There are several updates that we want to make sure you are aware of because of the impact to your practice.

Medicare 21.2% Payment Cut

As we reported last week, there was a 7-month patch to the 21.2% Medicare physician fee cut contained in a bipartisan jobs bill package. Unfortunately, Majority Leader Reid (D-NV) promptly killed that bill and instead introduced a stripped-down jobs bill that does not contain a patch to the Medicare cut effective March 1, 2010.

With Congress in recess this week, there is no clear path to legislation that would avert the 21.2% payment cut from going into effect on March 1st. Although some organizations are calling for a repeal of the sustainable growth rate (SGR), this is simply not going to happen in the sort term because of the $200+ billion price tag. What is more likely to happen is a multi-year patch, after a short-term patch.

We are alerting practices to prepare for either a delay in payments or for the 21.2% cut in Medicare services to go into effect on March 1st. Although we believe that most in Congress want to avert the cut by passing at least a short-term patch, the level of dysfunction on Capitol Hill and politics surrounding health care reform is worrisome. So, our message to practices is to be prepared. Our message to the Congress is that allowing this severe Medicare cut to occur, even on a short-term basis until it is addressed, is irresponsible and dangerous.

REM Program for ESAs

The FDA is requiring all Erythropoiesis-Stimulating Agents (ESAs) to be prescribed and used under a risk management program, known as a risk evaluation and mitigation strategy (REMS), to ensure the safe use of these drugs. FDA required Amgen, the manufacturer of Epogen, Procrit, and Aranesp, to develop a risk management program because studies show that ESAs can increase the risk of tumor growth and shorten survival in patients with cancer who use these products.

Click here for information. COA will be providing more materials as they become available.

Oral Cancer Drug Parity

There are numerous states that are currently considering parity legislation relating to the use of oral cancer drugs. The process differs slightly by state, but the typical path is for legislation to be introduced into state House and Senate assemblies; next, a hearing is scheduled and testimony provided; and, finally, a vote is taken.  

So that you understand, when a hearing is being held in your state, it is critical that you provide testimony, ideally with a patient who has been impacted by restrictive payer policies or co-insurance. COA will issue a statement to be read into the record as an advocacy organization for cancer care. It is helpful to rally people to call and email their local state Senator and Representative requesting support for legislation.
 
Just this week, a hearing was held in Oklahoma about orals parity and we worked with the Oklahoma Society of Clinical Oncology. There is a growing list of states in various phases of considering legislation. We will be sharing this information on the COA Administrators’ Network website, which you can access (after registering) through the COA website (http://www.communityoncology.org). If you hear of any legislation in your state, please contact Mary Kruczynski at
<maryk@COAcancer.org>.  

Medicare Claims Crossover to Supplemental Payer Problem

The Centers for Medicare & Medicaid Services (CMS) has identified a problem where claims were not automatically crossing over to supplemental payers even though the provider remittance advice indicated otherwise.  This problem began January 5, 2010 and impacted Part B professional claims.
 
Action is required on behalf of Part B professional providers where a remittance advice with an issue date between January 5, 2010 and February 12, 2010 has two or more service lines for a beneficiary where both of the following apply:

• One service line is 100 percent reimbursable (i.e., the approved amount and amount to be paid are equal,) AND    
• One service line where part of or the entire Medicare approved amount is applied to the Part B deductible and/or carries co-insurance amounts.  

CMS is not able to forward these beneficiary claims to supplemental payers even though the remittance advice may indicate otherwise.  Providers will need to identify these claims by reviewing their remittance advice with an issue date between January 5, 2010, and February 12, 2010, that contain the criteria noted above. Once identified, providers will need to take action to balance bill the beneficiary’s supplemental payer.  As of February 12, 2010, this system problem was fixed and all claims are crossing over to supplemental payers as indicated on the provider remittance advice.