86 investigations, in the past three years, into suspicious use of Herceptin, were opened by WellPoint, including four cases in Georgia in the past week alone. Last month, MOASC sent a letter to ASCO requesting their review and action regarding the packaging of the drug. Findings in a sweeping analysis published in November by HHS' watchdog office, documented a sky-high error rate of 77% in Medicare claims for Herceptin multi-use vials. That translated to $24 million in extra payments nationwide between 2008 and 2011, most of which has since been recovered.HHS' Office of the Inspector General report (PDF) concluded that many doctors and hospitals have been billing the government for a full vial of Herceptin, even though reviews of about 26,000 individual patient records show the treatment called for lower doses. Critics say it's unlikely that the hospitals, doctors and cancer centers threw away the Herceptin left in the bottom of a multi-use vial. The implication, then, is that at least some of them used the excess drug on other people, even though those patients' drugs would have been paid for separately under their own claims-creating a double-payment for the same drug. "It is unlikely that they are discarding the remainder of the multi-use vials, because it is so valuable and it is good for 28 days. My suspicion, based on the report, is that they are reusing it on other patients," said Jim Sheehan, former New York Medicaid inspector general who now works as executive deputy commissioner overseeing Medicaid and other programs for the Human Resources Administration in New York City. Since then, CMS officials say about $18 million has been repaid to the government, but the office that conducted the audit has urged for a wider review of the issue: "Herceptin is one of many multi-use drugs. Therefore, the problem of provider billing for full vials may exist for other such drugs." CMS Administrator Marilyn Tavenner, however, wrote in response to the audit that her agency disagrees. "CMS believes that Herceptin is an unusual situation. ... However, if OIG believes there are other multidose vials that are subject to incorrect billing as single-dose vials, CMS encourages OIG to bring them to our attention." Sheehan said the OIG may not be the only source that will bring information to the CMS' attention. "This is clearly a program vulnerability," he said. "I think you will also see whistle-blower attention in this area as well." Full article WellPoint, HHS target double-billing for cancer drug Herceptin. For more information, please click here. .
CMS has given providers another year to show they've met the Stage 2 criteria of the federal government's incentive program to encourage the adoption and meaningful use of electronic health records, which means the start of the next phase will also be pushed back a year. Meaningful-use deadline pushed back one year. For more information, please click here.
Below, please find a link to the "Request for Covered California Information" for physicians and other stakeholders. Physicians, staff, etc. can request "A Learning Session" about Covered CA and Covered CA patient materials, or both. These forms are being directed back to the CMA Foundation; CMAF staff will follow up with the physician office. Any questions, please do not hesitate to contact The CMA Foundation firstname.lastname@example.org. Please click here for the request form. For more information, please click here.
Noridian/JEMAC's website https://med.noridianmedicare.com/web/jeb has posted the following updates: Update to Medicare Deductibles, Coinsurance, and Premium Rates for 2014; 2014 MPFS Available Soon; Uniform Use of Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC) Rule. For more information, please click here.
The Administrator Manager Meeting was held on December 4th at the Mission Inn Hotel in Riverside. Below is a synopsis of the program, which was sponsored in part by the following companies: Miraca Life Sciences, Navigating Cancer, MedicoRx Specialty Pharmacy, Merck Oncology and Innovatix/Essensa.
The first speaker was Michelle Weiss, and she discussed “Addressing Reimbursement Issues.” The second speaker was John Akscin, Founder and Principal Consultant, John Akscin Consulting, Inc. John discussed “Implementing Migrated Thinking.. Leveraging the Power of Your Numbers for Success.” Then Shawn Ecksel, Vice President of Sales and Business Development, Premier Healthcare Processing, discussed “MOASC and Premier Healthcare Processing.” Followed by Lunch, Exhibit Hall and the MOASC Business Discussion. Since the MCN Board of Directors unanimously approved of moving forward with the first Payor contract in California, Kelli Kovak and Jim Hassel, Cardinal Health Specialty Solutions discussed this in more detail during the MOASC Business portion of the afternoon. Finally, Cheryl Bradley, Provider Outreach and Education Representative, Noridian presented “Noridian – The New Medicare Contract, 2014 Medicare Changes.” If you would like copies of the handouts, please email Danielle Overman at email@example.com.
Mobile Health Library is a powerful and versatile platform that provides access to patient education materials, interactive videos, sample requests, and much more, all in 1 convenient, easy to use place. Novartis Oncology is committed to delivering innovative tools, such as Mobile Health Library to support the oncology community in its effort to advance the care of patients. When using a desktop:
Write in the search field “Novartis Oncology”
Once on the site, click accept terms
Then you will be at the Novartis HCP (Healthcare Provider) Resource Center
PANO – (Patient Assistance Now Oncology) reimbursement support services link www.oncologyaccessnow.com Hotline number: 800-282-7630.
The MOASC LunchTime Series Webinar held on Wednesday, November 20, 2013. The topic was "LUCY - the online payment gateway built for the healthcare industry" Lucy Virtual Terminal - a virtual gateway solution for billing and accounts receivable cash flow, an easy conversion process that will get you up and running in minutes and VIMAS our 24/7 reporting and account management tool which will keep your practice current with all of your credit card transaction details. Additional deliverables of the Premier Healthcare Processing include: 1) State of the art equipment at no charge; 2) Onsite set up and training for easier transition time at no additional cost; 3) 24/7 account access and customer support; 4) Dedicated Client Relations Representative for improved customer support; 5) 6 month service Guarantee to ensure we earn your trust as your new Processor; 6) Annual program terms; 7) Rate reductions for every business. Presented by:Shawn Ecksel, Vice President of Sales and Business Development, Premier Merchant Processing.
In case you missed the webinar, the information will be presented again at the upcoming MOASC Administrator Meeting is scheduled for Wednesday, December 4th at the Mission Inn in Riverside. Meeting begins at 7:30am and concludes at 3:00pm. To RSVP for this meeting, call the MOASC Office at 909-985-9061 ext. 1 or via email to Danielle Overman at firstname.lastname@example.org
MOASC held its 1st Annual Oncology Leadership Economic Conference on November 13th at Disney’s Grand Californian Hotel.
In case you missed it, below is a synopsis of the evening:
MOASC Board of Directors met individually with each of the Platinum sponsors, which included: Millennium, Celgene, Cardinal Health, and Oncology Supply. ONYX Pharmaceuticals were unable to attend.
Innovatix presented further savings on credit card and check processing for practices, along with discount health insurance for practices in the face of the implementation of the ACA.
Exhibitions & Networking Reception included Lilly Oncology On Canvas (LOOC) art exhibit. This meeting was sponsored in part by: Medivation, Merck Oncology and Pfizer Oncology.
Robert Moss, M.D., MOASC President welcomed all attendees and began with introductions.
David Ford, Noteware Government Relations presented: “Affordable Care Act and Implications for Community Oncology”.
Dr. Lawrence Piro, MOASC Board of Directors & Chair of Executive Committee moderated panel and audience discussion regarding both the Affordable Care Act and the state exchange Covered California, and how both will affect community oncology. (Meeting handouts are available upon request)
Roundtable discussion with all Industry Partners addressing hot topics in pipeline and in their company.
MOASC Physicians in attendance were afforded the opportunity to ask questions and engage in dialogue throughout the meeting.
MOASC Chairman of the Board highlighted on ABC News regarding the high cost of prescription drugs.
Video below from abc7.com: