10/16/2018

Important Oncology Related News

CMS Accelerates Innovation and Promotes Patient Access to Medical Technology

Includes changes to the LCD Process for All MACS!  Reforms to Medicare’s Local Coverage Determination process will increase transparency and patient engagement in order to ensure that Medicare beneficiaries have access to the latest therapies and devices.

Important changes to the manual include:

• Requiring a consistent, standardized summary of the clinical evidence supporting LCD decisions 
• Including a beneficiary representative and other healthcare professionals in addition to physicians (e.g. nurses, social workers) on Contactor Advisory Committees that inform LCDs 
• Ensuring that Contractor Advisory Committee meetings are open to the public

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ATTENTION ALL MSHO MEMBERS - Managed Medicare Audits on Waste!

Make sure you are purchasing and utilizing the smallest vial when wasting drugs!

BRAND NEW AND VERY IMPORTANT – NEW AUDITS – Medicare Plus Blue recently began auditing drug waste – Priority Advantage to begin soon!  Some of the take backs have been incorrect and MSHO is working with our members' offices to have their money refunded. Some member offices have received take backs because they did not purchase the smallest available vial and therefore the waste they received reimbursement on was more than allowed and the monies are being taken back!

Medicare policy states:  

If the provider must discard the remainder of a single-use vial or other package after administering the prescribed dosage of any given drug, Medicare may cover the amount of the drug discarded along with the amount administered. The following elements must be followed in order for the discarded amount to be covered. 

1. The vial must be a single-use vial. Multi-use vials are not subject to payment for any discarded amounts of the drug. 

2. The units billed must correspond with the smallest dose (vial) available for purchase from the manufacturer(s) that could provide the appropriate dose for the patient. 

3. The left-over amount must actually be discarded and may not be used for another patient regardless of whether or not that other patient has Medicare.