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www.scosonline.com Winter 2007 |
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Transitioning to the Medicare Administrative Contractor (MAC) system is well underway. CMS contract reform under the MMA of 2003 for the administration of claims and billing activities for intermediary and carrier and outpatient services, which include physician care, will include 15 awards to contractors that submit proposals through three federal procurements. A RFP has been released for the jurisdictions in Cycle One that includes Colorado, New Mexico, Oklahoma, Texas, Iowa, Kansas, Missouri, Nebraska, Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania. These jurisdictions account for 23 percent of the fee-for-service claims workload. Contract awards for these jurisdictions are anticipated in July 2007. Another RFP was released for the jurisdictions in Cycle One that includes California, Hawaii, Nevada, Alaska, Idaho, Oregon, Washington, Arkansas, Louisiana, Mississippi, Connecticut, and New York. These jurisdictions account for about 22 percent of the fee-for-service workload. Contract awards for these jurisdictions are expected in late September 2007. The competition in Cycle Two that includes the remaining states will not begin until September 2007 with contracts to be awarded in September 2008. One major change in this process to note is that CMS has accelerated its schedule by two years to effectively transfer the current claims workload by 2009 rather than 2011. Most physicians are aware of the jurisdiction in which they are located and the timeframe for transitioning to the MACs, but many are not aware that they are encouraged to comment if they believe they can impact change.
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Thanks to the last minute "fix" by Congress, the conversion factor for 2007 remains the same as for 2006: $37.8975. The Centers for Medicare & Medicare Services (CMS) and the Relative Value Update Committee (RUC) also adjusted the relative value units (RVUs) for 2007. Overall, medical oncology practices can expect to see about a 2 percent payment increase in 2007. Payment for services provided by radiation oncologists is likely to remain static; estimates range from a 0 to 1 percent overall increase. In 2007, practices will see payment reductions from between 0.5 percent to 7.2 percent for most administration services. Only three codes experienced payment increases in 2007: 90772 (4.7 percent), 96401 (10.7 percent), and 96405 (7.3 percent). As for E&M, some of the most commonly billed physician visit codes (99213 and 99214) increased 9 to 13 percent, which results in payment increases of $6.72 and $7.47, respectively. (See Table 1. Impact on High-Volume Oncology Services and Table 2. Comparison of 2007 to 2006 Payments).Also included in the package is a 1.5 percent bonus payment for quality reporting that will begin on July 1, 2007, and continue to the end of the year. The exact quality reporting measures were not included in the bill. Congress has decided to use part of the Medicare Stabilization Fund to offset the costs of the fix. The next Congress will once again most likely seek a permanent fix to the SGR formula.
In August 2006 the State Society Services at the Association of Community Cancer Centers was changed to the Oncology State Society Network (OSSN). Many of you have now become familiar with the new name. We made the change to emphasize a network of value to the state societies across the country with whom we work. Staff at the Network have worked solidly over the last year to keep a meaningful promise: Provide strong business and customer service to each member. Collectively, the state societies that the Network manages want to deliver the high-quality products and good value that members expect. The Network promises to our best to build value by demonstrating the presence, credibility, reliability, and favorable track record of each state society working within the Network. OSSN hopes to have meaningful dialogue with your organization and work with you to reach your goals. Questions? Contact Marci Cali, Executive Director, Oncology State Society Network at 301.984.9496, ext. 238 or email: mcali.ossn@accc-cancer.org.
Since the implementation of the Medicare Modernization Act (MMA) of 2003, oncology practices have faced constant challenges adjusting to the mandated changes. Improving efficiencies is key to success. Here is how one oncology practice created a rapid reaction approach to review, update, and implement policy and procedures, and how they learned to keep better track of their drug costs.
A searchable database is now available of oncology drugs and their indications published in ACCC's Compendia-Based Drug Bulletin and recognized by the two national reference compendia. The database is updated four times a year: in February, May, August, and November. Click here to view.
Genzyme's in-vitro diagnostic test to identify patients with a greater risk for irinotecan toxicity was released in August 2005. Today, the UGT1A1 test is widely available from most reference labs. Many are offering UGT1A1 testing, which costs about $250 and is currently covered by most public and private insurers. Should every patient with colorectal cancer be offered this test? Here is an interview with Howard McLeod, PharmD, director of the UNC Institute for Pharmacogenomics and Individualized Therapy at the University of North Carolina, Chapel Hill, N.C., about this genetic test.
The Association of Community Cancer Centers (ACCC) will present its 33rd Annual National Meeting at the Baltimore Marriott Waterfront Hotel in Baltimore, Md., on March 28-31, 2007. For every paying Society/ACCC-member registrant, you may bring a colleague at half price! The offer does not apply to industry representatives and cannot be used in conjunction with any other promotional coupons or discounts. ACCC's Annual Meeting is the perfect opportunity for your entire cancer care team (physicians, nurses, administrator, and billers/coders) to strengthen their skills and network with their colleagues. Medicare rule changes, new technologies and treatments, e-prescribing/e-pedigree requirements, staffing issues, and more. ACCC's Annual National Meeting offers practice tracks with practical and timely information, to help the entire multidisciplinary cancer team.
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