National Policy Resources—Local Advocacy Results

As cancer care professionals who experience the challenges of providing quality cancer care first-hand, ESHOS 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.

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 WAHO and 11 other state societies from AZ, CO, IN, IA, NV, NM, NY, NC, SC, WA 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.

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.

State Advocacy

ESHOS Joins Support Letter for S5299/A1741

Copay assistance programs can give patients access to a lifesaving medication they may otherwise not be able to afford. Copay accumulators make it more challenging for patients to afford their medication. This bill would end the practice of copay accumulators and assist all patients with out-of-pocket expenses. Read support letter.

Posted 03/18/2021

Federal Advocacy

COVID-19 Clinical Trials Coalition Letter

The Empire State Hematology & Oncology Society (ESHOS) 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. 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.