• First quarter update to the Medicare Physician fee Schedule has been posted.
• Article on the Drug Administration Coding Revisions for
2005 - New G-Codes has been posted to the NHIC website.
• The March 2005 edition of Medicare B Resource is now available
MOASC continues to report problems in claims processing by
NHIC/Medicare for drug administration and demonstration project G-codes. We continue to solicit your answers to the following questions:
1) Have you received payments for chemotherapy administration services
rendered in 2005 and billed using the new G codes?
2) Did NHIC/Medicare recognize the new G codes and pay correctly based
on the codes reported? Did you have any problems?
3) If you experienced problems with having your claims processed,
please describe those problems.
We are specifically looking for problems in processing otherwise clean
claims (e.g., claims with demonstration codes pending while claims
without demonstration codes processed and paid correctly on time).
Please be as specific as possible in your responses to MOASC and
ASCO. Reply to the MOASC ListServ, and/or the COC ListServ (coc-admin@californiaoncology.org) and to ASCO at practice@asco.org.
In the meantime, NHIC/Medicare has published an article on the
demonstration project G codes at
http://www.medicarenhic.com/providers/billing/chemodemo_0205.htm.
The NHIC/Medicare article on
drug administration coding that will be published on the NHIC/Medicare
website in the near future is available here.
As we reported a few weeks ago, CMS has contacted ASCO seeking
information on "underwater" drugs - drugs for which the cost to your
practice is more than the Medicare payment rate. As a result, ASCO is
urging members who have not yet submitted the drug payment survey we
circulated earlier this year to take some time to complete it. For
your convenience, the survey spreadsheet as well as an explanation of
the survey can be downloaded here [Survey] [Explanations].
Survey data
will provide the best evidence about the impact of the new drug pricing
structure. If we provide information to CMS on drug pricing problems,
then CMS may take steps to address them.
ASCO can help you or your practice staff complete the survey, so it
will take as little of your time as possible. Please call ASCO's
Cancer Policy & Clinical Affairs Department at 703-299-1050, or e-mail publicpolicy@asco.org, and an ASCO staff member will help you. As
always, any information that you provide will be kept confidential.
The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule on the Competitive Acquisition Program (CAP) for Part B drugs. The details of the program are outlined in ASCO's summary of the rule. The CAP was required by the Medicare Modernization Act of 2003 (MMA). Under the proposed program, a physician could elect annually to receive drugs for Medicare patients from a contracted vendor selected by CMS. The contractor would be responsible for billing Medicare and the patient for the drugs.
The rule is open to public comment until April 26, 2005 . You may file comments with CMS electronically, by emailing them to MMA303DDrugBid@cms.hhs.gov. In the coming days, ASCO will be analyzing this proposed program and providing feedback to CMS. We would like your help in identifying issues to raise in our comments to CMS. Please contact ASCO's Cancer Policy & Clinical Affairs Department with any questions at publicpolicy@asco.org or 703-299-1050.
ASCO’s Clinical Practice Committee (CPC) and State/Regional Affiliates teleconferenced on Thursday afternoon, March 3rd, to discuss changes in Medicare drug and practice expense reimbursement as legislated in the Medicare Prescription Drug, Improvement, and Modernization Act of 2004 (MMA) and proposed in the 2005 Medicare Physician Fee Schedule. Read the summary here.
Effective July 1st, CMS and NHIC/Medicare will begin to implement a
process by which non-HIPAA compliant (aka "paper") claims could be
denied for providers who do not meet with a waiver or an exception. The
details of this compliance are provided in the following MedLearn
Matters article:http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3440.pdf
After July 1st, NHIC/Medicare will have the ability to track and
identify providers that submit non-compliant claims, who then may be
asked to substantiate their presumed waivers or exceptions. Only after
such waivers/exceptions are not substantiated (or no response given)
would denials occur.
Please note that one of the waivers/exceptions to this compliance is
for physicians, practitioners, or suppliers with fewer than ten (10)
FTEs that bills a Medicare carrier. More detailed information is available by reading the CMS transmittal at: http://www.cms.hhs.gov/manuals/pm_trans/R450CP.pdf
The MOASC office is in receipt of the NHIC website communication entitled, "Xeloda (capecitabine) in lieu of 5-FU for cancer therapy." As you read the article, it states that "NHIC will cover the Part B -reimbursed components of any chemotherapy regimens which typically include 5-FU, whether the clinician's judgment leads to inclusion of 5-FU or capecitabine (Xeloda) in the regimen."
For more information, please review the article.
The National Cancer Institute (NCI) is building a website for people
who are seeking information on cancer risk.
The website is in the early stages of development and NCI wants to
focus group test it with individuals who meet the criteria (i.e., no
previous history of cancer, over 40 years of age, English speaking,
able to use a Windows-based computer, access to the Internet) on the
following announcement.
As your oncology practice works to comply with the new protocols and regulations of the Medicare Modernization Act, you need concrete strategies for success that can be directly applied in your office to ensure that vital treatments and services for your cancer patients are not interrupted. At this symposium, experts in reimbursement and coding will provide practical examples and suggestions for maximum results. Bring your questions, as there will be time dedicated to addressing your issues. Read the meeting flyer here.
