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On behalf of National Marrow Donor Program(R) (NMDP)/Be The Match(R), we thank you for the opportunity to provide our comments on the notice of proposed rulemaking (NPRM) for the FY2021 Inpatient Prospective Payment System.
For the thousands of Americans diagnosed every year with life-threatening blood cancers like leukemia and lymphoma, a cure exists. NMDP manages the largest and most diverse marrow registry in the world through a competitively-bid contract with the
NMDP is very excited that cost-based reimbursement of inpatient hematopoietic stem cell transplant (HSCT) donor search and cell acquisition cost is now imminent for our transplant center network. We are also very appreciative of the Agency taking time to collaborate with us and to carefully implement Section 108 of the Further Consolidation Act of 2019. We are still analyzing proposals in this Section and other proposals in the NPRM beyond Section 108 and will be submitting more comments prior to the deadline. There is, however, one topic of concern for our transplant centers that we wish to submit early to CMS to provide the maximum amount of time to consider and change the Agency's proposal.
CMS proposes that, when transplant centers submit claims to Medicare, the charge billed under revenue code 0815 for the donor search and cell acquisition services must be a standard charge based on the average of all of the centers HSCT donor search and acquisition services for all allogeneic HSCT recipients. The proposed regulation text would be at 42 CFR 412.113(e)(3). Much of the impetus for this legislation is CMS' treatment of donor costs for solid organ transplants, and NMDP believes that CMS' proposal to use a standard average charge is modeled on similar regulations for solid organs. However, this is one area where solid organ and stem cell transplants are not analogous, and there are no organ procurement agencies for HSCTs.
We ask CMS to view the proposed regulation language 42 CFR 412.113(e)(3) together with the existing Provider Reimbursement
Currently, CMS allows transplant centers to bill actual donor charges. Medicare's claims processing manual instructions in Chapter 3, Section 90.3.1 require transplant centers to hold all actual donor search and cell acquisition charges for each Medicare transplant recipient and report those charges under revenue code 0815 on the recipient's transplant claim. This existing and long-standing instruction allows transplant centers to bill all other payers their actual charges for various donor evaluation, testing, and other unrelated donor search and cell acquisition charges. If CMS finalizes its proposal, hospitals would no longer be able to report their actual charges to other payers; instead, they would be forced to report an average acquisition charge on all patient accounts. This would fundamentally and significantly impact how transplant centers bill commercial insurances for donor search and cell acquisition services. It is likely to change the payment terms of each transplant center's negotiated contracts, and ultimately the payment the centers receive.
We do not believe that CMS intended for this to be the case. We urge the agency to revise its proposal and instead allow transplant centers to continue reporting their actual charges, which will still fully facilitate implementation of Section 108 in the manner
NMDP recognizes that, under the new cost-based rules, Medicare will settle with each hospital annually and pay the actual Medicare recipient donor costs. Hence, the concept of a standard average charge, modeled off the way solid organ charges work, would not be of any concern IF Medicare were the only payer. That is not the case, however. Since no similar settlement opportunity exists with commercial payers, CMS' proposal will have a deeply concerning impact on hospitals with respect to their commercial payer cases.
Furthermore, many commercial payers accept claims for related donor evaluation and testing charges on separate claims in advance of the recipient's transplant claim. In the spirit of transparency and data collection, in
In summary, the NMDP respectfully requests that CMS remove the standard charge language in this proposal. We urge the Agency, instead, to codify existing manual instructions that require transplant centers to hold their actual donor search and cell acquisition charges applicable to each Medicare transplant recipient's case, and include them all on the recipient's claim under revenue code 0815. The NMDP believes that continuing to allow transplant centers to report their actual charges--as has been the longstanding requirement--is the simplest approach. It will, moreover, accomplish appropriate implementation of Section 108 (e.g., paying reasonable cost for allogeneic donor search and cell acquisition) and allow transplant centers to continue billing their other payers in the manner to which they are accustomed, by reporting actual charges and using the new NUBC codes.
Thank you again for providing us with the opportunity to provide comments on the notice of proposed rulemaking. Please feel free to contact me with any questions at [email protected] or (763) 406-8566.
With best regards,
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The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2020-0052-0002
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