Journal of Oncology Practice, Vol 1, No 1 (May), 2005: pp. 23-25
© 2005
American Society of Clinical Oncology.
DOI: 10.1200/JOP.1.1.23
Navigating Change with Oncology Resources
 |
Abstract
|
|---|
This column is intended to provide oncology practitioners and their staff with important information about reimbursement, coding, coverage, and regulatory policies. Topic suggestions or questions for future issues should be sent to practice{at}asco.org.
The oncology community has been busy this year implementing a vast array of changes resulting from the Medicare Modernization Act (MMA). Reimbursement and coverage policies changed, new codes were implemented, and demonstration projects were introduced. Oncology practices in all settings, office-based and hospital-based, have already felt the impact of these changes. In this environment, it is essential that practitioners and their staff know where to find accurate, timely information. A list of important resources follows. See Table 1 for a listing of all CMS and ASCO Resources.
|
Centers for Medicare & Medicaid Services (CMS)
|
|---|
The Centers for Medicare & Medicaid Services (CMS) is the government agency that administers the Medicare and Medicaid programs. The CMS Web site (www.cms.hhs.gov) includes detailed information on every facet of these programs. This site should be your first stop when looking for general information about the Medicare program and its reimbursement and coverage policies. Some of the most useful pages for oncology practices follow.
Physician Information Resource for Medicare www.cms.hhs.gov/physicians/
CMS designed the Physician Information Resource page to provide links to the most relevant information for physicians, both office-based and hospital-based. Some of the topics on this page include provider enrollment and participation, coding, billing, and coverage. From this page you can get to all of the pages described below.
Medicare Physician Fee Schedule Lookup www.cms.hhs.gov/physicians/mpfsapp/default.asp
This page provides information on services covered by the Medicare Physician Fee Schedule including payment amounts and relative value units. Current Procedural Terminology and Healthcare Common Procedure Codes can be entered individually and viewed by payment locality. This resource is particularly helpful for verifying CMS payment amounts for individual codes and for comparing CMS payments to other payers on a code-by-code basis.
Medicare Drug Web Page www.cms.hhs.gov/providers/drugs/default.asp
The Medicare Drug Web Page provides Part B drug pricing files, drug payment methodology information, program transmittals, and program memoranda specific to drug payments. For information about the implementation of the average sales price (ASP) + 6 methodology and current ASP payment amounts go to http://www.cms.hhs.gov/providers/drugs/asp.asp. Information about the Competitive Acquisition Program planned for 2006 is located at http://www.cms.hhs.gov/providers/drugs/compbid/default.asp. Information about the Replacement Drug Demonstration Project can be found at http://www.cms.hhs.gov/researchers/demos/drugcoveragedemo.asp.
Medlearn Matters www.cms.hhs.gov/medlearn/matters
Medlearn Matters articles are designed to help providers understand Medicare policy. These articles provide education on a wide spectrum of important issues for healthcare providers including hospital outpatient departments and physician practices. This site includes a searchable database of articles and can be searched by title, article release date, or policy implementation date.
Join CMS Mailing Lists www.cms.hhs.gov/mailinglists
CMS provides a listserv service, an electronic mailing list that will provide your practice with information as it is published by CMS. This is an effective way to stay current on Medicare changes and receive updates directly from CMS. Lists are available by subscription for many interest areas. Lists particularly helpful to oncology practices include:
- CMS-COVERAGE to receive notice of new or updated Medicare coverage determinations.
- CMS-MMU for notification of up-to-date information on CMS efforts to implement the Medicare Prescription Drug, Improvement and Modernization Act of 2003. This information includes recently published regulations, notices, and manual instructions affected by provisions to the new legislation.
- CT-MED-L for information about clinical trials and Medicare.
- MEDLEARN-MATTERS-L to receive new articles designed to help providers understand new or changed Medicare policy.
- OP-PPS-L to receive current Medicare information for hospital outpatient departments.
- PHYSICIANODF-L to receive notification about monthly Physician Open Door Forum calls where you can personally ask questions of CMS officials.
Medicare Coverage Database www.cms.hhs.gov/mcd/search.asp
This database includes Medicare's national and local coverage decisions. The database is searchable and can be used to compare local policy to national policy or to compare local policy to other local policies. By subscribing to the CMS-COVERAGE listserv, you will receive notification of newly added or updated national coverage policies.
Contact your Carrier/Fiscal Intermediary www.cms.hhs.gov/medlearn/tollnums.asp
Your local carrier or fiscal intermediary provides important information on local coverage and reimbursement policies. This page on the CMS Web site provides contact information for your carrier or fiscal intermediary, including links to their Web sites. Most carriers have a listserv that you can join to obtain up-to-date information on local policy. These listservs are also used to provide notifications on draft policies as they are being developed and to solicit comments from the provider community.
|
ASCO Resources
|
|---|
The ASCO Web site (www.asco.org) provides helpful information for your practice as you implement changes in coding and reimbursement policy.
Medicare Modernization Act www.asco.org/mma
This page provides the most current information available about the implementation and impact of MMA. ASCO's list of frequently asked questions about MMA can be accessed here, as well as resources including the most recent drug payment allowances and an analyzer tool to assess the impact of MMA on your practice.
Oncology-Specific Local Coverage Policy www.asco.org/cac
CMS requires each carrier to have a Carrier Advisory Committee (CAC) to assist in the development of local coverage policies and serve as a mechanism for discussing and improving administrative policies within the carrier's authority. ASCO has created this site to provide background information about the CAC process and information on how to access local policies. If your carrier is proposing a new coverage policy, this site is a helpful resource to review policies in other parts of the country.
Practical Tips for the Practicing Oncologist, 3rd Edition www.asco.org/practicaltips
This ASCO publication is a comprehensive reference that answers the most frequently asked questions about reimbursement, coding, coverage, and regulatory policies for oncology practices. Practical Tips is a quick and easy to use indexed guide that features an appendix of important resource information, codes for services, sample forms, and pertinent pages from the Medicare Coverage Manuals and the Federal Register. ASCO members can access Practical Tips on the ASCO Web site. The book can be ordered by sending an e-mail toascopubs{at}asco.org or calling 888-273-3508.
Coding and Reimbursement Hotline
ASCO staff can answer your oncology billing, coding, and practice management questions. Contact the coding hotline in ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1054 or send e-mail inquiries topractice{at}asco.org.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
|
Top
Abstract
Centers for Medicare &...
