Medicare Program

Oncology professionals must understand a variety of Medicare programs and initiatives to effectively manage their practice, appropriately report services and ensure high-quality care is delivered to their patients. ASCO provides below some information and important resources for practices looking to better familiarize themselves with Medicare structure, policies, reimbursement and fraud and abuse efforts.

    2021 Medicare Changes and Updates

    2021 Evaluation & Management Changes

    Significant changes were made to the office and outpatient Evaluation and Management services in 2021. Read more about the updates in 2021 Coding Updates and Changes: CPT®, HCPCS, and ICD-10 CM and on the Coding and Reimbursement page.

    RAC Program Information and Resources

    The Recover Audit Contractors (RAC) initiative was developed by the Centers for Medicare and Medicaid Services (CMS) to fight fraud and abuse in the Medicare program. Some helpful resources are provided below.

    Coding Edits

    The National Correct Coding Initiative (NCCI) edits are developed by CMS to establish a uniform coding review method among MACs. NCCI edits help the agency promote correct coding, enforce Medicare payment policies and control improper payments made by inappropriate coding.

    NCCI edits include multiple types of edits such as the Procedure-to-Procedure edits, the Medically Unlikely edits, and the Add-on Code edits.

    CMS Medicare Manuals

    CMS’ internet-only manuals provide detailed information on Medicare eligibility, provider participation, benefits, coverage, claims processing and more. We have highlighted some important manuals and specific chapters for you.  

    MAC & CAC  

    Medicare Administrative Contractors (MAC) are private healthcare insurers contracted with CMS to process Medicare claims for predetermined areas or jurisdictions. Carrier Advisory Committees (CAC) are advisory groups established by MACs which are composed of physicians, a beneficiary representative, and representatives of medical organizations. CACs allow physicians to participate in the development of local coverage policies and comment on those policies, creating a forum for the exchange of information. 

    As of 2020, ASCO no longer hosts the annual CAC Network Meeting with the American Society of Hematology; however meeting materials can be found ASH/ASCO CAC Network Meeting