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REIMBURSEMENT UPDATE

Coverage and Optimal Reporting of HCT for 2018 - A Webinar Opportunity

Understanding and implementing accurate and complete claims and cost reporting can fundamentally transform the existing inpatient MS-DRG 014 reimbursement for allogeneic HCT, yet not all transplant centers’ reporting practices are up to par. Our experts will review correct coding of allogeneic stem cell transplants and current reimbursement rates along with claim billing rules and unrelated donor expense. Provider financial practices will be analyzed with regard to their impact on Medicare and commercial payer reimbursement. 

We will specifically review what transplant centers need to “self-audit” in terms of correctly prepared claims, including the reporting of all charges, professional services, and submission of cost reporting information for donor search and cell acquisition. Our experts will also cover the importance of appropriate mark-up practices and the regulatory requirements while taking pre-billing contractual allowances/discount deductions to meet commercial contract terms.

We will also present a brief update on our strategy to increase transplant coverage for Medicare beneficiaries who are diagnosed with lymphoma. There will be time for a Q&A session with our experts at the end.

Join us on Thursday, April 19 from 12:00 to 1:30 p.m. CDT for this important webinar and be sure to invite your coding, billing, revenue cycle, charge description, payer contracting and cost reporting staff.

Register for this webinar

 

PPP Center-Specific Report

Your Center-Specific 2018 Medicare Reimbursement Report

If you weren’t able to pick up your center’s report during the 2018 BMT Tandem Meetings Administrative Directors Conference, you are still able to request the report from the NMDP Public and Payer Policy department. Your center-specific report includes up-to-date Medicare data on how frequently your center bills revenue code 0815 for allogeneic HCT. Our team is also available for questions or further consult by request.

For more information or to request your center’s report, please email PayerPolicy@NMDP.org

 

We Still Need Your Support for Reforming Medicare Reimbursement  PACT Act (HR 4215)!

The Centers for Medicare and Medicaid Services (CMS) has not addressed inadequate Medicare reimbursement for allogeneic HCT and search and acquisition costs. Within the next month, the 2019 Inpatient Prospective Payment System (IPPS) rule proposal will be published for comment and we need to be ready to demonstrate support of HR 4215 in large numbers. Your dedication to protecting patient access to transplant and support of HR 4215 is absolutely necessary. If you haven’t done so already, please contact your legislators today!

 

Fertility Chapters

New HCT and Fertility Module

The Patient and Health Professional Services department at NMDP/Be The Match is excited to present a new resource on HCT and fertility education! Fertility is a concern for many patients who require medically necessary, life-saving treatments that are potentially harmful to reproductive health. Being transparent with patients about their fertility is important, but it is understandably difficult when there are immediate concerns about treating a life-threatening disease. This fertility education module is designed to help providers facilitate a conversation with patients and to help the patient self-advocate, ask the right questions, and navigate insurance coverage for fertility preservation.

 

2018 BMT Tandem Meetings Recap

Now that the frenzy of Tandem is over, many of us will take time to reflect on the year gone by and refocus our energy on new strategies. Public and Payer Policy team members facilitated an Advisory Group on Barriers to Transplant (AGBT) discussion around defining CAR-T value, financial toxicity, and value-based insurance with the hopes of identifying areas still needing more work. During the Administrative Directors Conference, Susan Leppke, the Director of Public and Payer Policy, presented valuable information on changes to Medicare coverage, reimbursement and coding with fellow experts Stephanie Farnia from ASBMT and Jugna Shah from Nimitt Consulting.

Some of the quiz-bowl questions at the end of the presentation were easy for most audience members to answer (do not bill donors for donor search and cell acquisition), while others were not as straightforward (hospital cost report line 77 is effective 1/1/2017 for reporting all allogeneic HCT donor search and cell acquisition costs).

Our team also valued the discussions around survivorship, fertility education, research efforts to decrease CAR-T toxicity, and defining effectiveness and value in the ever-changing cellular therapy and transplant space.

And while the meeting ended with a fun night of dancing and socializing, we are always thinking about the challenges ahead that connect us through a single mission – saving lives through transplant and cellular therapy. The Public and Payer Policy team thanks everyone for a great meeting. See you next year!

Where can you find us next? You can find Public and Payer Policy team members exhibiting at the 23rd NCCN Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care, March 22 – 24, 2018, in Orlando, Florida. Please stop by and say hello! We would love to talk to you.  

 


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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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