Get Informed Now - Medicare Part D Prescription Drug Coverage -

Public Service Announcements (PSAs) for Health Care Professionals:

These PSAs are designed to give health care professionals additional resources should their patients ask about the Medicare prescription drug coverage. Please note that both versions contain the same content; one is a vertical orientation and the other is a horizontal orientation.

• What Do You Say When Asked About New Medicare Prescription Drug Coverage? - Vertical
  ( 261KB)
• What Do You Say When Asked About New Medicare Prescription Drug Coverage? - Horizontal
  ( 1571KB)
  
  

Office of Inspector General Releases Report on Drug Pricing

ASCO reports in the October 13, 2005 Medicare and Quality Care Update:

" The HHS Office of Inspector General has released the results ( 4.05MB) of its survey of the prices that oncologists and hematologists pay for drugs, compared to the Medicare reimbursement amounts. The report presents the survey results in a manner suggesting that the new payment system is working well, stating, "Physician practices...could generally purchase drugs...at less than the MMA-established reimbursement rates." 

However, the OIG data show that for virtually every drug, many physicians paid more than the Medicare reimbursement amount. OIG's conclusion that physicians could "generally" purchase drugs for less than the Medicare reimbursement rate ignores that fact that large numbers of physicians could not.

Indeed, of the 39 drugs surveyed by the OIG, only three could be purchased by all physicians for less than the Medicare reimbursement amount. More than 20% of physicians could not obtain 17 of the 39 drugs without taking an out-of-pocket loss.



ACCC Asserts that OIG’s Conclusions Should Not Overshadow the Need to Enhance Quality Patient Care

The following information is provided by the Association of Community Cancer Centers (ACCC).

In response to a request from the Chairman of the Senate Committee on Finance in August 2005 (see Grassley letter, attached) ( 879KB), the Office of Inspector General (OIG) publicly released its preliminary assessment of the Demonstration of Improved Quality of Care for Cancer Patients Undergoing Chemotherapy (see Levinson letter, attached) ( 306KB ). This demonstration project pays physicians $130 per visit for reporting three measures, including nausea and/or vomiting, pain, and fatigue. The report highlights issues and concerns in several areas, including the costs to the Medicare program, beneficiary liability, the reliability and utility of the data collected, and the perceived disparity between levels of physician reimbursement with the services provided to beneficiaries. Read More >>

ASCO and National Societies Urge Senate and House to Stop Scheduled Cuts
On October 3, ASCO and more than 100 state and national medical societies sent letters ( 168 KB ) to Senate Majority Leader Bill Frist and Speaker of the House Dennis Hastert, urging them to prevent the scheduled 4.4% cut to Medicare payments currently scheduled to go into effect on January 1, 2006, as a result of the sustainable growth rate (SGR) formula. 

According to an American Medical Association survey, these projected cuts would result in the closure of facilities and a substantial reduction in the number of new Medicare patients accepted by physicians.



HR 261 UPDATE
House Resolution 261, which urges CMS to continue the oncology demonstration project in 2006 passed the House on October 6, 2005. We will continue to provide updates on timing and legislative action.

Contact the MOASC office for further details or ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050, or email publicpolicy@asco.org with any questions.

What's New (visit http://www.medicarenhic.com/whats_new/whats_new.shtml)

• CMS has posted a  Hurricanes Katrina and Rita Frequently Asked Questions article regarding Medicare issues. (SE0563)
• CMS has new procedures and specific instructions for voiding, canceling, and deleting claims. As a result of these changes, providers should note that some claims they were able to delete in the past will no longer be deleted from Medicare's systems, but will instead become denied claims. (CR 3627)
• Through the use of the Additional Documentation Request (ADR) , you may be asked for additional documentation regarding a particular Medicare claim. (CR 4022)
• CMS advises that the current ASC payment rates and wage index values remain in effect for FY 2006. (CR 4075)
• The update to the Healthcare Provider Taxonomy Codes (HPTC) Version 5.1 is now available. (CR 4072)
• CMS announces the CMS CMHCB Demonstration project and the associated Care Management Organizations (CMOs') programs for California and Massachusetts. These programs are being implemented under the demonstration project to test whether supplemental care management services can improve quality of care and health results, and reduce unnecessary hospital stays and emergency room visits for Fee-for-Service (FFS) beneficiaries who have one or more chronic diseases. (CR 4100)
• This article provides an overview of the many informational and educational products developed by the Centers for Medicare & Medicaid Services (CMS) to inform and educate physicians, providers, suppliers, and other health care professionals about the array of Medicare-covered preventive services and screenings available. (SE0556)
• CMS has revised the article on the National Provider Identifier (NPI) . (SE0555).
• CMS publishes The Quarterly Provider Update on the first business day of each quarter. It is a listing of all non-regulatory changes to Medicare including Program Memoranda, manual changes, and any other instructions that could affect providers.

• The following Local Coverage Determinations (LCDs) were revised due to ICD-9-CM updates: Cytogenetic Studies; Echocardiography, Transthoracic and Transesophageal; Electrocardiograms; Electrodiagnostic Studies; Erythropoietin Analogs for the Treatment of Anemia Unrelated to Dialysis Therapy; Gonadotropin-Releasing Hormone Analog; Intravenous Immune Globulin (IVIg); Lumbar MRI; and Psychiatric Pharmacology.  They may be accessed on the CMS website: National Heritage Insurance – Northern California – 31140
  National Heritage Insurance – Southern California – 31146
• The Local Coverage Determinations (LCDs) for Independent Diagnostic Testing Facilities (IDTF) has been finalized. It may be accessed on the CMS website: National Heritage Insurance – Northern California – 31140
  National Heritage Insurance – Southern California – 31146
• The lists of Opt-Out Providers have been updated.
• The listings of Health Professional Shortage Areas (HPSA) have been updated.
• The Questions & Answers from the Medicare Secondary Payer (MSP) ACT has been posted.
• The minutes from the September Medicare Advisory Forum have been posted.
• The CERT Newsletters for August and September have been posted.
• The Learning Network page has been updated.
• The ASC rates for 2006 have been posted. There are no changes from 2005.

MM4086 - 2006 Annual Update of Healthcare Common Procedure Coding System (HCPCS) Codes for Skilled Nursing Facility (SNF) Consolidated Billing (CB)
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4086.pdf

MM3942 - MMA - Changes to Chapter 29 - Appeals of Claims Decisions: Redeterminations and Reconsiderations (Implementation Date May 1, 2005)
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3942.pdf

MM4019 - MMA – Changes to Chapter 29 – General Appeals Process in Initial Determinations
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM4019.pdf

MM3311 - Override of Medicare System Edit for Observation Services Exceeding 48 Hours
Rescinded

MM3562 - Modification to Reporting of Diagnosis Codes for Screening Mammography Claims
Revised: 10/11/2005
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3562.pdf

MM3949 - MMA - Billing and Claims Processing Instructions for Claims Subject to Expedited Determinations Revised: 10/7/2005
http://www.cms.hhs.gov/medlearn/matters/mmarticles/2005/MM3949.pdf