Articles related to MEDICARE

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.

A video conversation between a senior advisor at ADVI, a physician from Texas Oncology, and the division director of practice health for ASCO discuss the main provisions of the Inflation Reduction Act (IRA) and its implications for oncologists and oncology practices. The panel discusses why practices may have to bear a larger share of the cost of drugs and be ready for utilization cuts by focusing on two important aspects of the IRA: the $2,000 cap on patients’ out-of-pocket expenses and Medicare price negotiation. All three concur that if the act isn’t changed, it might slow down the development of medicines for some indications.

Published in its entirety in the Journal of the American Geriatrics Society and available here from Guideline Central, the AGS Beers Criteria® also includes a host of resources— from mobile apps to a pocket reference card. The five lists included describe particular medications with evidence suggesting they should be avoided, used in caution, or dosed differently.

In this JAMA Original Investigation, the researchers studied 19,529 patients with Medicare coverage who initiated first systemic therapy for advanced non–small cell lung cancer (NSCLC) using 1 of 4 regimens of checkpoint inhibitor immunotherapy, cytotoxic chemotherapy, and combined chemoimmunotherapy. The goal? To gauge the uptake and effectiveness of immunotherapy among older patients outside clinical trials.