02/05/2019

Important Oncology Related News

MIPS 2019 Payment Adjustment Confusion

Practices have reported that they are receiving MIPS adjustments on not just their Physician Fee Schedule services but also on their Part B drugs!  Both ASCO and COA are looking into this issue and have found conflicting information.  

Remember, the adjustments in 2019 are based on services from 2017.  We've been told for services in 2017 - Part B Drugs were still considered for the Adjustment.  Beginning in 2018 - they carved that out (Act of Congress - Final Rule)
 
"Beginning with the 2018 performance year, the MIPS payment adjustment percentage will be applied only to Medicare Part B “covered professional services”. That means, most prominently, no MIPS payment adjustment for Part B drugs."

However, CMS released a Fact Sheet where it states:

Application of Payment Adjustments - Payment adjustments will only apply to payments made for covered professional services for which payment is made under, or is based on, the Medicare Physician Fee Schedule and are furnished by a MIPS eligible clinician. The payment adjustment will not apply to Medicare Part B drugs or other items and services that are not covered professional services. The payment adjustment is applied to the Medicare paid amount, so it does not impact the portion of the payment that a beneficiary is responsible to pay.  (CLICK HERE to view fact sheet)

So, is it your money or should you be expecting a CMS take back for these payments?  The answer is unknown at this time and hopefully this will be addressed very soon!

Trump Administration Proposes Big Changes In How Prescription Drugs Are Priced

(Washington Post) Jan 31, 2019 - The Trump administration on Thursday proposed bringing transparency to one of the most secretive aspects of drug pricing by ending the widespread practice of rebates to middlemen — an effort to reduce what consumers pay for prescription medicine. 

Read Article (free registration required) 

COA Applauds HHS for Taking Strong Step Towards Ending Secretive Rebate System

(COA) Feb 1, 2019 - The Community Oncology Alliance (COA) applauds President Donald Trump, Health and Human Services Secretary Alex Azar, Inspector General Daniel Levinson, and HHS staff for the just released, ambitious proposal to overhaul the nation’s secretive drug rebate system. 

Read Press Release

More than 60 Leading Health Care Organizations Call on CMS to Maintain Coverage for Medically Necessary Cancer Testing

(AMP) Feb 1, 2019 - Overly broad interpretation of national coverage determination for next generation sequencing restricts Medicare beneficiary access to vital testing and adversely impacts cancer care. 

Read Press Release

CMS proposes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage

January 30, 2019 - Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.  READ MORE