First Quarter 2008 - Issues in Hematology - ION Solutions

oncologistics reimbursement watchAnticipated MAC Award and Transition Schedule*Jurisdictions34, 5, 121, 2, 7, 136, 11, 14, 158, 9, 107/2006 3/20077/2007 6/20089/2007 6/20087/31/2008 6/20099/2008 5/2009* There has been a delay in awarding J2, J7, andJ13 (Cycle 1B anticipated award for September2007). This will likely cause the date of completeimplementation (cutover) for these jurisdictions tobe later than anticipated.1/2007 1/2008 1/2009 1/2010Anticipated MAC AwardsRange of Earliest Completed TransitionsAs new policies are posted, providers may want toconsider examining them and asking the followingquestions as they evaluate the policies:> Are the covered indications for a particular productor treatment regimen inappropriately restrictingcoverage or are particular indications of interest notlisted as covered?> Are the previously available ICD-9-CM codes stillincluded within the LCD (primary and secondaryICD-9-CM codes)?> Do the coverage limitations or utilizationrestrictions hamper services or therapies that werepreviously covered?Emily Phillips, analyst, is a member of theReimbursement Strategy & Solutions consultinggroup within Xcenda’s national consulting practice,where she works on reimbursement projects forclients across the product commercializationspectrum. She assists with research for strategicconsulting projects, new business development,and client strategies and tactical plans.It is imperative for providers to review new LCDs forcoverage changes and provide appropriate commentsto the contractor when needed.It is CMS’ mission to ensure healthcare security forbenefi ciaries by establishing a premier health plan thatallows for comprehensive, quality care and worldclassbenefi ciary and provider service. 4 Through theimplementation of MAC reform, CMS hopes to realizethis mission. Awareness and communication betweenthe provider community and each MAC is critical fora smooth transition. This will also help to incorporateprovider input as part of the policy revision process. ❚References:1. Pub. L. 108-173, 117 Stat 2066, “Medicare Prescription Drug,Improvement, and Modernization Act of 2003,” (MMA 2003)(December 8, 2003).2. Report to Congress, Medicare Contracting Reform,“A Blueprint for a Better Medicare.” February 7, 2005, pp. 9.http://www.cms.hhs.gov/MedicareContractingReform/Downloads/report_to_congress.pdf3. Centers for Medicare & Medicaid Services, MedicareAdministrative Contractor, Workload Implementation Handbook,March 1, 2007, 4.10.1 Local Coverage Determinations, pp. 4-7.4. Medicare Contracting Reform Overview. http://www.cms.hhs.gov/MedicareContractingReform/oncologistics 29