Practice Manager Insider

Interview on 2006 Revisions to CPT Codes

The 2006 American Medical Association revisions to Current Procedural Terminology (CPT) codes will significantly impact the work of practice managers in the approaching year. Practice Manager Insider interviewed editorial board member, Patricia Falconer, MBA, president of Health Options, regarding exactly how oncology practices will be affected by the 2006 CPT revisions.

Listen to an audio recording of the interview here.

Medicare Drug Plan Marketing Abuse

The Centers for Medicare & Medicaid Services (CMS) has another difficulty to overcome in helping seniors navigate the already confusing sign-up process for the new Medicare prescription drug plan—the hard-sell tactics of some private Medicare plan providers. Although Congress provided ample funding for private insurance companies to offer Medicare prescription plans, money was not set aside for state agencies to monitor the additional volume of policy sales. Jorge Gomez, head of the senior issues task force for the National Association of Insurance Commissioners, said the most blatant abuse has been “cross-selling, where salesmen were selling long-term care, annuities, and life insurance products” to customers seeking only to purchase a drug plan. There have even been reports of independent sales agents passing themselves off as employees of the Social Security Administration asking for personal data such as checking account numbers. Mr. Gomez, also Wisconsin’s Insurance Commissioner, warns, “Unless cross-selling is prohibited by Medicare, there will be a spike in fraud, stolen identities, and unsuitable sales.” Medicare has a 24-hour hotline (1-800-633-4227) to help explain the process for enrolling in Medicare prescription drug plans. Marketing complaints should be directed to a state insurance regulator.

New Drug Plan May Hurt Some with Special Needs

When the Medicare Prescription Drug Plan begins January 1, 2006, seniors and the disabled will finally have access to long-needed Medicare drug coverage. The plan is expected to save beneficiaries thousands of dollars a year and offers reduced premiums and deductibles based on need. However, health advocates warn that some beneficiaries could end up paying more under the new Medicare plan. Patients who are enrolled in both Medicaid and Medicare, particularly those in assisted-living, the mentally ill, or with a chronic illness, may lose benefits that cover a portion of their drug costs, and be unable to find a prescription plan that covers their specific medications. Jack Cheevers, a Medicare spokesperson in California, says they will continue to take suggestions from health advocates to further develop a system to ensure dual eligible Medicaid/Medicare beneficiaries can transition into a drug plan without any problems.

2006 Oncology Demonstration Codes Released

The Centers for Medicare & Medicaid Services (CMS) is making extensive revisions to the 2005 Oncology Demonstration Project for the coming year. The 2005 Oncology Demonstration Project centered on the submission of G-codes corresponding to nurse assessment of side effects from chemotherapy. However, for the 2006 Oncology Demonstration Project reimbursement will be per service during an office visit not solely for chemotherapy treatment, and the G-codes will be used to record how well oncologists follow evidence-based practice guidelines. The American Society of Clinical Oncology has listed out the newly revised 2006 G-codes that are essential for oncologists to learn so they may properly code and receive full reimbursement under the 2006 Oncology Demonstration Project.  In addition, ASCO has assembled a spreadsheet so practice managers can calculate the effect of the 2006 Demonstration Project on their office.

Community Oncology Alliance Rallies to Save Cancer Care

Oncologists, nurses, administrators, patients, caregivers, and cancer survivors came together to discuss community cancer care with members of Congress at the 4th Annual Cancer Care Legislative Day in Washington, DC, on October 26, 2005. The Community Oncology Alliance has showcased highlights of the meeting in a video urging the cancer care community to convince their congressional representatives to cosponsor The Community Cancer Preservation Act of 2005. The legislation, also known as HR4098, seeks to ensure access to quality cancer care in the face of nearly $500 million in Medicare reimbursement cuts for oncologists in 2006. Representative Nancy L. Johnson (CT) appealed to attendees, “Remember, democracy is representational government, and if your representative doesn’t know, you can’t blame them for not doing. There is absolutely no way any representative could know what it takes to deliver cancer care.”

Oncologists Face Potential “Demographic Tsunami”

The first annual Oncology World Congress Meeting held November 16-19, 2005 in New York City opened with a preconference session on practice management, which centered on how oncologists can improve cancer patient care as well as reimbursement. Dr. David H. Regan of Northwest Cancer Specialists, Portland, OR, lamented that although Medicare is spending more money on care in general, the increase in payments to oncologists is still less than the increase in costs to deliver the services covered. He warned, “we are entering a ‘demographic tsunami,’ if a serious discussion does not take place between policy makers, the private sector, insurance companies, and oncologists,” citing the combined effects of a population that lives longer, a greater demand for quality care, reduced coverage from Medicare, and opposition from private insurance companies as factors affecting the future of oncology care. In addition to being encouraged to search for ways to improve reimbursement for services, physicians were pushed to help patients enroll in clinical trials and use results from clinical trials as a way to move public policy toward better care choices.