What You Need To Know For 2006

The conversion factor for CY2006 is $36.1770, which is 4.4 percent lower than the CY2005 conversion factor of $37.8975. Calculated by the Office of the Actuary, the conversion factor is updated annually for inflation. The conversion factor is the multiplier that converts payment to dollar amounts. Because the conversion factors changes yearly to keep within the overall Medicare budget, it directly affects our bottom line.

There is an additional $69 payment for IVIG. In 2006, CMS created a temporary add-on payment to cover the additional pre-administration related services required to locate and acquire adequate IVIG products and prepare for the infusion. This code was established because inconsistent availability and the multiple varieties of available IVIG have made it very difficult for physicians to obtain the product or a specific brand of product for patients. CMS found that many of the IVIG products previously available in 2005 have been discontinued and are being replaced by new products.

Starting Jan. 1, practices should bill the temporary G-code G0332 (pre-administration related services for intravenous infusion of immunoglobin, per infusion encounter) in conjunction with administration of immunoglobin. This G-code can only be billed once per day in association with patient administration. The G-code is also used in the hospital outpatient setting.

Effective Jan. 1,  inpatient consult codes 99261 through 99263 and confirmatory consult codes 99271 through 99275 were deleted. The office/outpatient consults 99241 through 99245 and initial inpatient consults 99251 through 99255 have remained the same. The initial inpatient consult code should be use once per admission. Follow-up visits should be reported using 99231 through 99233.

There are 33 codes for administration 2006. Two new codes have been added that did not have temporary or CPT codes assigned last year: 90779 (unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion) and 96423. (96423 is an add-on code for chemotherapy administration, intra-arterial; infusion technique, each additional hour up to 8 hour. List 96423 separately in addition to code for primary procedure.) Remember that preparation, starting of the infusion, discontinuing of the infusion, and any related flushing of devices along with supplies used are included in the service payment provided and are not reported separately.

Prospective Competitive Acquisition Program Vendor Bidding Question and Answer Session

On December 1, 2005, the Centers for Medicare & Medicaid Services (CMS) held a call to address questions from prospective vendors of the Competitive Acquisition Program (CAP).  There were 185 callers seeking clarification of details about the program.  The attached reimbursement update provides highlights of the CMS Special Open Door Forum.

For additional information about this update, the CAP program, or other reimbursement matters, please contact Lash Group at (800) 357-5274 ( Charlotte), (800) 788-9637 ( San Francisco), or (202) 775-0135 ( Washington, D.C.).

ASCO's Advocacy Efforts Continue

ASCO continues to work with patient advocacy groups, Members of Congress and CMS to advance quality cancer care. Some of these priorities include:

• Refine the definition of Average Sales Price: ASCO will be working with key legislators and CMS to refine the definition of ASP to more accurately reflect practitioners' costs, including removal of "prompt-pay discounts" from the calculation. 
  
  
• Coding Initiatives:  ASCO will continue to pursue new CPT codes for treatment planning and supportive care services.  In addition, we will soon have the results of the support services survey of practices, which will provide critical data on the need for additional payments for these services.
  
  
• Guideline Development:  ASCO will continue developing companion materials for new or updated guidelines in order to facilitate the dissemination of guideline recommendations.
  
  
• Cancer Quality Alliance: ASCO and the National Coalition for Cancer Survivorship formed the Cancer Quality Alliance in October 2005. The Alliance will foster collaboration among stakeholders who are committed to cancer care quality improvement and seek to eliminate unnecessary duplication in cancer care quality efforts. By encouraging practical programs to improve quality of care, the Alliance seeks to become a national voice for quality of cancer care.  

Announcements

• The Medicare Contractor Provider Satisfaction Survey (MCPSS) begins January 1, 2006. Additional information is available on the CMS website at www.cms.hhs.gov/providers/mcpss or on the Westat website at www.mcpsstudy.org

What's New visit http://www.medicarenhic.com/whats_new/whats_new.shtml
CA Updates visit http://www.medicarenhic.com/cal_prov/updates.shtml

• CMS will no longer accept the Surrogate UPIN OTH000 to identify the ordering or referring physicians on claims submitted by billers, suppliers, physicians, and non-physician practitioners, effective for dates of service April 1, 2006, and later. (CR 4177)
  
• CMS has revised the article on Stage 2 requirements for use and editing of National Provider Identifier (NPI) numbers , in order to clarify the end date of the transition period. (CR 4023)
  
• CMS is pleased to announce the availability of the online flash demonstration of the redesigned cms.hhs.gov website.  You can find the link to the flash demonstration at http://www.cms.hhs.gov under the "spotlight" tab.  This is an excellent tool for making yourself familiar with the changes to the website before it goes live on Thursday, December 15.

• The Newsletter Index for the Medicare B Resource has been updated.
  
• A new educational article on Referring/Ordering Physician Name and UPIN has been added.