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).

COVID-19 Clinical Trials Coalition Letter

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 a PDF of the slides here.

Principal 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 a PDF of the slides here.

AMA 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 a PDF of the slides here.

CHI & 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 a PDF of the slides here.

FROM THE ACCCBUZZ BLOG

An Update on Healthcare Legislation at the State Level
By Christian G. Downs, MHA, JD
March 22, 2023
If you are looking for legislative action, look no further than your state's legislatures. Most—if not all—states have had issues relating to oncology care and healthcare in general come up during their 2023 sessions.
ACCC Announces its 2023 Advocacy Agenda
March 07, 2023
For 2023, ACCC members have identified four core areas of focus (e.g., reimbursement, utilization management, provider-patient choice), among a larger set of issues and concerns, that the association will be supporting this year.
ACCC Recognizes National Caregivers Day: Analyzing a Mental Health Crisis
February 17, 2023
Today is National Caregivers Day, and ACCCBuzz analyzes the current mental health crisis that is affecting the caregivers of loved ones everywhere.

Advocacy In the News

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

National Policy Resources—Local Advocacy Results

Implementing the New CMS Reimbursement Billing Codes for Patient Navigation Services

State Advocacy

Federal Advocacy

The New CMS Navigation Reimbursement Billing Codes: A 101

Principal Illness Navigation (PIN) Services Documentation, Coding, and Billing

AMA CPT® Coding Update for Oncology Navigation Services and The Cancer Moonshot

CHI & SDOH Risk Assessment Documentation, Coding, and Billing for Oncology Providers and Administrators & Series Wrap-up

FROM THE ACCCBUZZ BLOG

Advocacy In the News

CMS Announces CY 2023 PFS Proposed Rule

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