Oncology Practice Management - May 2012 Vol 2, No 3

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Before 2005, the Centers for Medicare & Medicaid Services (CMS) reimbursed physicians for drugs administered in their offices at a percentage of the average wholesale price. In 2005, however, the payment basis was changed to a percentage of a newly created measure, the average sales price. This change resulted in a significant change to the bottom line for all physician practices that administered chemotherapy and other infused drugs.

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Audits and reviews of medical claims are nothing new. However, we are seeing an unprecedented increase in the number of these audits in the hospital and in the physician practice setting. The increase in audits is directly related to the growing numbers of entities that are auditing medical claims and the increased focus on identifying and preventing overpayments.

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The majority of cancer care is well known to be delivered in the community setting. We also are starting to learn that there may be cost differences based on site of service. What does that really mean to a patient with cancer, a physician, a practice administrator, and a payer or employer? The real answer is…it depends.

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The Office of Civil Rights (OCR) has begun stepping up efforts to ensure that covered entities are in compliance with HIPAA regulations. OCR audits are typically conducted is response to a complaint. In order to be compliant, practices should have policies in place regarding the treatment of all health information containing individually identifiable information. The policy should extend to electronic as well as written information. Read More ›

Chicago, IL—The ability to use contract pharmacies to deliver drugs for covered entities is one provision of the 340B drug pricing program. This provision allows for the use of an inhouse pharmacy and/or an external retail pharmacy or mail-order pharmacies with the use of virtual inventories, according to Kent Nicaud, Vice President, Physician Administrative Services, Memorial Hos - pital at Gulfport, MS.

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The following sections will assist healthcare professionals and payers by providing appropriate coding and billing information associated with the management of colorectal cancer.

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Every day, increasing numbers of patients learn that a chemo - therapy has been developed that could save their lives, but the drug they need is unavailable, because no one is manufacturing it. Expensive to man ufacture, yet priced very low, generic sterile injectable chemotherapies are some of the drugs that are the most vulnerable to production shortages.

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My last article published in the March 2012 issue of Oncology Practice Man agement described the benefits of Key Person Replacement insurance and how it can benefit a medical practice. This article focuses on 2 additional types of disability insurance that are often used to protect a medical practice—Disability Business Overhead Expense insurance and Disability Buy-Out insurance.

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