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As the price of new cancer treatments continues to rise, physicians in both the inpatient and outpatient settings need to factor cost as well as efficacy into treatment plans. Julie Kennerly-Shah, PharmD, MS, MHA, facilitates the Hematology Oncology Pharmacy and Therapeutics (P&T) Committee at The Ohio State University Comprehensive Cancer Center, determining which agents will be available to providers …
The Comprehensive Error Rate Testing (CERT) for improper payment analysis was implemented by the Centers for Medicare & Medicaid Services to identify and measure improper payments in the Medicare Fee-for-Service program.
In the Department of Pharmacy at the University of North Carolina North Carolina Cancer Hospital, discarding partial drug vials was a significant source of waste. With their Innovator Award–winning drug vial optimization program, the program maximized the lifespan of drugs within single-dose vials and realized an annual cost savings of more than $40 million.
Ready or not, the requirement to consult Centers for Medicare & Medicaid Services (CMS)-approved Appropriate Use Criteria (AUC) when ordering advanced imaging studies is on its way and is slated to go into effect on Jan. 1, 2020.
Effective Oct. 1, 2018, the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention will add 279 new codes, revise 143 existing codes, and deactivate 51 codes in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) classification.
A multidisciplinary approach allows the formation of partnerships between expert professionals that extends beyond the boundaries of their individual specialties, reduces the potential for miscommunication, and eliminates the fragmentation of services that was once common in cancer care.
Cancer patients are typically treated with approaches ranging from surgery and radiotherapy to chemotherapy or immunotherapy. However, millions of patients every year seek additional options from a menu of complementary and alternative medicine (CAM).
Social workers in cancer centers typically provide psychosocial services to patients, families, and caregivers facing the impact of a cancer diagnosis.
Before enactment of the Affordable Care Act, hospitals began to purchase physician practices and, by converting these locations to outpatient hospital departments, were able to bill for both the professional fee on the CMS1500 claim form and the facility charges on the UB04 claim form.
Since 1992, Medicare has paid for the services of physicians, non-physician practitioners, and certain other suppliers under the Medicare Physician Fee Schedule (MPFS or PFS).
The Susan P. Wheatlake Regional Cancer Center lacked the infrastructure to fund survivorship and navigation software, but still needed to assess how to meet needs, procure service affiliations, and facilitate access to services in a fiscally responsible manner.
The Hospital Outpatient Prospective Payment System (HOPPS or OPPS) is not intended to be a fee schedule, in which separate payment is made for each coded line item. Instead, the OPPS is currently a prospective payment system that packages some items and services, but not others.
The 2018 Medicare final regulations, code updates, and other reimbursement changes will bring significant compensation shifts for oncology providers.
What is the correct number of physicians and support staff needed to meet the requirements of the cancer program? There may not be a single answer to this complex question.
For CY 2015, CMS will continue base payments on geometric mean costs
Ensuring compliance with the myriad of coding and billing regulations is everyone’s job, so make sure you are connected to your Compliance Department, or take the responsibility for compliance into your own hands.
There are procedure codes to report care management services, providing that all documentation requirements are met. It is important to note that while these are billable procedure codes, not all insurers reimburse for these services.
This year we have challenges with physicians and hospitals scrambling to update their respective chargemasters, fee schedules, and other reimbursement documents because in 2015 there are different procedure codes reported based on the radiation oncology setting.
The goal of oral anticoagulation is to maintain levels of anticoagulation capable of preventing thromboembolic events without increasing the risk of hemorrhagic complications.
With the advent of ICD-10-CM, providers on the receiving end of referrals are expecting complete and accurate clinical information that may ultimately be used for diagnosis code assignment to be part of the referral process. But what if the oncologist is the physician referring a patient for a diagnostic imaging study?
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