Articles related to MEDICARE

The Enhancing Oncology Model (EOM) only provides two risk arrangements with varying levels of downside risk, which means that any practice that participates may lose revenue or be required to refund payments to CMS. Furthermore, unlike the Oncology Care Model (OCM), the EOM focuses on systemic chemotherapy for seven cancers (breast, chronic leukemia, small intestine/colorectal, lung, lymphoma, multiple myeloma, and prostate), and each will have its own formula for predicting baseline costs. This uncertainty is exacerbated by proposed reductions in Monthly Enhanced Oncology Services (MEOS) payments, which would be reduced from $960 to $420. For practices, this means either receiving less money for value-based care staples like patient navigation and creating care management plans, or reducing their use of them.

CMS released its new, updated, and deleted codes specific to Medicare payers at the end of 2022. The document also highlights payment information that will impact practices providing care to Medicare beneficiaries in 2023.

The merit-based incentive payment system (MIPS), which adjusts clinician Medicare Part B payments for performance on quality, cost, improvement activities, and use of certified EHR technology for interoperability, along with EOM quality measurement systems for Medicare, should ideally be meaningful to physicians and patients and coordinated to magnify the quality signal. How do these novel methods compare, then, in terms of genuinely comprehending the standard of cancer care provided to Medicare beneficiaries?

Oncologists were mentioned in two important specialist areas in CMS’ examination of inappropriate payments made to Part B providers, with the dismal outcomes as follows: Four hundred (400) claims for oncology/hematology were examined; of these, 60.9% lacked sufficient supporting paperwork, 31.9% had inaccurate coding, and the remaining cases had neither, along with no other issues. Given these findings, CMS projects $146 million in erroneous payments. In medical oncology, 147 claims were analyzed; 54.5% had no documentation and 37.7% had inaccurate coding, with the balance (7.9%) having insufficient documentation. According to CMS data, the projected overpayments for this claim sample are $12.9 million.

The agency stated that the JZ modifier (zero drug amount discarded/not administered to any patient) “will be required for all drugs separately payable under Part B that are designated as a single-dose container on the FDA-approved label or package insert for which there are no discarded amounts” in the 2023 Medicare Physician Fee Schedule (MPFS), published Nov. 18, 2022. All suppliers and providers who purchase and bill Medicare Part B separately payment medications (single dose container/package) are subject to the JZ modifier. The modifier is eligible for billing as of January 1, and CMS has given providers until July 1 to adopt it.

It may not come as a surprise that there are so many doctors running for politics given that healthcare is a major legislative priority. According to the Patients Action Network of the American Medical Association, 19 doctors are currently serving in the 118th Congress. The task ahead for these 19 congressional representatives will be challenging. The AMA is concentrated on stopping Medicare payment cuts and implementing prior authorization reform among the myriad healthcare concerns facing the nation.