On January 27, CMS took action to cover Food and Drug Administration approved or cleared laboratory diagnostic tests using Next Generation Sequencing (NGS) for patients with germline (inherited) ovarian or breast cancer.

NGS tests provide the most comprehensive genetic analysis of a patient’s cancer because they enable simultaneous detection of multiple types of genetic alterations. Medicare first began covering laboratory diagnostic tests using NGS in March 2018 for Medicare patients with advanced cancer that met specific criteria. As a result of today’s decision, more Medicare patients will have access to NGS in managing other types of inherited cancers to reduce mortality and improve health outcomes.

Using genetic tests gives patients a more complete profile of their cancer cells and may help identify proven, targeted treatments. Patients who use NGS tests may also find they are good candidates for cancer clinical trials.

We want to ensure that patients have ready access to this diagnostic test when appropriate. Therefore, we provided Medicare’s Administrative Contractors with discretion over whether to cover certain other indications. Read the .

See the full text of this excerpted CMS Press Release (issued January 27).

Nursing Home Quality Initiative: Draft MDS 3.0 Item Set Change History

A new draft version of the MDS 3.0 Item Set Change History (PDF) for October 2020 (v1.18.0) is available. Visit the MDS 3.0 Technical Information webpage for more information.

Nursing Homes: Use Updated Infection Control Worksheet

The November 2019 State Survey Agency Directors Memorandum (PDF) includes infection control information and basic practices to improve resident safety and quality in nursing homes. Read the memo and log in to the Quality, Safety & Education Portal, which replaced the Integrated Surveyor Training website, to find these resources:

Updated Nursing Home Infection Control Worksheet: Self-assessment tool includes requirements and best practices to improve infection control programs, including new questions about facility water management to reduce the risks to residents of Legionella infections
Technical resources, especially when new organisms appear or there is an outbreak in your area
Antibiotic Stewardship Program for Nursing Home Providers: Training and resources on requirements to improve appropriate antibiotic usage

Note: CMS encourages use of alcohol-based handrub, instead of soap and water, in all clinical situations except when hands are visibly soiled (e.g., blood, body fluids) or after caring for a resident with known or suspected C. difficile or norovirus infection during an outbreak; in these circumstances, use soap and water.

Glaucoma Awareness Month: Make a Resolution for Healthy Vision

Encourage people with a higher risk for glaucoma to make healthy vision a priority this New Year. Recommend an annual screening if appropriate; Medicare provides glaucoma screening coverage for beneficiaries in at least one high risk group:

Individuals with diabetes mellitus
Individuals with a family history of glaucoma
African-Americans aged 50 and older
Hispanic-Americans aged 65 and older

For More Information:

Educational Tool
Medicare Vision Services (PDF) Fact Sheet
Initial Preventive Physical Examination (PDF) Booklet
Annual Wellness Visit (PDF) Booklet
National Eye Institute website

Visit the Preventive Services website to learn more about Medicare-covered services.

Compliance

Hospice Care: Safeguards for Medicare Patients

In a two-part report series, the Office of Inspector General (OIG) focused on hospice:

Quality of care and common deficiencies
Instances of beneficiary harm and vulnerabilities

CMS released the Safeguards for Medicare Patients in Hospice Care (PDF) Fact Sheet to help you recognize and address deficiencies in care and protect your patients from harm. Additional resources:

Hospice Deficiencies Pose Risks to Medicare Beneficiaries OIG Report
Safeguards Must Be Strengthened To Protect Medicare Hospice Patients From Harm OIG Report
Medicare Claims Processing Manual, Chapter 11 (PDF), Section 30.1
Eldercare Locator website
Contact Information For Filing a Complaint with the State Survey Agency (PDF)

Claims, Pricers & Codes

OPPS Pricer File: January 2020

CMS posted the first quarter 2020 Pricer text file and outpatient provider data on the Outpatient Prospective Payment System (OPPS) Pricer webpage.

Events

Ground Ambulance Organizations: Reporting Staff and Labor Costs Open Door Forum — February 6

Thursday, February 6 from 2 to 3:30 pm ET

During this Ambulance Open Door Forum, learn how to report required staff and labor costs in the new Ground Ambulance Data Collection system. The webinar will review Section 7 of the data collection instrument (PDF) and walk through illustrative examples with time at the end for questions and answers.

Participation Instructions:

Conference call only; you do not need to RSVP
Dial: 888-455-1397 and reference conference passcode 9375124
For TTY services dial 7-1-1 or 800-855-2880; a relay communications assistant will help

Visit the Ambulance Open Door Forum webpage for more information.

Target Audience: All ground ambulance organizations that use volunteer labor and ambulance stakeholders are welcome to attend; however, we strongly encourage the participation of all ground ambulance organizations selected to report the first year.

Ground Ambulance Organizations: Reporting Volunteer Labor Call — February 20

Thursday, February 20 from 2 to 3 pm ET

During this call, learn how to report volunteer labor in the new Ground Ambulance Data Collection system.

A question and answer session follows the presentation; however, you may email questions in advance to with “February 20 Call” in the subject line. These questions may be addressed during the call or used for other materials following the call. For more information, including ground ambulance organizations selected for the first round of reporting, see the Ambulances Services Center webpage, CY 2020 Physician Fee Schedule final rule, and Bipartisan Budget Act of 2018.

Target Audience: Ground ambulance organizations that use volunteer labor and ambulance stakeholders.

MLN Matters® Articles

Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked Questions

A new MLN Matters Special Edition Article SE20004 on Increasing Access to Innovative Antibiotics for Hospital Inpatients Using New Technology Add-On Payments: Frequently Asked Questions (PDF) is available. Learn about billing, payment, and qualified technologies.

January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS)

A new MLN Matters Article MM11605 on January 2020 Update of the Hospital Outpatient Prospective Payment System (OPPS) (PDF) is available. Learn about changes and billing instructions.

Update to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for Vaping Related Disorder

A new MLN Matters Article MM11623 on Update to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for Vaping Related Disorder (PDF) is available. Learn about the addition of a new code effective April 1.

Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS — Revised

A revised MLN Matters Article MM11335 on Add Dates of Service (DOS) for Pneumococcal Pneumonia Vaccination (PPV) Health Care Procedure Code System (HCPCS) Codes (90670, 90732), and Remove Next Eligible Dates for PPV HCPCS (PDF) is available. Learn about information included in eligibility transactions for PPV vaccines.

Calendar Year (CY) 2020 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment — Revised

A revised MLN Matters Article MM11598 on Calendar Year (CY) 2020 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment (PDF) is available. Learn about the delay until January 2021.

Publications

Safeguards for Medicare Patients in Hospice Care

A new Safeguards for Medicare Patients in Hospice Care Fact Sheet is available. Learn about:

Your responsibilities to protect patients from abuse and neglect
Survey and certification
Reporting abuse

Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B — Revised

A revised Medicare Learning Network Educational Tool is available. Learn about:

Administration and codes
Billing
FAQs

Skilled Nursing Facility Prospective Payment System — Revised

A revised Skilled Nursing Facility Prospective Payment System Medicare Learning Network Booklet is available. Learn about:

Payment rates
Quality Reporting Program
Value-Based Purchasing Program.

Multimedia

ESRD Quality Incentive Program: Audio Recording and Transcript

An audio recording (ZIP) and transcript (PDF) are available for the January 14 Medicare Learning Network call on the End-Stage Renal Disease (ESRD) Quality Incentive Program. Learn about the CY 2020 final rule.

MAC Listening Session: Audio Recording and Transcript

An audio recording (ZIP) and transcript (PDF) are available for the January 15 Medicare Learning Network listening session on Medicare Administrative Contractor (MAC) Performance and Request for Feedback on Opportunities to Enhance Provider Experience and Beneficiary Quality of Care. CMS requested feedback to improve processes and enhance interactions with your MAC.

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