FLASCO / Administrative

Genentech Access Solutions – Medicare Beneficiary Identifier (MBI) Update

Katrina Williams
October 17, 2019
Administrative
No Comments

Genentech Access Solutions – Medicare Beneficiary Identifier (MBI) Update This PDF provides important information about The Centers for Medicare & Medicaid (CMS) transition from the use of the Health Insurance Claim Number (HICN) to a Medicare Beneficiary Identifier (MBI) number, and how Genentech Access Solutions is addressing this conversion. Beginning January 1, 2020, Genentech Access…

CMS Permits Medicare Part B to impose step therapy on new starts

Katrina Williams
June 10, 2019
Administrative
No Comments

The Centers for Medicare and Medicaid Services (“CMS”) announced a final rule permitting Medicare Part B plans, including those administered through Medicare Advantage, to impose step therapy on new starts of Part B drugs. CMS noted that this utilization management tool will “ensure that Medicare beneficiaries pay less overall … for Part B drugs.” CMS…

Announcing a New First-Line Indication for a Genentech Therapy

Katrina Williams
March 22, 2019
Administrative
No Comments

Genentech is excited to share the news of a new FDA-approved indication. TECENTRIQ, in combination with carboplatin and etoposide, is indicated for the first-line (1L) treatment of adult patients with extensive-stage small cell lung cancer (ES-SCLC). Please see the attached TECENTRIQ 1L SCLC Day 1 Letter, as well as the TECENTRIQ full Prescribing Information, for…

FDA Approves Genentech’s Tecentriq in Combination with Chemotherapy for the Initial Treatment of People with Extensive-Stage Small Cell Lung Cancer

Katrina Williams
March 22, 2019
Administrative
No Comments

The FDA approved Tecentriq (atezolizumab), in combination with carboplatin and etoposide (chemotherapy), for the initial (first-line) treatment of adults with extensive-stage small lung cancer (ES-SCLC). It is the first new initial treatment option approved by the FDA for people with ES-SCLC in more than 20 years. The Genentech press release including Important Safety Information is…

Updated Clinical Practice Guidelines in Oncology for Colon and Rectal Cancer

Katrina Williams
March 22, 2019
Administrative
No Comments

National Comprehensive Cancer Network© (NCCN©) has updated the Clinical Practice Guidelines in Oncology for Colon and Rectal Cancer to include BRAFTOVI® in combination with MEKTOVI® and cetuximab or panitumumab as a Category 2a treatment for patients with BRAFV600E-mutant metastatic colorectal cancer (mCRC), after failure of one to two prior lines of therapy for metastatic disease….

FLASCO Administrator Network Patient Support Resources Webinar

FLASCO
January 12, 2017
Administrative
No Comments

On January 12, 2017, the FLASCO Administrator Network hosted its first webinar. The topic was Patient Support Resources, and it featured experts from community oncology and hospital settings, who shared their tips, helpful hints, and tools of the trade regarding assistance programs and resources available for cancer patients. Congratulations to Maggie Wiegandt, MBA and Gail…

CMS Finalizes the New Medicare Quality Payment Program – MACRA

FLASCO
October 14, 2016
Administrative
No Comments

On October 14, HHS finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), collectively referred to as the Quality Payment Program. Accompanying the announcement is a new Quality Payment Program website, which will explain the…

Announcing a Unique C-code for a Genentech BioOncology(R) product

FLASCO
October 5, 2016
Administrative
No Comments

The following is important information regarding a unique C-code that was recently assigned to TECENTRIQ™ (atezolizumab) by the Centers for Medicare & Medicaid Services (CMS). The C-code for TECENTRIQ is C9483 (Injection, atezolizumab, 10 mg). The unique C-code goes into effect on October 1, 2016. Payers may require its use until a permanent J-code is…

IMPORTANT – NEW PUMP CODE REPLACES THE NOC CODE BILLING FOR MEDICARE

FLASCO
September 16, 2016
Administrative
No Comments

Billing for the pump services rendered in the Part B setting are billed to PART B Medicare per the “Clarification” from CMS within MLN Matters, SE1609. CMS had “clarified” that prolonged drug and biological infusions using an external pump rendered IN THE PART B SETTING are billed to PART B MEDICARE and not the DME….

CMS Correcting Errors to Updated Coverage Policy for Genetic Tests

FLASCO
September 16, 2016
Administrative
No Comments

ASCO has confirmed that CMS is currently working to correct technical errors that occurred when they recently updated national coverage policies regarding certain genetic tests. CMS confirms that steps are being taken to reprocess claims that have been denied. According to CMS, the errors occurred during the mapping process from ICD-9 to ICD-10. During…

Cigna Revises Policy, Will Cover 3D Mammography For Breast Cancer Screening

FLASCO
September 16, 2016
Administrative
No Comments

Cigna has revised its medical coverage policy for breast cancer screening and will now cover three-dimensional (3D) mammography for routine breast cancer screening. Under its previous policy, the company covered 3D mammography for diagnostic purposes, but not for routine screening. The policy had been based on guidance from the U.S. Preventive Services Task Force…

Cigna – JW Modifier Start Date Update

FLASCO
September 16, 2016
Administrative
No Comments

FLASCO recently contacted Cigna on behalf of our 2,000 plus members requesting that Cigna reconsider the start date for the JW Modifier. It was pointed out to Cigna that Medicare had pushed the implementation back to 1/1/17. This will allow practices to ensure appropriate IT resources are in place to report the waste appropriately. At…

TYKERB®(lapatinib)NDC NUMBER CHANGE

FLASCO
September 16, 2016
Administrative
No Comments

TYKERB®(lapatinib)NDC NUMBER CHANGE Former GlaxoSmithKline (fGSK) Products EFFECTIVE IMMEDIATELY, please note that the current NDC numbers are being replaced by the NEW NDC NUMBERS referenced in Table A below: Table A: Product Name Old NDC # New NDC # Package Size Package Strength TYKERB® (lapatinib) 0173-0752-00 0078-0671-19 150 tablets 250mg Direct Purchasers:Effective immediately,…

Infusion Pump Billing Update

FLASCO
September 16, 2016
Administrative
No Comments

CMS recently provided additional clarification to MACs and providers regarding reimbursement for prolonged drug and biological infusions that are started in the office or outpatient hospital and are associated with care that is billed incident to a physician service using an external pump. In order for Medicare to pay for a drug or biological, the…

Independent Payment Advisory Board (IPAB) What is Happening Now (Source: Policy & Medicine)

FLASCO
August 9, 2016
Administrative
No Comments

The Independent Payment Advisory Board (IPAB) is one of the “cost control mechanisms” that can be found within the Affordable Care Act (ACA) and is designed to bring per-capita Medicare spending back in line with statutory benchmarks, if those benchmarks are exceeded. While an IPAB trigger was avoided this year, the IPAB continues to…

New Q code for VARUBI (rolapitant) effective 7/1/2016

FLASCO
June 14, 2016
Administrative
No Comments

As you likely know, CMS has a National Coverage Determination policy outlining when to bill under Medicare Part B vs Part D when using oral anti-emetic therapies. Under these policies, providers should bill under Part B only when specific criteria are met, including that the oral anti-emetics are used “as full replacement for the anti-emetic…

CMS Pushes Modifier -JW Requirement to 2017

FLASCO
June 10, 2016
Administrative
No Comments

CMS Pushes Modifier -JW Requirement to 2017 Source: Medicare Compliance Watch If CMS’ late April release of a change request requiring reporting of the previously optional modifier -JW (drug amount discarded/not administered to any patient) by July 1 seemed too sudden, the good news is many other providers—and the agency—agreed. Due to stakeholder concerns about…