ASCO, CMS, & Palmetto/J1MAC News

The following information has been received by ANCO.


****ASCO NEWS****
Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued its final Medicare physician fee schedule regulations for 2009.

The regulation announces that the Medicare physician conversion factor for 2009 will be $36.0666, which represents a decrease from the 2008 conversion factor ($38.0870). Congress took two actions in the Medicare Improvement for Patients and Providers Act (MIPPA) earlier this year which affected the conversion factor:

1) MIPPA provides for a 1.1% update (applied to the 2008 conversion factor) in 2009.
2) MIPPA requires that budget neutrality for the physician fee schedule be achieved through adjustments to the physician conversion factor, instead of negative adjustments across relative value units (RVUs) for individual services.

As a result of the last 5-Year Review of physician work, RVUs for certain codes increased. Mandated budget neutrality requirements provide that increased payments for some codes due to relative value changes must be offset by reductions in the values of other codes. Previously CMS achieved this offset by adjusting the RVUs. Now Congress has mandated that the adjustment be made to the conversion factor instead. While the 1.1% update was made and is reflected in the conversion factor, the impact of the budget neutrality adjustment is greater and therefore results in an overall reduction.

The final rule includes a number of provisions in other areas including imaging, e-prescribing, anti-markup, self-referral, and PQRI. We will be reviewing the entire regulation carefully and sending out a comprehensive summary of changes that will affect oncologists, and their estimated impact.

CMS also released the Medicare 2009 Hospital Outpatient Prospective Payment final rule yesterday. The rule finalizes CMS’ proposal to reduce drug payments in the outpatient department to ASP+4%. ASCO will also be reviewing and summarizing the hospital outpatient rules shortly.


****CMS NEWS****
The Centers for Medicare & Medicaid Services (CMS) today announced a new initiative for physicians to trade in their prescription pads and improve efficiency and safety when ordering drugs for patients with Medicare. The initiative is included in the Medicare Physician Fee Schedule (MPFS) final rule for calendar year 2009. To view the Press Release, go to the web page at http://www.cms.hhs.gov/apps/media/press_releases.asp.

A copy of the final rule (CMS-1403-FC) is available at http://www.cms.hhs.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?filterType=none&filterByDID=0&sortByDID=4&sortOrder=descending&itemID=CMS1216674&intNumPerPage=10


MM6212 – New 2008 Medicare Physician Fee Schedule (MPFS) Payment Rates Effective for Dates of Service July 1, 2008, through December 31, 2008
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6212.pdf


MM6213 - Laboratory National Coverage Determination (NCD) Edit Software for October 2008
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6213.pdf


Release of the 2009 HCPCS Annual Update
The Centers for Medicare and Medicaid Services is pleased to announce the scheduled release of modifications to the Healthcare Common Procedure Coding System (HCPCS) code set. These changes have been posted to the HCPCS website at http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/
All changes are effective January 1, 2009, unless otherwise indicated in the effective date column.


ICD-10-CM/PCS National Provider Conference Call for Physicians
Physicians may now register for the Centers for Medicare & Medicaid Services (CMS) ICD-10-CM/PCS National Provider Conference Call that will be conducted on November 17, 2008 from 12:30 p.m. – 2:30 p.m. EST. To register for this call, go to http://www2.eventsvc.com/palmettogba/111708. To find additional information about this conference call and to access the ICD-10 Overview Presentation that will be discussed during the call, go to http://www.cms.hhs.gov/ICD10/07_Sponsored_Calls.asp.


****PALMETTO/J1MAC NEWS****
November 2008 J1 A/B MAC Medicare Advisory
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20A~Publications~Medicare%20Advisory~November%202008%20J1%20AB%20MAC%20Medicare%20Advisory?opendocument

The November 2008 J1 A/B MAC Medicare Advisory is now available to be
viewed on the Palmetto GBA Web site. Click on the link to view this
advisory.


The Presentation is Now Available for the Part B November 3 and 12 Web
Safari
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%201%20Part%20B~The%20Presentation%20is%20Now%20Available%20for%20the%20Part%20B%20November%203%20and%2012%20Web%20Safari?opendocument

Click the link to locate the presentation for the J1 Part B Web Safari on
November 3 and 12.