MOASC in collaboration with AZTRAZENECA is presenting 3 Dinner Meetings for Administrator Managements/Nurses

MOASC’s Dinner Series presented by The LASH Group
Discussions regarding Medicare reimbursement and its impact on your practice, CAP, Pay for Performance, Medicare contractor reform, Patient-specific Part-D scenario analysis. 

Tuesday, June 27, 2006 6-8pm Morton’s, Burbank
Thursday, June 29, 2006 6-8pm Fairmont Hotel, Newport Beach
Thursday, July 6, 6-8pm Mission Inn, Riverside

This series is made possible by a grant from AstraZeneca, a MOASC sponsor.

If you have any questions please call 1-800-310-3553

Medicare Mass Adjustment for Procrit/Aranesp Denials

On May 8th, MOASC & ANCO were informed by NHIC/Medicare that claims updates to the EPO LCD led to inappropriate edits and denials for claims of EPO (e.g., Aranesp and Procrit). According to NHIC/Medicare, the claims processing system had been corrected and claims received on or after May 5th would process correctly. Mass adjustments to the incorrectly denied claims would be made the week of May 15th. 

Medicare NHIC's Payment Policy for 90767 and 90772

Following is NHIC’s response to previous inquiries regarding the use and payment of 90767 and 90772:

The Medical Review staff considered the information provided from ASCO, and as determined that both codes can be paid at multiple units.  As I previously communicated, procedure 90772 was corrected on April 6, 2006.  With the additional information available, code 90767 was corrected on April 18, 2006.

Providers may call Customer Service at 877-527-6613 for correction of any claims reduced as a result of the edit.  The Representatives will let you know if there were other issues on any individual claims that would require a written request for adjustment.

Providers may call Customer Service at (877) 527-6613 for correction of any claims reduced as a result of the edit. Representatives will let providers know if there were other issues on any individual claims that would require a written request for adjustment. 

National Oncologic PET Registry (NOPR)

The National Oncologic PET Registry (NOPR) was developed in response to CMS's expanded coverage of FDG-PET scans. Medicare will cover FDG-PET scans when providers are participating in and patients are enrolled in an approved FDG-PET clinical trial. Providers will be required to submit patient and clinical data to the NOPR. Data will be reviewed and assessed to make ongoing coverage determinations regarding PET scans.

The National Oncologic PET Registry (NOPR) will open for patient data on May 8th. Visit www.cancerpetregistry.org for full details. CMS will pay for previously non-covered PET scans listed on the NOPR. ASCO plans a national audioconference on NOPR later in May.

NHIC Medicare Educational Articles - Important Reads

Two new educational articles have been posted:

-- Darbepoetin Alfa (Aranesp) and Epoetin Alfa (Epogen, EPO)

-- Revised ESRD Billing and Modifier 25

-- Focus on...Medical Necessity Denials - National Coverage Determination (NCD) for Clinical Labs

-- Top Four Improper/Illegible Claim Submissions

-- Reporting of Diagnosis Code V06.6 on Influenza Virus and/or Pneumococcal Pneumonia Virus (PPV) Vaccine Claims.

Section 1011: Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens – An Update

Physicians, hospitals and ambulance services that provide emergency health services to undocumented aliens should be aware that The Medicare Prescription Drug Improvement and Modernization Act (MMA) (Section 1011) provides $250 million each year, for Fiscal Years (FY) 2005-2008, for payments to eligible providers for emergency health services given to undocumented and other specified aliens. You may not be receiving funds that are available to you for services you furnish to undocumented aliens. We have prepared a Special Edition article to inform and/or remind you aboutthese available funds. Please click on the following url for more details:

http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0633.pdf

Medicare to Hold Payments

A brief hold will be placed on Medicare payments for ALL claims (e.g., initial claims, adjustment claims, and Medicare Secondary Payer (MSP) claims) for the last 9 days of the Federal fiscal year, i.e., September 22, 2006- September 30, 2006. (CR 5047)

Chemotherapy Consent Form

The Cancer Institute of New Jersey is pleased to announce the development of a "chemotherapy consent form" that is available for your use on the CINJ web site (www.cinj.org). You may wish to utilize this form in your practice as it provides patients with information of all risks and benefits associated with the procedures.

Are you seeing this? The link is to an article from Medical Economics

*** Blending: The new downcoding *** http://www.memag.com/memag/content/contentDetail.jsp?id=322627

This Ohio Blue Cross/Blue Shield plan makes the same payment for level 3 and level 4 visits. Is it the start of a trend?

Please let us (MOASC) know of your experience, as we are arranging a meeting with Blue Cross and Blue Shield. Thank you for your response.

The Schwarzenegger administration released its revised 2006-2007 budget proposal. The $131.1-billion spending proposal released on Friday includes substantial funding for statewide disaster and pandemic preparedness. The budget proposal also allocates funds to increase enrollment in county-based children’s health care initiatives.

Although the state’s fiscal outlook is positive, the budget does not include a long-overdue rate increase for fee-for-service Medi-Cal providers.

Two Cancer Bills Introduced in the House this Week

We wanted to make you aware of two bills introduced in the past week in the House of Representatives that aim to improve the quality of care for cancer patients on Medicare.

Comprehensive Cancer Care Improvement Act of 2006
On Wednesday, Reps. Lois Capps (D-CA) and Tom Davis (R-VA) introduced HR 5465, the "Comprehensive Cancer Care Improvement Act of 2006," to reform the Medicare system so it more appropriately pays for all of the services needed to provide patients with comprehensive cancer care.

Medicare Early Detection of Cancer Promotion Act of 2006
HR 5437, the "Medicare Early Detection of Cancer Promotion Act of 2006," introduced May 19 by Rep. Clay Shaw (R-FL), would eliminate coinsurance payments for mammograms and colorectal screenings in Medicare.

Read more on these new bills >>

"Revision of Payment Methodology for Drugs and Biologicals." H.R. 5179

Rep. Hall introduced H.R. 5179, "Revision of Payment Methodology for Drugs and Biologicals." H.R. 5179 would give Medicare the authority to adjust drug prices when a significant number of practices cannot purchase drugs at the current payment rate, 106% of ASP. Medicare currently does not have this authority. The bill also would remove the prompt pay discounts offered to distributors and wholesalers from the ASP formula to better reflect the market prices available to physicians. 

ASCO thanks Rep. Hall for his continuing commitment to quality cancer care and for his leadership on H.R. 5179. ASCO urges others in the cancer community who share the vision for sustainable long-term solutions to support the efforts of Rep. Hall. Please contact your Member of Congress to ask him or her to co-sponsor H.R. 5179. You can find the contact information for your Representative at http://capwiz.com/asco.

CAP Links and Information

The Competitive Acquisition Program (CAP) announced that BioScrip is the sole national vendor for the CAP program.

The Physician Election Period for the Medicare Part B Drug CAP will begin on May 8, 2006 and conclude on June 2, 2006. The CAP is a voluntary program that offers physicians the option to acquire many drugs they use in their practice from an approved CAP vendor, thus reducing the time they spend buying and billing for drugs.

Additional information about the CAP is available at the following website: http://www.cms.hhs.gov/CompetitiveAcquisforBios/01_overview.asp#TopOfPage .

Additional information for physicians, including the physician election form is at http://www.cms.hhs.gov/CompetitiveAcquisforBios/02_infophys.asp#TopOfPage .

The list of drugs supplied by the CAP vendor, including NDCs, is in the Downloads section at http://www.cms.hhs.gov/CompetitiveAcquisforBios/15_Approved_Vendor.asp#TopOfPage .

Please note that completed and signed physician election forms should be returned by mail to your local carrier. Forms must be postmarked on or before June 2, 2006

More Articles:

SE0634 - Facilitating Your Medicare Enrollment
http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0634.pdf

MM4404 - MMA - Competitive Acquisition Program (CAP) for Part B Drugs Physician
Election
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4404.pdf

MM4064 - MMA - Competitive Acquisition Program (CAP) for Part B Drugs - Coding,
Testing, and Implementation
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4064.pdf

MM4309 - MMA - Additional Requirements for the Competitive Acquisition Program
(CAP) for Part B Drugs and Biologicals
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM4309.pdf

Genentech Donate $21 Million for Patient Assistance Programs

Genentech, Inc. announced that it recently donated more than $21 million to various, independent, non-profit public charities that will provide financial assistance to eligible patients who cannot access the treatment they need due to out-of pocket costs. The donations will support patients with a number of diseases, regardless of the therapy they are receiving. Read More >>

Single Point of Contact

Single Point of Contact (SPOC) provides reimbursement information and assistance for patients so that they can focus on treatment. Patients and their caregivers should contact SPOC if they are experiencing difficulties with access to Genentech's products for financial reasons. Read More >>