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REIMBURSEMENT UPDATE

Take Action to Support New Legislation to Improve Medicare Reimbursement for HCT

We urge health professionals like you to support legislative reform so that Medicare reimbursement adequately covers the entire cost of bone marrow, peripheral blood stem cell, and cord blood transplants. Legislation will soon be introduced that would require cell acquisition costs to be reimbursed in the same way that Medicare already reimburses for solid organ and tissue acquisition. Become an advocate for reducing financial barriers to transplant for Medicare beneficiaries by sending a message to your Members of Congress in support of this legislation.

Learn more about the legislation.

Contact your Member of Congress now.


CY2018 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) released the CY2018 OPPS Proposed Rule for public comment on July 13, 2017. The NMDP/Be The Match Public and Payer Policy team drafted a comment letter to address the proposed status indicator assignment shift for CPT code 38205 from “B” to “S”. Assignment of CPT code 38205 to status indicator “B” is in alignment with CMS billing guidance instructing that all services provided to the donor must be held and reported through revenue code 0815 on the recipient’s transplant claim.

Shifting assignment to status indicator “S”, as is proposed in the 2018 OPPS Proposed Rule, would allow donor services to be payable separately under OPPS, with the potential for inappropriate billing of donor services to the donor’s insurance. NMDP/Be The Match’s position is that donor services continue to be held and reported on the transplant recipient’s claim and therefore, we will provide comment to encourage that CMS maintain assignment of CPT code 38205 to status indicator “B”.

On August 21, we were invited to present this position during the Advisory Panel on Hospital Outpatient Payment (HOP) meeting and received support on the issue. Look for detailed analysis of the OPPS Final Rule in November.

Read our CY2018 OPPS Proposed Rule comment letter.


Request for Patient Stories

We want to share powerful patient stories with US Members of Congress. If you know of a patient who has been impacted by blood cancer and had challenges accessing care, their story has potential to positively impact legislative and policy reform efforts.

Share your patient story with us.


Meet the NMDP/Be The Match Public and Payer Policy team at the 2017 TFCA Annual Workshop

A strong focus of the NMDP/Be The Match Public and Payer Policy team is to continue educating transplant professionals on coding, billing, and reimbursement changes and issues. The team will be presenting during the 2017 Transplant Financial Coordinators Association Annual Workshop on topics regarding Medicare coverage and reimbursement, policy work, recent coding and billing updates, advocacy initiatives and successes, our grants for patient financial assistance, and the Jason Carter Clinical Trials Program. This is a great opportunity to stay current, ask questions, access resources to support your work, and connect with members of the Public and Payer Policy team!

The 2017 TFCA Annual Workshop will be in Seattle, WA from September 26-28.


 

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If you have any questions or need additional information, please contact the Payer Policy Team at PayerPolicy@nmdp.org. All of our resources are available on our website: Network.BeTheMatchClinical.org/Reimbursement.

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