Meeting Handouts Available

The December 1st, 2005 Administrator Manager symposium at The Mission Inn in Riverside was an excellent meeting. We want to thank our presenters Marianne Diana of NHIC Medicare, and Marty Neltner of Neltner Billing and Consulting for their informative presentations.
Handouts from Marty's presentations are currently available here in Powerpoint form :
• Value Based Purchasing
• Medicare Part D
• Medicare 2006 Coding Update

(.pdf form available soon)

2006 CPT Codes Published

The 2006 CPT codes for drug administration have been published.  ASCO has developed a cross-reference sheet between the 2006 CPT codes, Medicare's 2005 G-codes, and the 2005 CPT codes for drug administration.

Update on V58 code changes

Effective October 1, ICD-9-CM encounter code V58.1 was expanded. Code V58.1 was revised and is now defined as an encounter for antineoplastic chemotherapy and immunotherapy. V58.11 should be used for an encounter for antineoplastic chemotherapy, and V58.12 should be used to report an encounter for antineoplastic immunotherapy. There is no longer a grace period to use the old codes so practices should ensure that the new codes are being reported. 

Demonstration Project 2006

Last week, the Centers for Medicare & Medicaid Services (CMS) released the new G-codes established for the 2006 Oncology Demonstration Program. CMS’s Oncology Demonstration Project for 2006 will be different from the 2005 Project. The 2006 Project will be available to office-based hematologists/oncologists and will be tied to office visits. An additional payment of $23 will be available for established patient, Levels 2-5 office visits if patients have one of 13 specific cancer diagnoses and physicians submit three G-codes related to the focus of the visit, the status of the disease, and the physician’s adherence to treatment guidelines. CMS is still preparing instructions for the Project.

• ASCO has developed an easy-to-read listing of the demonstration codes.
• The complete 2006 HCPCS coding update as posted by CMS.
• ASCO has developed a spreadsheet to help you determine the impact of the demonstration on your practice.
• ASCO’s clinical practice guidelines and technology assessments can be accessed at www.asco.org/guidelines, and NCCN’s guidelines can be accessed at www.nccn.org.



ASCO Reports on Medicare Cuts and Demonstration Project

CMS released the 2006 Medicare fee schedule earlier this month, which outlines the new oncology demonstration project for 2006. While the extension of the demonstration project into 2006 is a positive step given that it was set to expire, the fee schedule does include a 4.4% cut to all physicians due to the Medicare physician payment formula (sustainable growth rate, or SGR).

ASCO is seeking clarification of several aspects of the 2006 Project from CMS and will prepare practice tools once these clarifications are received. A spreadsheet is already available to analyze the economic impact of the 2006 Project versus the 2005 Project. The 2006 oncology demonstration project will assess the extent to which practices adhere to quality evidence-based practice guidelines for patient care. ASCO has prepared a crosswalk from 2005’s G-codes to the 2006 CPT codes for drug administration. An updated FAQ document is also being prepared. Finally, ASCO is working on making its clinical guidelines more easily accessible. These (and other) resources are available at www.asco.org/mma (under MMA Regulation& Resources).

Medicare Part D Fact Sheet

ASCO has written a fact sheet with basic information about the program and will be providing additional resources in the coming weeks.

CMA Provides Medicare Prescription Drug Coverage Information for Physicians and Patients

"What Physicians (and Patients) Need to Know About the Medicare Prescription Drug Program"
The California Medical Association (CMA) has developed this physician guide to help you understand the new program and to answer your patients’ questions about Medicare’s prescription drug benefit. This information is also available in CMA's Medicare Prescription Drug Program Brochure. Please feel free to download this brochure and make copies for your patients. Read More >>

CMS/ What's New  ---  http://www.medicarenhic.com/whats_new/whats_new.shtml

NHIC/CA Updates  ---  http://www.medicarenhic.com/cal_prov/updates.shtml

EDI  Updates  ---  http://www.medicarenhic.com/edi/updates.shtml

• CMS has posted information on the update to Medicare deductible, coinsurance, and premium rates for 2006. (CR 4132)
  
• CMS has posted the 2006 quarterly average sales price (ASP) Medicare Part B drug pricing file, effective January 1, 2006. (CR 4140)
  
• This article clarifies and corrects the definition of "new patient" and "physician" for billing evaluation and management (E/M) services and updates the policy on billing E/M services with drug administration codes. (CR 4032)
  
• Note that the quarterly update to Correct Coding Initiative (CCI) edits, Version 12.0, will be effective on January 1, 2006. (CR 4168)
  
• The remittance advice remark code and claim adjustment reason code list has been updated. (CR 4123)
  
• CMS clarifies recent changes made to the "Medicare Secondary Payer Questionnaire." (CR 4098)
  
• CMS has revised the article on the 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)
  
• This CMS article is being provided to keep physicians and healthcare professionals informed about important Medicare initiatives and additional new Medicare benefits available in Calendar Year (CY) 2006. (SE0453)
  
• This is a Reminder - Beneficiary Enrollment for Medicare Rx Coverage Begins November 15. Beginning January 1, 2006, Medicare prescription drug coverage will be available to people with Medicare. Health care professionals can find information about this new coverage at www.cms.hhs.gov/medlearn/drugcoverage.asp , on the CMS website. (JSM 05541)
  
• CMS's Provider Communications Group presents the Medicare Remit Easy Print (MREP) software brochure. This two-sided tri-fold brochure is now available for download at http://www.cms.hhs.gov/medlearn/remit_easy_print.pdf on the Medlearn website. MREP software allows professional providers (including physicians, suppliers, and qualified non-physician practitioners) to view and print the Health Insurance Portability and Accountability Act (HIPAA) compliant 835, in the Standard Paper Remittance Advice format, from their own computers! Benefits of MREP software include its search capabilities and great reporting features. Best of all, MREP software is free!
  
• The Flu Bulletin has been posted.
  
• The Clinical Lab Fee Schedule has been posted.
  
• CMS's Provider Communications Group presents the Medicare Remit Easy Print (MREP) software brochure. This two-sided tri-fold brochure is now available for download at http://www.cms.hhs.gov/medlearn/remit_easy_print.pdf on the Medlearn website. MREP software allows professional providers (including physicians, suppliers, and qualified non-physician practitioners) to view and print the Health Insurance Portability and Accountability Act (HIPAA) compliant 835, in the Standard Paper Remittance Advice format, from their own computers! Benefits of MREP software include its search capabilities and great reporting features. Best of all, MREP software is free!
  
• CMS has posted the 2006 annual update for Clinical Laboratory fee schedule and laboratory services subject to reasonable charge payment. (CR 4144)
  
• Information on payment allowances for the Influenza Virus Vaccine (CPT 90655, 90656, 90657, and 90658) and the Pneumococcal Vaccine (CPT 90732). (CR 4109)
  
• CMS has posted information on filing initial claims electronically when subjected to prepayment medical review . (CR 4052)
  
• CMS has revised the article on the 2006 quarterly average sales price (ASP) Medicare Part B drug pricing file, effective January 1, 2006. (CR 4140)
  
• Article about change in the amount in controversy requirements for Administrative Law Judge (ALJ) and Federal District Court Appeals. (JSM06034)
  
• The following files have been posted to the Fee Schedule page : ASC Listing of Codes, ASC Changes - Adds/Deletes, Clinical Laboratory Travel- P9603 and P9604, Pricing Equivalency for Automated Tests, List of Deleted HCPCS Codes for 2006 MPFSDB, Fee Schedule for Splints & Casts and CSV files to download for the Physician Fee Schedule.
  
• Two articles on issues that providers should be aware are now available:
  
  Do You Know an Identity Thief?
  
  Part-Time Physician Involvement in Diagnostic Clinics
  
  
• The Questions and Answers from the ACT on Billing Tips have been posted.
  
• CMS has released an article to notify Medicare contractors and Medicare providers about the upcoming transition to the new second level of the appeals process , the appeals of claims decisions: redeterminations and reconsiderations and appeals rights for dismissals. (CR 3939)
  
• Medicare providers who appeal claims decisions made by Medicare carriers and fiscal intermediaries need to be aware of the new appeals processes. (CR 3944)
  
• CMS has announced the changes to the Laboratory National Coverage Determination (NCD ) edit software for January 2006. (CR 4161)
  
• CMS has revised the article on filing initial claims electronically when subjected to prepayment medical review . (CR 4052)
  
• CMS has revised the article on the claim appeals process   that was amended by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA). (CR 4019)
  
• CMS has revised the article on Stage 2 requirements for use and editing of National Provider Identifier (NPI) numbers . (CR 4023)
  
• CMS has published an article to alert providers about influenza resources that are available to them and their patients. While some of these resources are not CMS-sponsored websites or products, they are respected informational sites and products sponsored by health care professionals. (SE0580)
  
• CMS has revised the article containing information on Medicare prescription drug coverage as it applies to nursing home residents .(SE0575)
  
• Due to an overwhelming response of registrations for the December 6th call, the Provider Communications Group will host a second toll free provider training conference call with Q&A session, about the CCI Edits as they will apply to outpatient providers that furnish rehabilitation services, effective January 1, 2006.  The conference call is scheduled for Thursday, December 15, 2005, 2:00 pm to 4:00 pm. The training will include a presentation on basic CCI concepts and structure, as well as, its application to rehabilitation therapy services. After the training presentation, providers will have an opportunity to ask questions of CMS staff regarding the CCI Edits as they apply to Therapy Providers.  It is important that all participants register for the conference call.
  
• NHIC's Local Coverage Determination for "Independent Diagnostic Testing Facilities (IDTF)" became effective November 28, 2005. To access this LCD please go to CMS website and scroll down to the appropriate policy.
  
  National Heritage Insurance - Northern California - 31140
  
  National Heritage Insurance - Southern California - 31146
  
  
• The CERT Newsletter for November been posted.

Here is the recent package insert reading of the new indication with Aromasin:

"Aromasin is indicated for adjuvant treatment of postmenopausal  women with estrogen-receptor positive early breast cancer who have received two to three years of tamoxifen and are switched to AROMASIN for completion of a total of five consecutive years of adjuvant hormonal therapy".