CMS

In letters to bill sponsors, Representatives Phil Roe, MD (R-Tenn.) Allyson Schwartz (D-Pa.) and Senator John Cornyn (R-Tex.), ASCO is supporting the “Protecting Seniors Access to Medicare Act,” which would repeal the Independent Payment Advisory Board (IPAB). The IPAB, created by the Affordable Care Act, is a 15-member panel charged with the authority to make targeted cuts to Medicare, including payments to physicians, if the program’s overall costs rise faster than a certain rate.

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Practices who have received a denial for add-on code 96361 will have the opportunity to appeal the denial or resubmit their claims after July 1 due to revisions by the agency.

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ASCO has formally recommended that the Centers for Medicare and Medicaid Services use the Quality Oncology Practice Initiative® (QOPI) as a model clinical registry through which practices can meet their Physician Quality Reporting System (PQRS) requirements. The society made this recommendation in submitted comments in response to the agency’s request for information on how practices can meet their PQRS requirements by participating in clinical registries.

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Representatives Pete Sessions (R-Texas) and Gene Green (D-Texas) are asking fellow members of Congress to sign a bipartisan letter that seeks more information from the Centers for Medicare and Medicaid Services (CMS) on the impact of sequestration on chemotherapy drugs.

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This afternoon, President Obama released his proposed budget for fiscal year 2014. Among several cost-cutting measures designed to preserve Medicare solvency is a proposal to reduce reimbursement for life-sustaining cancer drugs. Currently, reimbursement to physicians for “Part B” drugs is based on the average sales price plus a 6 percent payment for services needed to administer chemotherapy in physicians’ offices, where most cancer patients receive their care. The President has proposed to reduce the 6 percent service payment to 3 percent. (The budget proposal appears to apply cuts primarily to physicians, but also mentions rebates that will be required by manufacturers.)

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The first three installments of ASCO’s new payment reform series provide context and background on the growing call for reform of the Medicare physician payment system. Rising healthcare costs, along with misaligned payment formulas, have triggered an unprecedented national dialogue on the need to change the way Medicare reimburses physicians for patient care. Congress, the Administration and the oncology community are seriously examining options for restructuring care delivery and reimbursement to ensure higher-quality and more cost-efficient patient-centered care.

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ASCO, patient advocacy groups, and other provider organizations recently sent a letter to Centers for Medicare & Medicaid Services Acting Administrator Marilyn Tavenner urging the agency to correct a longstanding inequity in Medicare coverage for cancer patients wishing to participate in clinical trials.

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ASCO recently released a new 12-month overview of 2013 Centers for Medicare and Medicaid Services (CMS) deadlines for new Medicare reporting requ...

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