Medical Oncology Association of
Southern California
P.O. Box 161
Upland, CA 91785
Phone: (909) 985-9061
Fax: (909) 985-8581
email: moasc@moasc.org
|
|
|
MOASC would like to recognize and thank the following sponsors for their continued support of MOASC:
|
|
|
|
|
|
|
March is National Colorectal Cancer Awareness Month
March is National Colorectal Cancer Awareness Month. As you know, colorectal cancer is the third most common type of cancer, and the second leading cause of cancer death. Like many other diseases, older adults are at greater risk for colorectal cancer. CMS wants health care professionals to encourage their Medicare patients ages 50 and older to get screened for colorectal cancer.
Medicare covers colorectal cancer screening tests and procedures, specifically:
• Fecal Occult Blood Test • Flexible Sigmoidoscopy • Screening Colonoscopy • Barium Enema
Read the CMS announcement >>
|
|
Senator Specter Introduces Community Cancer Care Bill
“... I am introducing legislation to provide community oncologists with the tools to withstand the CMS reforms brought forth under the Medicare Prescription Drug and Modernization Act. The bill's $1.7 billion price tag, over the next 5 years, is a relatively small cost in the face of the vast reductions in CMS’s reimbursement to oncologists.”
“This legislation provides Medicare reimbursement assistance for community oncologists and ensures Medicare beneficiaries’ access to community-based cancer treatment. I encourage my colleagues to work with Senators Coleman, Isakson and me to move this legislation forward promptly.”
Senator Arlen Specter, a Republican from Pennsylvania, introduced the Community Cancer Care Preservation Act (referred to as S2340).
The Community Cancer Care Preservation Act (S2340) is similar to the Community Cancer Care Preservation Act of 2005 (HR4098), which was introduced last year to the House of Representatives by Congressman Jim Ramstad (R-MN). Specifically, S2340 will accomplish the following:
Fix critical aspects of ASP. S2340 will provide a true-up or reimbursement correction for drugs that are increased (or decreased) in price by the manufacturer. This will correct the current problem whereby community cancer clinics are subsidizing Medicare for six months on average for price increases. Additionally, S2340 will eliminate prompt payment discounts from the calculation of ASP. Currently, the inclusion of prompt payment discounts, which average about 2%, artificially depress drug reimbursement rates from ASP + 6% to ASP + 4%.
Pay for pharmacy facilities. S2340 will reimburse community cancer clinics for pharmacy facilities at 2% of ASP.
Reinstitute the 2005 demonstration project at the $300 million funding level. S2340 will reinstitute the 2005 quality care demonstration project at the $300 million funding level. This will provide needed additional funding so that the Centers for Medicare & Medicaid (CMS) Services can carry out the intent of the Medicare Modernization Act (MMA) to properly adjust rates for existing codes and add new payment codes, such as for treatment planning. CMS was supposed to do this during 2004, which was the reason why the MMA created a 32% transition payment increase for 2004.
Additionally, S2340 will involve community oncology in the definition of what is quality cancer care and in increasing availability of clinical research trials. This is important because the vast majority of Americans are treated in a community oncology facility. Community oncologists need a more active role in the allocation of funds towards research and treatment.
Please contact your Senators today to ask them to cosponsor S2340.
There are a variety of tools available to help you in contacting your Senators to cosponsor S2340. On the COA website at http://www.communityoncology.org in the Legislative Action Center (lower red menu bar) is an email template that you can customize or send as is from the COA website. Also on the COA website is a copy of S2340. If you need other tools or have any questions please contact the COA office at 202-756-2258.
There is no substitute for a meeting with your Senators and their legislative staff. Your Members will not ignore calls, faxes, and emails asking for their support to cosponsor S2340. They will respond to their constituents.
Anyone truly committed to community oncology and wanting to retain critical funding for cancer care will actively support, in word and action, S2340. It is a positive, simple solution to averting further patient access problems already occurring in 2006.
We should all appreciate the extraordinary efforts of Senator Specter who has taken the time to comprehend a very complicated issue.
MOASC is encouraging all MOASC members to e-mail, call, and/or fax to:
AND
Please tell them that you support, and encourage their co-sponsorship of, Senate Bill 2340 as introduced by Sen. Specter and co-sponsored by Senators Coleman and Isakson, for the preservation of, and access to, community cancer care.
Office of the Inspector General report on the "Calculation of Volume Weighted ASP for Medicare Part B Prescription Drugs."
The report states that: "The method CMS uses to calculate volume-weighted average sales price (ASP) is incorrect."
In addition the report states: "Because CMS calculates volume-weighted ASPs incorrectly, current and future reimbursement amounts might not be accurate."
Further the report states..."According to our analysis of prices published in the first quarter of 2005, 46 percent of HCPCS codes had a reimbursement amount that was HIGHER THAN IT SHOULD HAVE BEEN, resulting in an estimated $115 million loss to Medicare in 2005."
In other words providers were paid too much under the new ASP system! The report recommends fixing the ASP formula to adjust for this overpayment!!
The Office of Inspector General (OIG) recommends: "CMS should change its method for calculating volume-weighted ASP's."
What is the impact - another $115 million (minimum) cut from providers under the new ASP system.
At BEST - As it stands now ASP + 6 = ASP -6.3 how....
2% for prompt pay discounts
2% (minimum) for pharmacy facilities cost
5.3% (minimum) for bad debt - uncollectible co-pays
3% (minimum) billing and administrative costs
This latest news only exacerbates the equation. Making ASP + 6 = ASP - 7 (or worse)
In the background of the report is the implication that some drug reimbursements should be AMPed or WAMPed - which will cut reimbursement further.
Some say CAP is the answer. This is the same crew that said ASP + 6 was sufficient for our practices. CAP increases costs to the practices, disrupts patient care, and increases costs to the system. ASP + 6 was never sufficient and is exacerbating each quarter and each year.
|
|
Grant Applications Available for Cancer Patients, Their Families
Attorney General Bill Lockyer (D) is accepting applications for grants to benefit cancer patients or their families in California, according to the Cypresfunds.net Web site. The grants will be paid from the Taxol Settlement Fund, which resulted from a suit filed by state attorneys general alleging that the company illegally delayed generic competition for cancer drug Taxol (Cypresfunds.net Web site).
Bristol-Myers Squibb in 2003 agreed to pay $55 million to all 50 states and some U.S. territories as part of the settlement. Under the settlement, about $12 million will be earmarked for "direct compensation" to people who bought Taxol between Jan. 1, 1999, and Feb. 28, 2003; more than $37 million will be distributed to 50 states, Puerto Rico and U.S. territories; and $7.6 million worth of Taxol will be distributed to DEA-approved health care facilities (California Healthline, 04/25/03).
Attorneys general from California and other states filed the suit.
Not-for-profit organizations and public agencies are eligible for the grants. The application deadline is April 4 (see Cypresfunds.net web site).
|
|
|
Proposed CMS 1500 claim form available for public comment
The Centers for Medicare & Medicaid Services announced a 30-day comment period on the revised 1500 paper claim form. Following the comment period, the Office of Management & Budget will review the remarks and make a determination for approval or further revision of the form.
The National Uniform Claim Committee (NUCC) modified the paper form to allow use of national provider identifier (NPI) numbers. NPIs must be used on electronic transactions for the Health Insurance Portability and Accountability Act by May 23, 2007. The NUCC has recommended that the industry move to the new 1500 paper form by February 2007. MGMA serves on the NUCC.
Read the Federal Register Comments
|
|
CMS News and Information
• CMS has added gynecological oncologists to the list of physician specialties qualified to participate in the 2006 Oncology Demonstration Project. (CR 4347)
• In a joint effort to improve billing and data quality, the American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS) have joined together in establishing the AHA clearinghouse to handle coding questions on established Healthcare Common Procedure Coding System (HCPCS) usage. (MESSAGE 200602-04)
• Revised article: CMS has provided additional information on the new second level in the administrative appeals process , a “reconsideration.” Reconsiderations will be processed by Qualified Independent Contractors (QICs). (CR 3942)
• April 2006 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing File and Revisions to January 2005, April 2005, July 2005, October 2005, and January 2006 Quarter ASP Medicare Part B Drug Pricing Files. (CR 4319)
• Medicare Remit Easy Print (MREP) software available . (Message 200603-02)
• March is National Kidney month. (CMS Message 200603-07)
• An Important Message for Providers Regarding Medicare Part D from the CMS Administrator, Dr. Mark McClellan:
Prescribers are vital to the well being of their patients and the Centers for Medicare & Medicaid Services is doing everything we can to streamline the new Part D coverage to make it easier for you to help your patients, while not infringing on the scarce clinical time you have with them. The following link will take you to a video that we hope explains what we are doing during the transition to help prescribers and their office staffs smoothe the process of prior authorizations, exceptions and appeals. Go to our provider center at http://www.cms.hhs.gov/center/provider.asp (go to Part D tools) and select the video. There are a number of other useful lists that we have assembled there to help ease the process of helping your patients with their new drug coverage. CMS has a dedicated email for prescriber's questions at PRIT@cms.hhs.gov, as well as a standing teleconference every Tuesday at 2PM by calling 1-800-619-2457 Passcode: RBDML (CMS Message 200603-10)
• NEW! Visit www.cms.hhs.gov/center/provider.asp and scroll down to “Part D Tools for Health Care Professionals” for a comprehensive list of links to agency-wide resources for providers on Medicare Rx coverage. These resources can help providers and office staff access direct phone numbers to a Medicare drug plan's coverage determination staff, as well as obtain model forms that will help speed the process. Additionally, a new fact sheet, as well as other educational products for the FFS community, is now available at www.cms.hhs.gov/medlearn/drugcoverage.asp on the CMS website. (JSM-06312)
NHIC News and Information
|
|
|
|
|
ION Meetings For Physicians Only
September 15 - 17 - GI/Lung Symposium - Westin Copley Place, Boston, MA
October 13 - 15 - National/Business Meeting - Gaylord Texan, Dallas, TX
Contact ION for further details.
Clarifying the Role of Advanced Practitioners in Oncology Practices
You are cordially invited to Clarifying the Role of Advanced Practitioners in Oncology Practices, an audio conference CE program for Nurse Practitioners and Physician Assistants in oncology practices. Read More >>
AstraZeneca Cancer Support Network Educational Seminars
AstraZeneca is pleased to offer you this series of educational programs to increase your understanding
of reimbursement-related changes resulting from the Medicare Modernization Act.
Download the brochure >>
NCCN Clinical Practice Guidelines in Oncology Symposium
The National Comprehensive Cancer Network (NCCN) presents an NCCN Clinical Practice Guidelines in Oncology Symposium on Breast Cancer.
Friday, May 19, 2006 - Sheraton Palo Alto
625 El Camino Real, Palo Alto, CA
Visit http://www.nccn.org for more details.
|
|
ASCO 2005 Breast CA CE Program Materials
| |
|
|
|
|
