Navigating the Business of Oncology for 2008

rn a , the This new imum 07 ttles elinrers sitive c r of o b ical a entifi ll of o e s for t ral ( comp we d view t spect Medic the r mat summ volu for t all s are s this s tor w onth p This r sion p tal P his c for t n is a ount, a the q units s o by w ur industry has seen changes in the way w business. First, we faced the paramou change in the manner of payment for che herapy and adjunct drugs under the Medicare syst or years, Medicare reimbursed on an average wh ale price (AWP) payment methodology. The dr ere adjudicated at a certain percentage of AWP; h ver, we saw the percentage incrementally decre hrough the years. Then the hammer was evo edicare, after their General Accounting Office (GA ndings of wide discrepancies in the cost of acqu rugs relative to the payment physicians were rec ng, decided to develop what we know as AS 6 Average Sales Price). This is important to rehash ause subsequent to the restructuring of the drug ent changes, it prompted our practices to analyze mpact to our bottom lines. In addition, it cre remendous concerns on how effective care for can atients would be sought. The voice of our indu as partially heard. Medicare decided to create a ad of additional CPT codes for the administratio hemotherapy and therapeutic/prophylactic/diagnos ic procedures. This was to accurately reimburse he “complexities” associated with certain administ ions, as well as the adverse effects and the onsumption in the delivery and preparation for a ient. In the field, we were left with the dubious t oding these new procedures accurately. To further complicate matters, we needed to lea emporary set of G-Codes for 2005. Then, in 2006 MA published standard CPT codes for use. rompted us to insure that all the applicable staff k ow to use and apply the new codes so that max eimbursement could be captured. Fortunately, 20 aw fewer changes; however, we still face uphill ba very day with regards to understanding coding d ations not only for Medicare, but for private insu s well. Moreover, once we think we are in po