health innovative payment model intended to improve health care quality and access, while lowering the cost of care for Medicare, Medicaid, or Children’s Health Insurance Program (CHIP) beneficiaries with behavioral health conditions. The…
CMS Announces Summer Meetings on 2018 Clinical Lab Fee Schedule Update
By Debra A. McCurdy on
CMS has scheduled two days of meeting this summer on updates to the Medicare clinical laboratory fee schedule (CLFS) for 2018. First, the public meeting on payment amounts for new or substantially revised HCPCS codes being considered for Medicare payment under the 2018 CLFS will be held on July 31, 2017. This meeting also…