CMS/Medicare: Questions and Answers on Announced 10 Day Hold

The Questions and Answers below apply to the recent decision by the Centers for Medicare & Medicare Services to hold for up to 10 business days claims paid under the Medicare physician fee schedule (MPFS) that contain July 2008 dates of service.

Q1. Will claims containing services paid under the MPFS be held that contain both June and July dates of service?
A1. Yes, your local contractor will hold the entire claim for 10 business days.

Q2. Will claims be held that contain both services paid under the MPFS and services paid under a separate fee schedule?
A2. Yes, claims that contain both services paid and not paid under the MPFS will be held. For example, a claim with a July date containing an Evaluation and Management code and a drug code would be held.

Q3. Does the holding of claims paid under the MPFS also include anesthesia and purchased diagnostic services?
A3. Yes, contractors will hold all claims with dates of service July 1, 2008, and after that contain services paid under the MPFS, including anesthesia and purchased diagnostic services.

OTN/Onmark Legislative Calls: July 15th and 16th

The following information is provided by OTN/Onmark, McKesson Specialty Companies, an ANCO Corporate Member.

Join your fellow community-practice physicians for a presentation and discussion, led by John Akscin, OTN's Vice President of Government Relations.

When:

OTN and Onmark have scheduled two times for your convenience:

· Tuesday, July 15 at 3 p.m. CST

· Wednesday, July 16 at 12 p.m. CST

Where:

Call 877-719-9786 at least 10 minutes prior to the meeting start time. No pre-registration required!

Discussion will include:

· Medicare PFS Fix

· Summary CMS Proposed Rule, 2009 MC-PFS

· CMS Updates on Held Claims

· Update, 2007 PQRI Participant Reports

· Summary NEJoM, Physician Adoption of EHR

· Review, GAO Report, Expenses for MC-Part D

· Summary CBO Report on Biologics

· New Drug Reimb Info: Hycamtin Oral

· CMS Tidbits

· CMS Transmittals and MLMs

· Legislative Update

· Q&A

The Legislative, Regulatory and Reimbursement program is made possible through the generous support of Genentech. OTN appreciates their sponsorship of these calls.

ANCO's ASCO/ONS Highlights 2008

ANCO's ASCO/ONS Highlights 2008
Saturday, September 6th, 2008, 8:00AM-1:00PM
The Claremont Resort • Ashby & Domingo Avenues
Oakland, California • (510) 843-3000

ASSOCIATION OF NORTHERN CALIFORNIA ONCOLOGISTS
&
INDIANA UNIVERSITY SCHOOL OF MEDICINE

Program Overview
ASCO/ONS Highlights 2008 will summarize the major research and treatment advancements presented at this year’s ONS Congress and ASCO Annual Meeting. The program will focus on breast, gastrointestinal, genitourinary, gynecologic, and lung cancers as well as hematological malignancies. The faculty will place these developments in context as to their immediate clinical utility. A plenary talk on pharmacogenomics will also be presented.

Download the meeting announcement and registration form at www.anco-online.org/ascohl2008.pdf.

Educational Objectives
At the conclusion of this educational activity, participants should be able to:

• Review, summarize, and interpret new advances and implement changes in the treatment of breast, genitourinary, gynecologic, gastrointestinal, and lung cancers and hematological malignancies presented at the 2008 ASCO Annual Meeting.

• Review, summarize, and interpret new advances and implement changes in oncology nursing presented at the 2008 ONS Congress.

Target Audience
ASCO/ONS Highlights 2008 has been designed to meet the educational needs of oncologists, oncology nurses, oncology pharmacists, and other health-care professionals involved in the care of people with cancer.

Accreditation
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of Indiana University School of Medicine and the Association of Northern California Oncologists (ANCO).

Designation of Credit
The Indiana University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The Indiana University School of Medicine designates this educational activity for a maximum of 4.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. The California State Board of Registered Nurses accepts courses approved for AMA PRA Category 1 Creditä as meeting the continuing education requirements for renewal.

Disclosure Statement
In accordance with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support, educational programs sponsored by the Indiana University School of Medicine (IUSM) must demonstrate balance, independence, objectivity, and scientific rigor. All faculty, authors, editors, and Planning Committee members participating in IUSM-sponsored activity are required to disclose any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services that are discussed in an educational activity.

Program Planning Committee
The Physician Course Director for ASCO/ONS Highlights 2008 is David R. Gandara, MD, Univ. of California, Davis. Dr. Gandara was assisted by the ANCO Board of Directors (Richard A. Bohannon, MD, Norman Cohen, MD, Jeffrey Cronk, MD, Bradley Ekstrand, MD, Ellie Guardino, MD, PhD, John A. Keech, Jr., DO, L. Wayne Keiser, MD, Primo Lara, Jr., MD, Daniel P. Mirda, MD, Bimal J. Patel, MD, Robert L. Robles, MD, and Antoine Sayegh, MD), Institutional Member contacts (George A. Fisher, MD, Hope Rugo, MD, and Margaret Tempero, MD), and Group Member contact (Joseph Mason, MD) in the selection of the faculty for ASCO/ONS Highlights 2008.

Content Consultant
The Indiana University School of Medicine content consultant is Lawrence Einhorn, MD.

Supporters & Exhibitors
This educational activity is supported in part by AMGEN, AstraZeneca, Bayer HealthCare Pharmaceuticals/Onyx Pharmaceuticals, biogenIDEC, Celgene, Eisai, Enzon Pharmaceuticals, Genentech BioOncology, Genomic Health, Genzyme Oncology, GlaxoSmithKline, Imclone Systems, Millennium, Novartis Oncology, Ortho Biotech, OSI Pharmaceuticals, Pfizer Oncology, Roche Oncology, Sanofi Aventis Oncology, and possibly others (as of the date of this mailing). The final list of supporters and exhibitors will be available at the meeting.

Agenda & Faculty
7:00AM
REGISTRATION, EXHIBITS, AND BUFFET BREAKFAST (available through 9:00AM)
8:00AM
OPENING REMARKS & INTRODUCTION
David R. Gandara, MD, Program Moderator
8:15AM
PHARMACOGENOMICS
Heinz-Josef Lenz, MD, Univ of Southern Calif
9:00AM
HEMATOLOGICAL MALIGNANCIES
Jeffrey Wolf, MD, Univ of Calif, San Francisco
9:30AM
LUNG CANCER
David R. Gandara, MD, Univ of Calif, Davis
10:00AM
GASTROINTESTINAL CANCER
Andrew H. Ko, MD, Univ of Calif, San Francisco
10:30AM
BREAK
11:00AM
ONCOLOGY NURSING
Patricia Palmer, RN, MS, AOCNS, Univ of Calif, Davis
11:30AM
GENITOURINARY CANCER
Sandy Srinivas, MD, Stanford Univ
12:00PM
GYNECOLOGIC CANCER
Sidney A. Scudder, MD, Univ of Calif, Davis
12:30PM
BREAST CANCER
Louis Fehrenbacher, MD
The Permanente Medical Group
1:00PM
ADJOURN

THIS WEEK AT ACCC: JUNE 30 - JULY 4, 2008

The Association of Community Cancer Center's This Week at ACCC was published and is available online at http://www.accc-cancer.org/mediaroom/newsletters/media_ACCC_june30_08.html.

It features:

Administration Freezes Physician Medicare Cuts; No Congressional Fix Yet

CMS Releases Proposed 2009 Physician Fee Schedule and Policy Changes

Some Flooding Continues, Recovery Underway

House of Representatives Passes Historic Prostate Cancer Resolution

See You in San Francisco at ACCC's 25th Oncology Economics Conference

ACCC to Host Oncology Pharmacy Meeting in September

ACCC Welcomes Eisai Inc. to its Industry Advisory Council

ACCC Welcomes Cephalon Oncology to its Industry Advisory Council

FDA Approves New Sprycel 100 mg Tablet

FDA Approves Velcade for Injection for Patients with Previously Untreated MM

Heard on the ACCC Listserv: Infusion Center Staffing

ACCC's CE Blackboard: New Continuing Education Programs for You

State Medical Oncology Societies Host Upcoming Meetings

ASCO Cancer Policy Alert Published

CMS to hold claims for 10 Business Days; Urge Congress to pass a Physician Payment Fix

In light of Congress's failure to pass legislation preventing the 10.6% Medicare payment cut, the Centers for Medicare and Medicaid Services (CMS) is directing contractors not to process claims for dates of service July 1 through July 15. CMS is attempting to give Congress time to pass legislation when they return to work from the July 4th recess that would avert the cut, however, passage of such legislation is not guaranteed. CMS informed Congress of their intent via e-mail on Friday, June 27, 2008.

Payments for dates of service June 30 and earlier will be processed and paid as normal. After July 15, contractors will begin releasing claims for payment under the current law with the 10.6 percent cut. If Congress does pass an SGR fix retroactive to July 1, CMS will be prepared to automatically reprocess most of those claims that have already been processed.

It is important that your Members of Congress hear from you about this important issue while they are home over the July 4th recess. Please tell them how a 10.6% cut in Medicare payments will affect your practice. What you can do:

Meet with your Senator or Representative at a town hall meeting to raise the SGR issue. To find out if your Members of Congress are hosting town hall meetings over the next week, please contact ASCO's Cancer Policy & Clinical Affairs Department at grassroots@asco.org. If they supported H.R. 6331 to prevent the SGR cut, thank them. If they did not vote for the legislation, urge them to do so when the next vote occurs. Please let ASCO know who you met with at publicpolicy@asco.org.

Make an appointment to meet Senators, Representatives, and staff in the state office. Remember, meeting with staff is just as good as meeting with the member. Again, please tell ASCO who you met with and the result of the meeting at publicpolicy@asco.org.

Write a letter to the editor of your local newspaper. Information on how to write a letter to the editor can be found in your local paper.

ASCO will continue to keep members updated on this issue. If you have any questions, please contact ASCO's Cancer Policy & Clinical Affairs Department at 703-299-1050 or publicpolicy@asco.org.

NHIC/Medicare: Claims Paid Under the Medicare Physician Fee Schedule

To the extent possible, the Centers for Medicare & Medicaid Services (CMS) is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other Fee-For-Service (FFS) providers of services paid under the Medicare physician fee schedule, beginning July 1. In this regard, CMS has instructed its contractors to hold these claims for the first 10 business days of July, for dates of service in July. This should have minimum impact on provider cash flow because, under current law, electronic claims are not paid any sooner than 14 days (29 days for paper claims) after the date of receipt. Meanwhile, all claims for services delivered on or before June 30 will be processed and paid under normal procedures.

After 10 business days, contractors will begin releasing claims into processing under the fee schedule which implements current law. This, of course, could result in claims being processed with the negative 10.6 percent update. If a new law is enacted which changes the negative 10.6 percent update, retroactive to July 1, CMS is prepared to automatically reprocess most of those claims which have already been processed.

Under the Medicare statute, Medicare pays the lower of submitted charges and the Medicare fee schedule amount. Claims with dates of service July 1 and later billed with a submitted charge at least at the level of the January 1-June 30, 2008, fee schedule will be automatically reprocessed if Congress retroactively reinstates the update that was in effect for that time period. Any lesser amount will likely require providers to re-submit a revised claim.

To the extent possible, providers may hold claims in-house until it becomes clearer as to whether new legislation will be enacted or until cash flow becomes problematic. This will reduce the need for providers to reconcile two payments (i.e., the initial claim and the reprocessed claim), and it will simplify provider billings of beneficiary coinsurance and payment calculations for payers which are secondary to Medicare.

In addition, be on the alert for more information about other legislative provisions which may affect Medicare FFS providers.

Medicare Physician Pay Cut Forestalled As Administration Freezes Payments; Take Action Now to Support a Payment Fix

The U.S. Department of Health and Human Services (HHS) announced Friday it will essentially freeze the current Medicare physician payment system because the Congress left Washington for its July 4 recess without reaching agreement on legislation to avert the scheduled 10.6% pay cut. Congressional staff report the freeze could last up to 10 days past the statutory July 1 deadline, which means that the Senate will have three days after it reconvenes July 7 to pass a payment fix before the HHS freeze is lifted.

New talks between Senate Democrats and Republicans will need to resolve this issue before July 10. Until then, physician payments will stay as is.

Advocacy by all physicians continues to put pressure on the Senate to pass needed legislation to avert the payment cuts.