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.
Medicare Changes for 2020 (Physician Fee Schedule, HOPPS & QPP)
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.
- Map of RAC Regions
- RAC Contact Information
- Current/Recent Oncology-related RAC Audit Listing
- Provider Options for RAC Overpayments
- Medicare Parts A & B Appeals Process
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. ASCO and the American Society of Hematology annually co-host the ASH/ASCO CAC Network Meeting, which is a national meeting for oncology and hematology CAC representatives and Medicare Contractor Directors.