Posted: August 24, 2004

ASCO Data Collection - Immediate Attention Required
In recent weeks you have been asked to respond to various data collection efforts ASCO has undertaken to better understand the impact of Medicare's new payment policies.  We realize your time is limited and resources stretched-but this information is vital to making our case with Congress and CMS. 

1.   Collection of practice information about drug prices and impact of the new Medicare payment amounts.  These kinds of data will be the only information CMS and Congress will have on the effect of Medicare reductions in payment for chemotherapy drugs and services.  The policy cannot be addressed without knowing how and why it does not work.  Our goal is to have 200 completed spreadsheets we can share with CMS.  We have 40. 

2.   Survey to evaluate physician time/resources for new CPT codes.  We have previously reported that the AMA's Relative Value Update Committee (RUC) is evaluating new codes for chemotherapy administration.  Establishment of these codes will, in part, correct the longstanding underpayment of patient services necessary for chemotherapy.  But these codes will not happen without your help.  If you are asked to participate in this effort, please respond.

ASCO RUC Survey on Drug Infusion Codes
New codes or revisions that are approved by the CPT Editorial Panel will be referred to the AMA/Specialty Society Relative Value Scale Update Committee (RUC) for assessment of the physician work involved with providing the procedure in question.  This is where ASCO needs your help. Your commitment in completing 10 surveys (one survey per code) is requested.  If you commit to completing these surveys, you will be asked to assess the physician work as defined by physician time, physician mental effort and judgment, and physician technical effort involved with the procedure or service.  Because these surveys request specific input on physician effort, they must be completed by a physician.  We estimate that each survey will take approximately 10 minutes to complete.  All surveys will be conducted electronically through an online software program; we anticipate sending the surveys out during the last week of August. View the PowerPoint presentation which provides additional information about the CPT and RUC processes for the drug administration codes for more expansive context for our request.

DHS/Medi-Cal Clinical Lab Provider Number
Previously, DHS/MediCal has accepted CLIA certification, and the tests have been billed under the Physician provider number, coupled with the E&M visit.

Effective September 1st, the POL must apply for a separate clinical laboratory provider number, the Physician must be certified as the Lab Director, and all testing staff must be independently credentialed. Additionally, the POL may be subject to regulatory inspection over and above CLIA.

The DHS/Medi-Cal application form is 30 pages long.

CMA Cost Survey Deadline Approaching
Just a reminder that the deadline for physicians to participate in CMA’s 2004 Cost Survey is less than two weeks away (Tuesday, August 31st is the last day to submit survey responses). Physicians who have not yet participated can do so online at http://www.calphys.org/html/bb609.asp. 

Cigna Claims Settlement Filing Options Opens August 23, 2004
Virtually all physicians are entitled to damages under the class-action settlement regardless of whether they treated CIGNA patients or not. The class includes all physicians who provided covered services between August 4, 1990 and September 5, 2003 to any patient covered by any of the defendants in this case—CIGNA, Aetna, Anthem, Coventry, HealthNet, Humana, PacifiCare, Prudential, United Healthcare, and WellPoint. CMA has reached an agreement with a company to provide claims analysis and filing assistance to CMA members at a significant discount. The company—the Managed Care Advisory Group (MCAG)—uses computer analysis to identify all eligible claims and streamline the claims submission process for physicians.

Visit http://www.calphys.org/html/bb654.asp for complete details.

ASCO Releases Colon Cancer Guidelines
The American Society of Clinical Oncology (ASCO) has developed a set of recommendations to address whether patients who have had successful surgery for Stage II colon cancer should be offered adjuvant chemotherapy in routine clinical practice.

The guideline, published in the August 15 issue of the Journal of Clinical Oncology, states that the routine use of adjuvant chemotherapy for medically fit, average-risk patients with Stage II colon cancer is not recommended. Clinical trials have not established with certainty a significant degree of clinical benefit for adjuvant chemotherapy in patients with Stage II colon cancer, although most trials show a small benefit from adjuvant chemotherapy.

NHIC/Medicare 2005 Participation Enrollment & Fee Schedule
In November 2004, National Heritage Insurance Company (NHIC), the Part B contractor for California, Maine, Massachusetts, New Hampshire, and Vermont, will once again prepare and send the 2005 Medicare Participation Enrollment and Fee Schedule information on CD format.  No internet access is required to access the CD information.

Making Voluntary Refunds to Medicare
If you discover that an overpayment of Medicare funds has occurred, you are expected to notify the program and take appropriate actions to remedy the situation. National Heritage Insurance Company (NHIC) would like to emphasize the importance of submitting voluntary refunds with proper information to ensure that the refund is processed accurately and on a timely basis.

Beneficiary Signature Requirements
Beneficiary signatures are required on submitted claims in item 12 of the CMS-1500 claim form. The beneficiary may sign a statement or authorization form to be retained in the provider’s file indefinitely, unless revoked by the patient. The provider can then submit “signature on file” or a computer generated signature in item 12.

CMS Quarterly Fee Schedule - DME, Prosthetics, orthotics and Supplies
CMS has released information for updating and implementing the October Quarterly 2004 fee schedule amounts for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS).(CR 3377)

CMS Covers 2 New Drugs for the Medicare Drug Replacement Program
CMS announced that it is adding two more drugs to the list of drugs covered under a Medicare demonstration program providing substantial savings to beneficiaries with serious diseases, including cancer, multiple sclerosis, and rheumatoid arthritis.(SE0443)

CMS NCDs Reponses
CMS has issued responses to commonly asked questions regarding the negotiated laboratory NCDs and the edit module used to implement the NCDs uniformly. (CR 3374)