ADVOCACY
HELPFUL LINKS
National Policy Resources—Local Advocacy Results
As cancer care professionals who experience the challenges of providing quality cancer care first-hand, IOS members are well positioned to educate decision-makers on how coverage and reimbursement issues affect community oncology. State and federal legislation can have a significant impact on the financial viability of local cancer programs, which is why it's so important that our members make their voices heard.
In an effort to provide resources needed to effectively advocate on the issues that are important to them, our redesigned advocacy webpage features activity from the Centers for Medicare & Medicaid Services (CMS), national healthcare coverage through the Association of Community Cancer Centers (ACCC), local news articles and webinars, and more.
We want to hear from you! If there is a specific piece of legislation you want to know more about, an important resource we're missing, or if you want to get more involved, please contact us!
Implementing the New CMS Reimbursement Billing Codes for Patient Navigation Services
As of January 1, 2024, the Centers for Medicare and Medicaid Services introduced new codes so that Medicare could reimburse for patient navigation services. To address challenges of implementation, the Association of Cancer Care Centers, in partnership with TACOS and 11 other state societies from CO, IN, IA, NV, NM, NY, NC, SC, WA, WI, and WY, has a 4-part webinar series, Implementing the New CMS Reimbursement Billing Codes for Patient Navigation Services, hosted by Teri Bedard of Revenue Cycle Coding Strategies.
State Advocacy
House Unanimously Votes to Curb Non-Medical Switching of Prescriptions
The Iowa House has unanimously voted to set new rules to prevent prescription drug switches that are not done for medical reasons. Representative Gary Mohr of Bettendorf said this is to protect patients from being denied coverage or being required to accept higher co-pays in the middle of a health plan’s year.
Do you have a patient that has experienced this challenge? We would like to speak with you and/or the patient. Our goal is to share as many of these stories with Iowa legislators as we can. We can help put the message together and, if you’re interested, set up a meeting with your legislator. To participate, please contact Lu Anne Bankert at !lbankert@accc-cancer.org by Thursday, March 23, 2023.
Federal Advocacy
IOS Joins Coalition Letter Urging Addition of the Cures 2.0 Concept Paper Title IV Provisions in the Next COVID-19 Relief Package
The Iowa Oncology Society (IOS) joined in a coalition letter to congressional leadership urging that Congress include the 21st Century Cures 2.0 concept paper, recently released by Representatives Diana DeGette and Fred Upton in upcoming legislation to further address the COVID-19 public health crisis. Specifically the letter urges leadership to include policy to provide Medicaid coverage of the routine care costs of clinical trials participation for patients with life-threatening conditions in every state. This critical protection is championed by Representatives Ben Ray Luján and Gus Bilirakis in the Clinical Treatment Act (H.R. 913).
The New CMS Navigation Reimbursement Billing Codes: A 101
The 2024 Physician Fee Schedule included 7 new codes specific to care management. This webinar reviews how these differ from the care management codes available from the American Medical Association, common questions, and challenges for implementing these new codes.
Access SlidesPrincipal Illness Navigation (PIN) Services Documentation, Coding, and Billing
The 2024 Physician Fee Schedule includes four new codes specific to Principal Illness Navigation–Peer Support. With these new codes, providers will be able to bill for the services of navigators, social workers, and support personnel. This webinar goes into a deep dive, reviewing components of the new codes, answering common questions, and addressing challenges for providers.
Access SlidesAMA CPT® Coding Update for Oncology Navigation Services and The Cancer Moonshot
The American Medical Association (AMA) released a coding update for oncology navigation services in alignment with The Cancer Moonshot program. Featuring discussion on the updates and guidelines from the AMA and review of the components of the AMA’s codes, how these differ from the codes from CMS, and challenges for providers.
Access SlidesCHI & SDOH Risk Assessment Documentation, Coding, and Billing for Oncology Providers and Administrators & Series Wrap-up
The 2024 Physician Fee Schedule includes seven new codes specific to CHI services, SDOH Risk Assessment, and Principal Illness Navigation–Peer Support. With these new codes, providers can bill for the services of navigators, social workers, and support personnel. This final installment reviews the components of these new codes, common questions, and challenges for providers.
Access SlidesFROM THE ACCC BLOG
ADVOCACY IN THE NEWS
CMS Announces CY 2023 HOPPS Proposed Rule
On July 15, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2023 Medicare Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, including proposals that align with several key goals of the Biden Administration like advancing health equity in rural areas, promoting competition in the healthcare system, and promoting safe, effective, patient-centered care.
For more information, read the proposed rule and the CMS fact sheet.
Posted 7/18/2022
CMS Stakeholder Call: Strategic Plan Update
Administrator of the Centers for Medicare & Medicaid Services (CMS) Chiquita Brooks-LaSure and her leadership team will provide an update on the agency's recent accomplishments, including how its initiatives are advancing the CMS strategic plan.
When: July 19, 2022 from 1:00-2:00 PM EDT.
Who: National and local CMS stakeholders and partners.
Register to attend and visit the CMS website for more information.
Posted 7/14/2022
CMS Announces CY 2023 PFS Proposed Rule
On July 7, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) proposed rule, which would significantly expand access to behavioral health services, Accountable Care Organizations (ACOs), cancer screening, and dental care—particularly in rural and underserved areas.
“Integrated coordinated, whole-person care—which addresses physical health, behavioral health, and social determinants of health—is crucial for people with Medicare, especially those with complex needs,” said Dr. Meena Seshamani, deputy administrator at CMS and director of the Center for Medicare. “If finalized, the proposals in this rule will advance equity, lead to better care, support healthier populations, and drive smarter spending of the Medicare dollar.
For more information, read the proposed rule as well as the CMS press release and fact sheet.
Posted 7/8/2022
ACS National Consortium Releases Recommendations to Increase Screening
On February 16, 2022, the American Cancer Society's National Consortium for Cancer Screening and Care (ACS National Consortium) announced new cancer screening recommendations to accelerate recovery from the COVID-19 pandemic. These recommendations also look to improve the United States' ability to provide quality cancer screening and care for all.
The nine consensus recommendations include themes on:
- National partnerships
- Coordinated messaging
- Proven programs
- Quality measures
- Pandemic-related innovations
- Public trust
- Comprehensive preparedness plans
- Transdisciplinary teamwork
- Document and understand cancer disparities.
Posted 7/8/2022
New CMS Data Shows Increased Medicare Telemedine Utilization During COVID-19
On December 3, 2021, the Centers for Medicare and Medicaid Services (CMS) released a new data snapshot, featuring telemedicine utilization data that make the case for expanded and permanent telehealth coverage for Medicare beneficiaries.
These data are about people with Medicare who used telemedicine services between March 1, 2020, and February 8, 2021, and they come from Medicare Fee-for-Service data, Medicare Advantage encounter data, and Medicare enrollment information.
CMS states that the agency has seen large increases in telemedicine use during the defined time frame with variations across geographic and demographic groups. This increase is credited to the agency's expansion of telemedicine services during the COVID-19 public health emergency.
The snapshot shows that telemedicine utilization (e.g., telehealth, e-visits, and virtual check-ins) increased from 910,490 unique users pre-pandemic to 28,255,180 unique users during the pandemic. And the majority (53%) of the pandemic's telemedicine users were Medicare beneficiaries. To see a detailed breakdown of these data, read the full snapshot report.
For more information on Medicare's telemedicine expansions, visit its dedicated telehealth website.
Posted 12/9/2021
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