Practice Management

Donald M. Berwick, the Director of Centers for Medicare and Medicaid Services (CMS) of the Health and Human Services Department as of March 2010, has written a perspective on the accountable care organizations (ACOs) of the Medicare Shares Savings Program.

The Centers for Medicare and Medicaid Services (CMS) say that the first-ever cancer vaccine, sipuleucel-T (Provenge) from Dendreon would be covered for FDA-approved usages of the treatment.

At the Association for Community Cancer Centers annual national meeting in Washington, DC this past March, the session on “Oncology Care in 2021” featured three panelists with significant experience in shaping healthcare policy.

The prostate cancer drug Provenge (sipuleucel-T) offers a moderate survival benefit to patients, according to an analysis performed by the U.S. Centers for Medicare and Medicaid Services. The analysis was undertaken as part of a CMS review initiated in July to determine whether to cover the cost of the therapy.

It appeared that the controversy surrounding the pros­tate cancer immunotherapy Provenge ended with FDA approval in April. But now Medicare is questioning whether the government should pay for the new therapy. The CMS decision is just as important to the biopharmaceutical indus­try as it is to Dendreon.

We work with medical oncologists/hematologists across the country in both the private practice and hospital settings. Based on our experience, I'd like to point out a couple of key flaws in the current Medicare code interpretations.

Community cancer clinics, which treat more than 75% of all cancer patients, are struggling with Medicare reimbursement. Cuts in the Proposed 2011 Medicare Physician Fee Schedule will a have devastating effect on the delivery of cancer care. COA is calling for action.

On August 18th during a meeting with “The Pink Sheet Daily” Biotechnology Industry Organization CEO Jim Greenwood said, CMS decision to conduct Provenge NCA could be “Chilling to future innovation.”

Did you know there is going to be a Center for Medicare and Medicaid Innovation? The authority comes from the new health reform law. And it appears to give the Health and Human Services Secretary enormous discretion to try almost any new idea she finds interesting.

For the first time in Medicare history, the Medicare Chief Actuary has called the projections in a Medicare Trustees Report “unreasonable” and “implausible” and encouraged everyone to ignore them and view instead an “Illustrative Alternative” report.

Nationally recognized oncology consultant takes a look at Medicare coding. Seems like the devil is in the details when it comes to Medicare…

A flood of cancer-specific applications is answering the call of oncologists, for whom keeping pace with new clinical developments is a higher priority than for your average family practitioner.

Since Obama signed healthcare reform into law, 22 states have filed lawsuits challenging the constitutionality of reform; at least 36 states have introduced initiatives repealing all or parts of healthcare reform.

Medicare is now questioning whether the government should pay for new therapy's such as Provenge. The CMS decision is just as important to the biopharmaceutical industry, doctors, and their patients as it is to Dendreon. H. R. 4732, The Compassionate Access Act, calls to give access to novel drugs;will CMS serve as a roadblock?

As covered in the RPM Report, CMS announced June 30 that it had opened a national coverage analysis (NCA) for Provenge to determine whether the therapy is “reasonable and necessary.”

I work with medical oncologists/hematologists across the country in both the private practice and hospital settings. Based on my company’s experience, I would like to point out a couple of key flaws in the current Medicare code interpretations.

It’s a kind of man bites dog story: unusual, remarkable, yet oddly plausible. The Centers for Medicare and Medicaid Services has told its contractors to hold claims containing services paid under the Medicare Physician Fee Schedule for the first 10 business days of March.

Experts from health systems, government, and the insurance industry offer insights into how quality is defined and measured in medicine today.

In my practice as an oncologist specializing in gastrointestinal tract cancers, a recent week was fairly typical. I saw 50 patients, ranging in age from 32 to 87, equally divided between men and women. Though a couple of them have inherited a gene that may have caused their GI cancers, I have no explanation for why most developed their disease. It is as if they were simply struck by lightning.

The oncology community is happy about next year’s cut in Medicare reimbursement. Well, maybe not so much happy as relieved.

Freestanding and community-based cancer centers will be leading with their chins if the Centers for Medicare and Medicaid Services revises its reimbursement rules on equipment utilization.

Bucking the tide of medical professional opinion, CMS decided against granting payment for CT colonography as a screening test for colorectal cancer. CMS ruled that the clinical evidence remains inadequate to conclude that CTC is appropriate for that role.

Members of the Congressional Black Caucus have joined the ranks of virtual colonoscopy (VC or CT colonography [CTC]) advocates to pressure the Centers for Medicare and Medicaid Services to reverse a proposal to deny reimbursement for VC screening. Proponents argue that the policy could widen existing colon cancer screening inequalities.

Physicians regularly miscalculate their non- Medicare fees, which means that revenue is slipping away. Have you reviewed your fee schedules lately to determine if you’re getting proper reimbursement for all your services? Now is a great time to take a look and make appropriate changes for 2009. Here are some steps to determine if private payers are reimbursing you at a fair rate.

The clinical trials program in the U.S. is broken and apparently nobody has noticed,” Vincent T. DeVita, Jr., MD, wrote in a recent editorial in Nature Clinical Practice Oncology (5:683, 2008), of which he is editor-in-chief.

Oncologists face special patient communication challenges, as cancer treatments are highly complex and prognosis is often grim. For various reasons, important information is often avoided or communicated poorly, leaving cancer patients in emotional limbo.

The ever-growing complexity of chemotherapy coding is so onerous that office managers sometimes lose track of their non-drug billing items. Here are four questions that oft en pop up about nondrug billing and coding.

In January 2005, Medicare changed the coding and billing of injection and infusion services in order to describe more precisely the complexity of the services and provide adequate reimbursement for the nursing time involved.

Electronic health records can help oncology practices save money and work smarter. Then why has the adoption of e-technology been so frustratingly slow? A recent survey in the New England Journal of Medicine found that only 4% of physicians reported having a fully functional electronic health record (EHR) system; only 13% reported having a basic system (NEJM 359: 50-60, 2008).

Since the passage of the Medicare Modernization Act of 2003, the changes in chemotherapy reimbursement have altered the economic model of community oncology practices.