Medical Assistant with oncology experience relocating to Orange County. Phleb. certified. Able to administer growth factors. Trained in operating Cell-Dyne hem alalyzer and ACE chemisrt analyzer. Assists with bone marrows. Contact Robin @RobinOCN@aol.com or call 760-568-3613.
The MOASC office is in receipt of a resumé from an individual seeking an Oncology Billing Supervisor position that has over 10 years experience in the oncology field. Employment in the Orange County area would be preferred.
If interested, please call the MOASC office for further details. (909) 985-9061
Meeting materials are available for MOASC members from our November 9, 2004 Medicare Update with Kim Rowe, Medicare NHIC, and Marty Neltner, Neltner Billing and Consulting.
To assist members in understanding Medicare's recent announcements regarding changes to coding for drug administration services and reporting requirements for the new cancer care demonstration project, ASCO has compiled an extensive set of Frequently Asked Questions.
Read the preliminary comments submitted by COA to CMS on this rule. It includes a detailed analysis (recommendations, concerns, and questions) conducted by the COA Cancer Care Comprehensive Coding Task Force.
- Medicare has adopted a new series of drug administration codes for use in 2005.The net effect of the codes is to increase payments for drug administration services above what they would otherwise have been, although the payment amounts will generally be lower than they are in 2004 because the transitional add-on amount will be reduced from 32% to 3%.
- Medicare has adopted a program that will pay physicians $130 per patient per day if the patient receives chemotherapy by intravenous push or infusion and the Medicare claim form provides information about the patient’s nausea/vomiting, pain, and fatigue. This is a one-year demonstration program in effect in 2005.
- In a change from current policy, Medicare will permit billing for an injection on the same day that another service is furnished.
- The revised system of paying for drugs based on 106% of the manufacturer’s average sales price (ASP) will go into effect in 2005.
- If utilization of drugs and services is assumed to be unchanged, Medicare revenue to oncologists will decline by about $200 million from 2004 to 2005.This compares to the estimated $500 million decline that would have resulted from the original proposal.
- ASCO believes that the changes should be evaluated by considering the effect on the funds available to support chemotherapy – drug margins plus payments for drug administration services. On that basis, and assuming no change in utilization of drugs and services, available Medicare funds to support chemotherapy will decline by about 30% from 2004 to 2005.This compares to the estimated 50% decline that would have occurred under the original proposal.
- Based on historical experience, CMS assumes that there will be an increase in utilization of drugs and services. On that basis, CMS estimates that Medicare payments to oncologists will actually increase 8% from 2004 to 2005.
- ASCO has prepared a summary of the new codes for 2005 and the associated payment amounts, together with a cross-walk to the 2004 codes.CMS stated that it will provide further clarifications about use of the codes before they go into effect.
- The new codes distinguish between the “initial” infusion or other type of drug administration and a sequential administration of the same type.Only one “initial” service may be billed during each patient encounter.Where there are multiple types of administrations in the same encounter (e.g., both chemotherapy infusions and non-chemotherapy infusions), an issue is whether the “initial” service must always be the service that was performed first.CMS states that the “initial” code should be used for the action “that best describes the service . . . irrespective of the order in which the infusions occur.”
- In 2005, Medicare will pay physicians who furnish chemotherapy in the office an additional $130 per patient for every day on which chemotherapy is furnished by intravenous push or infusion. To earn the extra payment, the physician would be required to assess the patient's status with respect to nausea/vomiting, pain, and fatigue and to report those assessments through a new series of billing codes that will supplement the normal billing codes.
- Patients will be assessed with respect to each of the factors on a four-point scale – “not at all,” “a little,” “quite a bit,” or “very much.”Each level corresponds to a new G-code, and therefore three new G-codes will be included on the Medicare claim form to report the patient’s status on each of the three factors.ASCO will provide more information about the demonstration project payment as it becomes available.
- ASCO has prepared a table showing the estimated Medicare payment rate of drugs in the first quarter of 2005 compared to the current payment rate.These estimated payment rates are based on ASP data submitted by manufacturers for the second quarter of 2004, whereas the actual payment rates for the first quarter of 2005 will be based on ASP data for the third quarter of 2004.The actual payment rates for the first quarter of 2005 will probably not be available from CMS until early December.The payment rates will change each calendar quarter based on the ASP information submitted by manufacturers for the second previous quarter.
The 2005 Medicare NHIC Fee schedule is now posted on the NHIC website. Access your geographic location via the link below. Drugs and biologicals are not listed, that fee schedule should come out sometime in December 2004. The 2005 Physician Fee Schedule and Participation Enrollment on CD has been mailed to active physicians. The fees and enrollment information are also posted on the Fee Schedule pages of the website. http://www.medicarenhic.com/cal_prov/fee_sched.shtml
The Office of Inspector General (OIG) recently performed an audit on place of service coding for physician services. The objective of this audit was to determine the extent of Medicare Part B overpayments made to physicians for billings with incorrect place of service codes. Seventy-nine of 100 sampled physician services were performed in a facility, but were inappropriately billed by a physician using the incorrect "office" place of service code.
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. The attached form is required, or a similar document containing the following information, to accompany every unsolicited/voluntary refund so that receipt of check is properly recorded and applied.
The instructions for completing the 1500 CMS Claim Form has been updated.
CMS has issued an article informing providers that Medicare will implement the
payment limit for Amifostine (HCPCS drug code J0207). (CR 3552)
