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Practice Management Series 2004 2005

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Understand 'investment mentality' and be able to classify your practice ... Webster's New Twentieth Century Dictionary, Unabridged. Why is efficiency important? ... – PowerPoint PPT presentation

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Title: Practice Management Series 2004 2005


1
Practice Management Series 2004 - 2005
  • Presented in Conjunction with

2
Thomas R. Barr, MBA Louisiana Oncology
Society May 14, 2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
3
Who should attend
  • Physician Leader of the Practice
  • President of the PA, Founder
  • Practice Administrator
  • CEO, Executive Director, COO
  • Contracting Officer
  • Contract Administrator, Director of Billing
  • Clinical Manager
  • Medical Director, Nursing Team Leader

4
At the end of this session, you will
  • Know why your practice needs to change
  • Understand investment mentality and be able to
    classify your practice in terms of investment
    potential
  • List the common characteristics of effective
    physician practice leaders
  • Understand the relationship between the physician
    practice leader and the practice administrator
  • Be able to apply simple self assessment tools to
    position your group to take advantage of market
    changes today

5
The Old Days Median Per FTE Medical
Oncologist Compiled from MGMA Cost Survey through
2003 Report on 2002 Data. Second order polynomial
trend lines by OM
Why Change?
6
Eroding Margins Per Oncologist with projections
by Oncology Metrics
Why Change?
Now
Then
7
Service Line Changes Five physician practice
2004 Compared to 2003
Why Change?
8
Service Line Changes Five physician practice
2005 Compared to 2003
Why Change?
9
Why Change
  • Because we must change
  • Population economics demand it
  • GDP growth cant match Boomers march into SEER
    cohorts
  • Other sectors or medicine have done it
  • DRGs, ACPs, Cardiology, Radiology
  • Market dynamics support it
  • Everywhere the old order changes, and happy are
    those who can change with it. Sir William Osler,
    1895

Because it is wise to change
10
Developing Investment Mentality
Rising Demand
Increasing Market Share
Problem Child
Rising Star
?
Mature Investment
Dog

Modified BCG Business Growth Matrix
11
Dog ?
Problem Child
  • Practice sees a low of new cancer cases in
    market
  • Overall market for cancer services is stagnant,
    shrinking, or being consumed by competitors
  • Presently failing, either rapidly or slowly and
    showing declining period-to-period revenue
  • Stagnation of capital investment
  • Susceptible to sudden closings
  • Smart dogs join up to form a dog pack
  • Typical of a new practice or outreach clinic in a
    new service area
  • operations need investment
  • offer the potential of rapid growth
  • always have high costs initially
  • must be properly capitalized to keep from running
    out of money just before they take off
  • shows real potential
  • has a sustainable customer base

12
Mature Investment
Rising Star
  • High market share
  • Stable business with revenue growth driven by
    existing customers and products.
  • Weak need or desire to innovate means low to no
    capital needed
  • Profits are high and the contribution margin is
    also high
  • Must maintain the strong market position as
    competition wants to enter and claim margin
  • Certain growth in demand for cancer services.
  • Declining or stable number of providers able to
    meet increasing demand
  • Significant barriers to entry for new competitors
  • Financing mechanism for many service buyers
  • Legacy of inefficient operations offer
    significant process improvement opportunities
  • Promising new technology offering significant
    opportunity for service line expansion

13
Evaluating Product and Service Lines for
Additional Investment
Investment Mentality
  • In-house pharmacy is a Product Line
  • Research is a Product Line
  • Chemo. Admin. is a Service Line
  • Patient EM is a Service Line
  • Laboratory is a Service Line
  • RT is a Service Line
  • CAT/PET is a Service Line

?
?


14
To execute growth, you must have Management
  • Physician Leader
  • Seeing patients but on a reduced schedule
  • About .5 FTE physician
  • One of the founders or otherwise senior
  • Active in hospital or community
  • Can say I dont know, let me think about that
  • Was (or is) the productivity leader
  • Trusts the administrator
  • Administrator
  • Trained MBA, CPA, MHA
  • Can read and write basic contracts
  • Computer literate and analytically proficient
  • Can say I dont know, let me think about that
  • Trusts the physician leader

15
To execute growth, you must have Patients
Investment Mentality
  • Counting the number of new patients that are seen
    in your practice is the starting point of most
    feasibility studies.
  • New patients are the denominator across which to
    leverage investment and costs.
  • 1,500 new patients/yr. can generally support a
    CT and/or PET with reasonable margins

16
New Patients / Physician AOHA/MGMA 2003 Report on
2002 Data
Investment Mentality
17
Building New Patient Flow Physician Practice
Leaders Role
  • Promote and support the ability of the physician
    team to build and maintain a powerful referral
    system that will provide at least 400 new
    patients/year/physician.
  • Design clinical staffing pattern sufficient to
    support time for physicians to pay attention to
    referral patterns.

18
Building New Patient Flow Physician Practice
Leaders Role
  • Build partnership and pay policy that rewards
    individual and group efforts to build patient
    referrals.
  • Routinely measure and discuss referral patterns
  • Support your administrator by not allowing staff
    to circumvent or undermine your joint initiatives.

19
Building New Patient Flow Administrators Role
  • Develop reliable ways to count new patients and
    their referral source
  • Monitor and understand the insurance status of
    incoming patients looking for patterns by
    referral source
  • Reward front office staff for facilitating
    incoming calls from referrals sources to a
    physician
  • Support your physician leader by not allowing
    staff to circumvent or undermine your joint
    initiatives.

20
To plan for growth, you must have Managerial
Measurement
Investment Mentality
  • Not for tax purposes
  • You get to make estimates and judgments.
  • On an accrual basis
  • Balance sheet shows what you own and what you
    owe.
  • PL shows what you earned, (whether you have been
    paid or not) and what you bought (whether you
    have paid for it or not).

21
Sample Balance Sheet
Investment Mentality
22
Managerial measurements produce Financial
Indicators that are
  • Important to the bottom line
  • Easy and reliable
  • Benchmarked on a FTE physician basis
  • Tied to new patient accrual

23
Sample PL Per Physician
24
Steps to Managerial growth oriented Service Line
Accounting
  • Identify revenue centers from procedure
    productivity report. This will also give you the
    gross revenue (collections) for each center.
  • Allocate the direct cost to each revenue product
    or service line as these are incurred in the
    production of the product of service.
  • Allocate shared, or indirect, costs across
    product and service lines in relation to the
    gross profit from each product line. Collections
    - direct costs gross profit.
  • Calculate net profit for each product line. Gross
    revenue direct costs indirect cost net
    profit.

25
Managerial Measurement Physician Practice
Leaders Role
  • Learn to read your basic financial statements
    Balance Sheet, PL, Statement of Cash Flows
  • After you learn to read them, dont insist that
    other physicians do the same
  • Understand how the basic financial statements
    inform your managerial measurements

26
Managerial Measurement Physician Practice
Leaders Role
  • Be the one who reports managerial measures to the
    physicians of your group
  • Only report the three managerial metrics you
    think are most important for example
  • New patients/FTE physician ytd. vs. goal vs.
    prior period
  • Revenue/FTE physician ytd. vs. goal vs. prior
    period
  • Cost/FTE physician - ytd. vs. goal vs. prior
    period
  • Support your administrator by not allowing staff
    to circumvent or undermine your joint initiatives.

27
Managerial Measurement Administrators Role
  • Learn to read your basic financial statements
    Balance Sheet, PL, Statement of Cash Flows
  • After you learn to read and understand them,
    review these regularly with your physician
    practice leader
  • Understand how the basic financial statements
    inform your managerial measurements

28
Managerial Measurement Administrators Role
  • Be prepared to provide supporting details when
    the physician leader reports managerial measures
    to the physicians of your group
  • Double check the managerial measures to make sure
    they agree with the basic financial statements
    and are consistent with past reports.
  • Support your physician leader by not allowing
    staff to circumvent or undermine your joint
    initiatives.

29
To execute growth, you must have Capital
  • All business expansion requires capital
    investment.
  • All business expansion that is properly executed
    supports both the cost of capital and repayment
    of capital.
  • ROI means Return on Investment

30
To execute growth, you must have Capital
Investment Mentality
  • IRR means Internal Rate of Return
  • Retained Earnings are the source of most business
    capital.
  • Debt is a tool of expansion.

31
Capital Resources Physician Practice Leaders
Role
  • Understand the clinical drivers behind all
    capital investments
  • Assure yourself that new patient referrals are
    not threatened by capital projects
  • Talk to other physicians who have made similar
    decisions and learn from them

32
Capital Resources Physician Practice Leaders
Role
  • Be the financial spokesperson to your groups
    physicians
  • Explain the need to create capital reserves and
    retain earnings
  • Be willing to equitably shoulder capital risk
  • Support your administrator by not allowing staff
    to circumvent or undermine your joint
    initiatives.

33
Capital Resources Administrators Role
  • Perform all analysis for new product line
    development
  • Capital requirements, affect on referral
    relationships, cash flow, and staffing needs
  • Development convincing managerial measurements
    that inform capital decisions
  • Establish banking relationships and instruments
    that cushion practice from capital shocks

34
Capital Resources Administrators Role
  • Plan a margin of safety into every capital
    project
  • Establish an internal Hurdle ROI and only
    recommend projects that are above that rate
  • Be willing to equitably shoulder capital risk
  • Support your physician leader by not allowing
    staff to circumvent or undermine your joint
    initiatives.

35
"Risk comes from not knowing what you're doing."
Why do all of this?
  • Warren Edward Buffett  (1930- ), Reasonably
    successful American financier, chairman of
    Berkshire Hathaway Inc.

36
Practice Management Series 2004 - 2005
  • Presented in Conjunction with

37
Elaine Towle Louisiana Oncology Society May 14,
2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
38
Generating Practice Efficiencies
  • Streamlining work flow
  • Increasing patient flow per physician
  • Maximizing charge capture
  • Managing expensive inventories
  • Lowering cost

39
Who should attend
  • Physician Leader of the Practice
  • President of the PA, Founder
  • Practice Administrator
  • CEO, Executive Director, COO
  • Contracting Officer
  • Contract Administrator, Director of Billing
  • Clinical Manager
  • Medical Director, Nursing Team Leader

40
At the end of this session, you will
  • Be able to perform a simple assessment to
    identify areas where cost savings may be found
  • Know how to plan to implement beneficial changes
    in these areas
  • Believe that 2004 offers the time to prepare for
    new realities of community oncology practice

41
  • Efficiency
  • Ability to produce the desired effect with a
    minimum of effort, expense or waste
  • Websters New Twentieth Century Dictionary,
    Unabridged

42
Why is efficiency important?
  • The oncology world has changed….
  • …life as you know it is over
  • Medicare Prescription Drug Improvement and
    Modernization Act (MMA) 2003

43
The Old Days Median Per FTE Oncologist Compiled
from MGMA Cost Survey through 2003 Report on 2002
Data. Second order polynomial trend lines by OM
44
The Old Days Per Median Oncologist Source
MGMA\AOHA Cost Survey
45
MMA Impact Per Oncologist with projections by
Oncology Metrics
Why Change?
Now
Then
46
Practice Efficiency Focus on Largest Expenses
First AOHA/MGMA 2003 Report on 2002 Data
47
Practice Efficiency
  • Drug Management
  • Staffing
  • Ensure that you are using all staff in the most
    appropriate way for the size of your practice
  • Manage your overtime
  • Task Analysis
  • Who does it?
  • Can anyone else do it?
  • How do they do it?
  • Can it be done better?
  • Consider variations in small, larger practices

48
Benchmarking
  • Why?
  • Benchmark your practice metrics to discover
    potential work flow and/or staffing efficiencies
  • Lower the cost of practice operations
  • Better inventory control
  • Improved patient scheduling
  • Streamlined work flow from clinic to billing
    office

49
Benchmarking
  • How?
  • Informal conversations, visits with colleagues,
    oncology practice list serves
  • More formal use a standard such as MGMAs Cost
    Survey for Hematology Oncology Practices
  • Most important to benchmark against yourself over
    time

50
COGS Benchmarking Using the MGMA AOHA
Hematology/Oncology Cost Survey 2003 Report
Based on 2002 Data
1 Cost
51
COGS Benchmarking Using the MGMA AOHA
Hematology/Oncology Cost Survey 2003 Report
Based on 2002 Data
1 Cost
  • Write down your COGS for 2003
  • Multiply it by .87 to adjust for 13.4 increase
    in COGS 2002 to 2003 (based on prior 2 years
    increase)
  • Divide it by 1,053,518, the survey median COGS
    per Physician in 2002
  • Result is the number of physicians that your COGS
    would support
  • Compare this to actual physicians and if it is
    much higher or lower, keep asking why

52
Drug Management
1 Cost
  • Drug procurement and inventory management
    processes must be tight
  • Contracting
  • Ordering
  • Inventory management
  • Monthly reports - match inventory levels to
    billed units
  • Who is managing this process for your practice?

53
Drug Management
1 Cost
  • Look at how you add new drugs to your practice
    formulary to assure financial feasibility
  • Practice standardization, pharmaco-economics
    review
  • Start simple - hydration, anti-emetics
  • Then look at treatment protocols by disease, one
    disease at a time
  • Knowledge is power, you cant control what you
    dont measure

54
Drug Management
1 Cost
  • Pharmacy safety
  • OSHA fines are expensive
  • Nursing policies
  • Errors are expensive charge capture errors,
    chemo preparation errors
  • Who is mixing your drugs?
  • Recent articles indicate 50 nurses, 50
    pharmacists
  • Dependent on practice size, state regulations

55
Physician Productivity Benchmarking Using the
MGMA AOHA Hematology/Oncology Cost Survey 2003
Report Based on 2002 Data
2 Cost

56
Physician Productivity Benchmarking Using the
MGMA AOHA Hematology/Oncology Cost Survey 2003
Report Based on 2002 Data
2 Cost
  • Write down the number of consultations and new
    patients (99241-99255, 9920199205) in 2003
  • Divide it by 231, the survey median of
    consultations per physician in 2002
  • Result is the number of physicians that your new
    patient service volume would support
  • Are you above or below the actual number of
    physicians in your practice?
  • Why?

57
Relative Benchmarks
  • 1. New Patients and COGS are both greater than
    the actual number of physicians and yielding
    about the same physician count
  • Indicates good physician utilization and pharmacy
    control
  • 2. New Patients about right but COGS shows higher
    number of physicians
  • Indicates potential savings at COGS management

58
Increasing Patient Flow Physicians Should…
2 Cost
  • Communicate with referring physicians this
    drives practice growth
  • See new patients this drives practice growth
  • Be seen at the hospital and participate in
    medical staff life
  • See follow-up patients on a regular, clinically
    appropriate basis
  • Delegate some follow-up visits to other providers
    as appropriate PA, NP, RN
  • Ensure quality of care throughout practice

59
Increasing Patient Flow Physicians Should Not…
2 Cost
  • Routinely be late for clinic
  • Spend time filling out forms (ex. disability,
    tumor registry)
  • Routine patient education
  • Return routine patient phone calls (prescription
    refills, etc.)
  • Micro-manage staff
  • Undermine authority of administrator

60
Increasing Patient Flow Administrators Should…
2 Cost
  • Assure that there are adequate exam rooms for
    each physician
  • Provide appropriate patient scheduling,
    individualized by physician if necessary
  • Use other staff, clinical and administrative, to
    free up physician time whenever possible

61
Increasing Patient Flow Administrators Should Not…
  • Practice medicine or offer their clinical opinion
    to anyone, ever!
  • Undermine the clinical authority of any of the
    practice physicians
  • Undermine the business and leadership authority
    of the physician leader

62
Increasing Patient Flow Should you consider a
Non-Physician Practitioner?
2 Cost
  • Also known as mid-level providers, includes PA,
    NP, CNS
  • Increase patient volume at less expense than
    adding a physician
  • Allow more flexibility in scheduling patient
    visits, more consistent schedule than physicians
  • Generate revenue for practice even if physician
    is out of office
  • Coverage for physician vacations better
    continuity of care

63
Increasing Patient Flow Non-physician
Practitioners Should…
2 Cost
  • Work as an adjunct to the physicians
  • See routine follow-up patients, chemotherapy
    visits, other routine visits
  • Allow physicians to see more new patients,
    consultations
  • Serve as a resource for nurses, other staff

64
Increasing Patient Flow Non-physician
Practitioners Should Not...
2 Cost
  • See new patients
  • Practice beyond their state scope of practice

65
Practice Efficiency Nurses Should…
3 Cost
  • Administer chemotherapy patient assessment,
    check doses, discuss side effects, prepare chemo
    in some practices
  • Counsel patients symptom relief, social issues
  • Phone triage - answer patients symptom-related
    phone calls
  • Patient education
  • Help with drug assistance programs and indigent
    drug forms

66
Practice Efficiency Nurses Should Not…
3 Cost
  • Handle pre-certs, pre-auth
  • File
  • Schedule appointments

67
Practice Efficiency Chart flow

3 Cost
  • Can you find a chart when you need it?
  • How does it get from file to desk or file to exam
    room?
  • Who gets it there?
  • Do you have a policy on charts leaving the
    office?
  • How long (and how many staff) does it take to
    find a chart that is MIA?

68
Practice Efficiency Patient Flow
3 Cost
  • How do your patients get from waiting room to
    exam room?
  • Who checks vital signs, preps patients for their
    visit?
  • Who assists the physician with exams?
  • Who gives injections?
  • Does it have to be a nurse?

69
Other Efficiency Opportunities
  • Billing is important
  • Review your billing processes
  • Charge capture
  • Who selects the level of service?
  • Chart reviews to find lost charges and injections
  • Charge entry
  • How quickly are your charges billed to insurance?
  • Superbill
  • Is it updated every year?
  • Training
  • Billers, nurses
  • Coding updates

70
Other Efficiency Opportunities
  • Collecting is important too!
  • Financial Counseling
  • Identify patients with no insurance, poor
    insurance
  • Identify patients with no 2nd insurance
  • Refer patients to appropriate resources
  • Inform the physician and nurse of insurance
    issues as soon as they are identified

71
Other Efficiency Opportunities
  • Purchasing
  • Chemotherapy Drugs shop wholesalers
  • Medical supplies put out to aggressive bidding
    process
  • Office supplies whos in charge? Dont let the
    little things add up

72
Other Efficiency Opportunities
  • Information Systems
  • Practice management system
  • Network administration
  • Software and hardware support
  • Clinical Management Systems - LIS, EMR

73
  • Efficiency
  • Ability to produce the desired effect with a
    minimum of effort, expense or waste
  • Websters New Twentieth Century Dictionary,
    Unabridged

74
Practice Management Series 2004 - 2005
  • Presented in Conjunction with

75
Elaine Towle Louisiana Oncology Society May 14,
2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
76
Adapting to Changes in Medicare
  • Identifying and understanding the Medicare
    changes in 2004 and their effect on your practice

77
Who should attend
  • Physician Leader of the Practice
  • President of the PA, Founder
  • Practice Administrator
  • CEO, Executive Director, COO
  • Contracting Officer
  • Contract Administrator, Director of Billing
  • Clinical Manager
  • Medical Director, Nursing Team Leader

78
At the end of this session, you will
  • Be able to assess the degree to which your
    practice has made the necessary changes to adapt
    to new Medicare regulations
  • Understand the new regulations and be sensitive
    to the threats and opportunities they embody
  • Be prepared to adapt to further changes as we
    move to a very low margin on all chemotherapeutic
    and supportive care products
  • Understand the role of the physician practice
    leader and the administrator in adapting to these
    changes

79
Medicare Prescription Drug, Improvement, and
Modernization Act of 2003
  • Average Wholesale Price decrease with most drugs
    at 85 of AWP April 1, 2003
  • Drugs without an AWP as of this date will be
    reimbursed at 95 of AWP
  • As of April 1, 2004, 5 drugs repriced, on appeal,
    by CMS
  • 2004 Conversion factor at 37.3374 (1.5 over
    2003)
  • 0.17 RVUs added for chemotherapy administration
    practice expense
  • 32 transitional add-on to the practice expense
    component for 2004 only

80
Relative Value Calculations
  • Code 96410 (infusion, 1st hour)

81
Relative Value Calculations
  • Code 99214 (level 4 office visit)

82
MMA Impact Per Oncologist with projections by
Oncology Metrics
Why Change?
Now
Then
83
2005 - ASP
  • Transitional 32 increase reduced to 3 for chemo
    therapy administration codes
  • ASP 6 for drugs
  • RVUs will be reviewed

84
2006 Competitive Bidding Option Added
  • Physicians must choose between
  • ASP 6 or Competitive Acquisition
  • (bidding process has not yet
  • been established)

85
Billing Hotspots
  • 99211 Minimal visit, physician presence not
    required
  • As of 1/1/04 cannot be used the same day
    chemotherapy is administered
  • Other EM services may be billed with a -25
    modifier if medically necessary
  • Document all services

86
Billing Hotspots
  • 96408 Chemotherapy administration, intravenous
    push technique
  • Prior to 1/1/04 only one push code was allowed by
    Medicare
  • After 1/1/04 multiple push codes are allowed for
    chemotherapy drugs when multiple chemotherapy
    drugs are administered on the same day
  • It is not clear how commercial carriers will
    address this change

87
Billing Hotspots
  • 96410 Chemotherapy administration,
  • infusion technique, up to one hour
  • Multiple infusion codes are still not allowed,
    even when multiple chemotherapy drugs are
    administered on the same day

88
Drug Billing Units Changes
  • Before 2004
  • Oxaliplatin 50mg J3490 unlisted code
  • Neulasta 1mg J3490 unlisted code
  • Epirubicin 50mg J9178
  • 2004
  • Oxaliplatin 0.5mg J9263
  • Neulasta 6mg J9205
  • Epirubicin 2mg J9178

89
Revenue Trends
Margin in the drugs we used
Margin on Services we Provide
Slopes are not equal. Overall combined margins
are declining
2004
2005
2006
2007
90
Act Now
  • Stop billing leaks
  • Capture all service charges
  • E M
  • Chemotherapy administration
  • Therapeutic Infusion
  • Laboratory
  • Documentation is critical
  • Dont lose any drug charges!
  • Chemotherapy
  • Supportive care

91
Act Now
  • Understand rule changes
  • Document and bill by the rules (CMS, AMA)
  • Disseminate billing and coding information in
    your practice
  • Update drug pricing/charges ASAP
  • Update fee schedule, superbill at least yearly
  • Dont miss any billing opportunities

92
Act Now
  • Financial consultation
  • Know your patients insurance status BEFORE
    treatment
  • Identify co-pay, co-insurance problems
  • Have a plan for indigent care
  • local/state resources
  • pharmaceutical companies
  • www.needymeds.com

93
FAQ Multiple pushes of chemotherapy agents are
now allowed on the same day
  • Q. Is it necessary to append a modifier to CPT
    Code 96408 (CHEMOTX ADMIN IV, PUSH)?
  • A. No modifier should be necessary. The CMS-1500
    form should include the HCPCS code for each drug
    administered via push and CPT code 96408 with the
    corresponding number of units.

94
FAQ EM Service with Chemo Administration
  • Q. Is a separate (non-chemotherapy, non-cancer
    related) diagnosis required to bill a separately
    identifiable evaluation and management service in
    conjunction with chemotherapy administration?
  • A. No. There is no requirement that a separate
    diagnosis must be reported to justify billing for
    a separately identifiable EM service in
    conjunction with chemotherapy administration.

95
FAQ EM Service with Chemo Administration
  • Q. What sort of documentation is required to
    justify billing an EM visit in conjunction with
    a chemotherapy administration code?
  • The documentation requirements have not changed.
    Chart documentation for the EM service must
    justify the level of visit being billed, in
    accordance with either the 1995 or 1997 Medicare
    documentation guidelines.
  • Bill for the EM service using the -25 modifier
    along with the appropriate EM Code.
  • NOTE 99211 cannot be billed if chemotherapy is
    administered the same day.

96
FAQ EM Codes with non-chemotherapy infusion
  • Q. Can CPT 99211 (established patient, may not
    require physician presence) be billed with
    non-chemotherapy drug infusion code (90780
    -90781)?
  • ASCOs understanding of CMSs current payment
    policy is that a 99211 should NOT be billed on
    the same date of service as the nonchemotherapy
    infusion.
  • If a higher level office visit occurs, the -25
    modifier should be used with the EM code and
    appropriate documentation should be provided.

97
FAQ EM Codes with non-chemotherapy injection
  • Q. Can CPT 99211 be billed with non-chemotherapy
    drug injection codes (90782 90788)?
  • A. No. CMS has not changed its existing policy.
    It is not permissible to bill for a
    non-chemotherapy injection code on the same day
    as another physician service. If a 99211 visit is
    billed, 90782 should not be billed.

98
FAQ Billing Units
  • Q. Some billing software will not accept the 3
    digit unit that is required to bill
    Eloxatin/Oxaliplatin. The new HCPC code is for
    only 0.5 mg. A typical dosage of 150 mg will
    equal 300 units (3 digits). How should this be
    billed?
  • HIPAA compliant electronic transactions should be
    able to accommodate 3 digit billing fields so if
    yours doesnt, think about an upgrade. In the
    meantime, you should bill on separate lines with
    no two lines having the same number of units.
    For example, you would bill 300 units as
    J9263 x 99 units
  • J9263 x 98 units
  • J9263 x 97 units
  • J9263 x 6 units.

99
Role of the Physician Practice Leader
  • Stay current on the moving target of Medicare
    rules and regulations
  • Reinforce to your partners the importance of
    Medicare compliance
  • A great resource is the CMS Carrier Advisory
    website, and the CAC website
  • Work with your state society to establish
    productive relationships with your Medicare
    carrier and commercial payers
  • Support your Practice Administrator as they
    implement policies to deal with these changes

100
Role of the Administrator
  • Update your coding books, reference materials,
    fee schedule, superbill annually or as changes
    occur
  • Ensure that your staff is knowledgeable about
    reimbursement issues for all payers
  • Establish and implement policies to immediately
    respond to changes as they occur
  • Enroll in Medicare list serves to stay up-to-the-
    minute on changes
  • Work cooperatively with your physician leader in
    providing leadership for your staff in this
    challenging environment

101
Know Your Medicare Carrier
  • Carrier Website
  • http//www.lamedicare.com/
  • Carrier Medical Director
  • Lynn Hickman, MD
  • Carrier Contact Information
  • Subscribe to your carriers listserv
  • Circulate carrier bulletins to staff

102
Know Medicare Nationally
103
Know Medicare Nationally
104
ASCO Resources
  • Practical Tips for the Practicing Oncologist
    2nd edition (3rd edition is coming soon!)
  • Ask a Coding Question
  • Call 703-299-1050 or
  • Email practice_at_asco.org

105
ASCO Resources
  • www.asco.org/MMA
  • Look for the FAQs - updated as new information
    available
  • www.asco.org/CAC
  • A great resource for information on the Medicare
    Carrier Advisory Committee process
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