On April 10, 2024, the Centers for Medicare & Medicaid Services issued the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule. The rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025. Initial highlights of the proposal are included here.
ASCO in Action provides the latest news and analysis related to critical policy issues affecting the cancer community, updates on the Association for Clinical Oncology’s ongoing advocacy efforts, and opportunities for members and others in the cancer care community to take action.
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April 12, 2024
April 9, 2024
The Centers for Medicare & Medicaid Services released the 2025 Notice of Benefit and Payment Parameters final rule and the 2025 Medicare Advantage and Part D final rule. The Association for Clinical Oncology (ASCO) submitted comments on the proposed versions of both rules. Summaries of the final rules, highlighting provisions ASCO commented on, are included here.
March 18, 2024
President Biden signed the Consolidated Appropriations Act of 2024, which included a +1.68% adjustment to the Medicare Physician Fee Schedule (MPFS) conversion factor (CF) for the remainder of calendar year (CY) 2024. This increase results in a 1.68% reduction to the 3.37% CF cut finalized in the 2024 MPFS final Rule. The Association for Clinical Oncology (ASCO) advocated for Congress to address the full 3.37% Medicare physician reimbursement cut, and while ASCO appreciates congressional action, the Association is disappointed that Congress failed to eliminate the entire reimbursement cut.
March 12, 2024
The Association for Clinical Oncology (ASCO) is closely following cases before the United States Supreme Court that have the potential to significantly impact the delivery of cancer care in the U.S. by reshaping the authority of the federal agencies that regulate health care in the country. The Court is expected to issue rulings in these cases before its current session ends in June 2024.
February 26, 2024
The Federal Trade Commission and the U.S. Department of Health and Human Services issued a joint Request for Information on how group purchasing organizations’ and drug wholesalers’ practices are impacting the generic drug market. The Association for Clinical Oncology encourages stakeholders within the cancer community to comment to give federal agencies the perspective they need from across the myriad settings of cancer care.
February 13, 2024
The Centers for Medicare & Medicaid Services (CMS) has finalized prior authorization policy updates within Medicare Advantage (MA), Medicaid Managed Care and Fee for Service, Children’s Health Insurance Plans (CHIP) Managed Care and Fee for Service, and Qualified Health Plans (QHPs) on the Federally Facilitated Exchanges (FFEs). These changes come in response to the Association for Clinical Oncology (ASCO) and other stakeholder concerns that prior authorization processes limit beneficiary access to care in Medicare Advantage.
January 29, 2024
CMS has released guidance on the billing requirements for G2211 to ensure that coding and billing staff know when to bill the code, the necessary documentation requirements, and the associated patient coinsurance and deductibles.
January 16, 2024
The Association for Clinical Oncology (ASCO) submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to two proposed rules: the 2025 Medicare Advantage and Part D proposed rule and the 2025 Notice of Benefit and Payment Parameters proposed rule. ASCO’s comments support provisions that address utilization management and health equity, which have the potential to improve access to care for the cancer community.
January 16, 2024
In a response to the Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking proposed rule, the Association for Clinical Oncology (ASCO) urges the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) not to implement the disincentives as proposed. ASCO also asks CMS for further clarification on the enforcement process, and the Association supports establishing a meaningful opportunity for appeals.
January 16, 2024
As of January 1, 2024, oncology practitioners can bill and receive Medicare payment for connecting patients to navigation services. The Centers for Medicare & Medicaid Services adopted two billing codes for Principle Illness Navigation services: G0023 for the initial 60 minutes per patient per month, and G0024 to capture each additional 30 minutes per patient per month. The American Society of Clinical Oncology has received many inquiries about coding and billing for these new services and has made resources available for the oncology community.