Clinical Practice Updates

Centers for Medicare & Medicaid Services (CMS) Releases the First Ten Drug Prices Negotiated in IRA Process for Part D

• Kelly Wilson
• August 28, 2024
• Clinical Practice Updates
• No Comments

The Biden-Harris Administration announced that it has reached agreements for new, lower prices for all 10 drugs selected for negotiations. According to CMS, these negotiated drugs are some of the most expensive and most frequently dispensed drugs in the Medicare program and are used to treat conditions such as heart disease, diabetes, and cancer. The…

2025 Hospital Inpatient Payment Rule Addresses Drug Shortages, Social Determinants of Health, Graduate Medical Education; Finalizes New Payment Model

• Kelly Wilson
• August 28, 2024
• Clinical Practice Updates
• No Comments

CMS issued the fiscal year (FY) 2025 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) final rule. The rule finalizes updates to Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025. Key highlights of the final rule include: Standardized Amount, Drug Shortages,…

ASCO Research Statement Details Recommendations To Improve Accessibility Of Cancer Clinical Trials Through Decentralization

• Kelly Wilson
• August 19, 2024
• Clinical Practice Updates
• No Comments

Strategies to bring clinical trials closer to patients gained momentum during the COVID-19 pandemic, enabling more participants to receive treatment and/or testing in their local communities. Incorporation of decentralized trial elements presents both opportunities and challenges, spanning regulatory, technical, and operational aspects. This ASCO research statement includes timely consensus-driven recommendations and a call for engagement…

Health Information Exchange Proposal Focuses on Real-Time Benefit Tools, Information Blocking, Interoperability

• Kelly Wilson
• July 22, 2024
• Clinical Practice Updates
• No Comments

The Department of Health and Human Service, through the Office of the National Coordinator for Health Information Technology (ONC), released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule. The HTI-2 proposal includes new and revised standards and certification criteria for the ONC Health IT Certification Program…

Nationwide Recall of Docetaxel Issued Over Particulate Concerns

• Kelly Wilson
• June 7, 2024
• Clinical Practice Updates
• No Comments

On May 28, Sagent Pharmaceuticals announced a voluntary nationwide recall of two lots of docetaxel injection (80 mg per 8 mL multidose vials and 160 mg per 16 mL multidose vials). The move was prompted by a customer complaint regarding possible particulate matter. Although no adverse events have been reported thus far, injection of particulate…

New Cervical Cancer Guidelines Released

• Kelly Wilson
• March 26, 2024
• Clinical Practice Updates
• No Comments

The American Society for Colposcopy and Cervical Pathology (ASCCP) is proud to announce a major milestone by the groundbreaking Enduring Guidelines initiative, aimed at revolutionizing the fight against cervical cancer. In a bid to ensure the most current and effective clinical management strategies, the Enduring Guidelines process seeks to integrate emerging technologies and the latest…

2024 MEDPARD Available Now!

• Kelly Wilson
• February 21, 2024
• Clinical Practice Updates
• No Comments

The 2024 Medicare Participation Physicians / Suppliers Directory (MEDPARD) is now available. As in the past, there will be no hardcopy distributions. Beneficiaries can use the Physician Compare website or contact 1-800-MEDICARE for assistance in locating a participating supplier near their home.

CMS Releases Guidance for Code G2211

• Kelly Wilson
• February 1, 2024
• Clinical Practice Updates
• No Comments

The Centers for Medicare & Medicaid Services (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. In the 2024 Medicare Physician Fee Schedule Final Rule, CMS finalized coding and reimbursement…

CMS Releases Final Rule on Prior Authorization and Interoperability

• Kelly Wilson
• January 17, 2024
• Clinical Practice Updates
• No Comments

On January 17, 2024, the Centers for Medicare and Medicaid Services released the “CMS Interoperability and Prior Authorization final rule (CMS-0057-F).” The rule would place new requirements on Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP)…

New Guidance on Medicare Inflation Rebates Adjusts for Drug Shortages

• Amanda Bridges
• December 21, 2023
• Clinical Practice Updates
• No Comments

CMS published revised guidance on the Medicare Prescription Drug Inflation Rebate Program. That program was established under the Inflation Reduction Act (IRA), which requires drug companies to pay a rebate to Medicare if they raise their prices for certain drugs faster than the rate of inflation. Specifically, IRA established inflation rebates for single-source drugs and…

CMS Investigative Study to Examine Benefit of Multi-Cancer Early Detection Tests for Medicare Beneficiaries

• Amanda Bridges
• December 1, 2023
• Clinical Practice Updates
• No Comments

A Pathway to Coverage Once Tests Show Clinical Benefit a Critical Next Step WASHINGTON, DC – November 20, 2023 – Grail, LLC announced this morning that the Centers for Medicare and Medicaid Services (CMS) and Food and Drug Administration (FDA) approved an Investigational Device Exemption (IDE) study for the company’s Galleri multi-cancer early detection (MCED) test…

Medicare Physician Conversion Factor Cut 3.37% for 2024

• Amanda Bridges
• November 13, 2023
• Clinical Practice Updates
• No Comments

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released its final rule for the 2024 Medicare Physician Fee Schedule (MPFS) and updates to the Quality Payment Program (QPP). The agency also released the 2024 Medicare Hospital Outpatient Prospective Payment System (HOPPS) and Ambulatory Surgical Center (ASC) Payment System final rule, along with the 340B…

UnitedHealthcare policy that might affect your workflow or process within your practice/facility.

• Katrina Williams
• April 17, 2019
• Clinical Practice Updates
• No Comments

Effective June 1 or October 1, 2019, (based on your contract) UnitedHealthcare will no longer reimburse Current Procedural Terminology (CPT) Consultation Codes 99241 to 99255 when billed by any health care professional or medical practice.    For detailed information about the updated policy, please review page 20 of the March 2019 edition of the UnitedHealthcare Network…

NCCN has published updates to theNCCN Guidelines® and NCCN Compendium® for Penile Cancer.

• FLASCO
• January 12, 2017
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Penile Cancer. These NCCN Guidelines® are currently available as Version 1.2017. Primary treatment Tis or Ta disease (PN-1) The second option was revised: “Wide local excision .” The fifth option was…

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Non-Small Cell Lung Cancer

• FLASCO
• October 27, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and the NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Non-Small Cell Lung Cancer. These NCCN Guidelines® are currently available as Version 2.2017.  Metastatic Disease (NSCL-17) Testing results modified for PD-L1: PD-L1 positive and EGFR, ALK, ROS1 negative or unknown Subsequent…

New Resource about ICD-10 Coding and Use of the JW Modifier

• Amanda Bridges
• October 13, 2016
• Clinical Practice Updates
• No Comments

CMS has communicated that the ICD-10 flexibilities expire on October 1, 2016. At this time, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. In addition, effective January 1, 2017, CMS will require the use of the JW modifier on…

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia and Survivorship

• FLASCO
• October 5, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Acute Lymphoblastic Leukemia. These NCCN Guidelines® are currently available as Version 2.2016.  The Discussion section has been updated to reflect the changes in the algorithm. (MS-1) *For your reference, the previous update (Version 1.2016) to the NCCN Guidelines for Acute…

Free PQRS Reporting Now Available Through QOPI®; No Additional Reporting Required 

• FLASCO
• September 29, 2016
• Clinical Practice Updates
• No Comments

ASCO is pleased to announce that oncology practices can now complete all of their Physician Quality Reporting System (PQRS) requirements through the Quality Oncology Practice Initiative (QOPI®) platform. All users will be able to use the QOPI system to fulfill the Oncology Measures Group set of seven measures for PQRS reporting. QOPI is free to…

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal and Kidney Cancer

• FLASCO
• September 29, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Colorectal. These NCCN Guidelines® are currently available as Version 2.2016.  The Discussion section has been updated to reflect the changes in the algorithm. (MS-1) *For your reference, the previous update (Version 1.2016) to the NCCN Guidelines for…

NCCN has published updates to the NCCN Guidelines® and NCCN Compendium® for Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL).

• FLASCO
• September 29, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) and NCCN Drugs & Biologics Compendium (NCCN Compendium®) for Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL). These NCCN Guidelines® are currently available as Version 1.2017.  ·         The NCCN Guidelines for CLL/SLL (previously included as part of NCCN Guidelines for Non-Hodgkin’s Lymphomas) have…

NCCN has published updates to the NCCN Guidelines® for Genetic/Familial High-Risk Assessment: Breast and Ovarian.

• FLASCO
• September 22, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Genetic/Familial High-Risk Assessment: Breast and Ovarian. These NCCN Guidelines® are currently available as Version 1.2017. Breast and Ovarian Cancer Risk Assessment (BR/OV-1) First column, 2nd bullet, “An individual with a breast cancer diagnosis meeting any of the following” For the 4th…

ASCO, ASTRO and SSO update guideline on postmastectomy radiotherapy

• FLASCO
• September 22, 2016
• Clinical Practice Updates
• No Comments

Three leading national cancer organizations today issued a joint clinical practice guideline update for physicians treating women with breast cancer who have undergone a mastectomy. The update provides additional considerations for physicians to determine which patients might benefit from postmastectomy radiotherapy (PMRT). “We still don’t have a single, validated formula that can determine who needs…

NCCN has published updates to the NCCN Guidelines and Chemo Order Templates

• FLASCO
• July 14, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Melanoma. These NCCN Guidelines® are currently available as Version 3.2016.  Imaging recommendations were clarified, including the following: Addition of footnote “i”, specifying modalities wherever imaging is mentioned: “Chest/abdominal/pelvic CT with contrast, brain MRI with contrast, and/or FDG PET/CT. Neck CT with…

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer

• FLASCO
• July 7, 2016
• Clinical Practice Updates
• No Comments

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Ovarian Cancer. These NCCN Guidelines® are currently available as Version 1.2016.  ·         For patients with a suspicious palpable mass and/or symptoms, the following primary treatment option has been revised: “Patients with bulky stage III/IV who are poor surgical candidates due…

ASCO Issues Series Of Guidelines On The Management Of All Stages Of Pancreatic Cancer

• FLASCO
• June 14, 2016
• Clinical Practice Updates
• No Comments

The American Society of Clinical Oncology (ASCO) has issued a series of guidelines on the management of all stages of” pancreatic cancer. The “guidelines on the management of potentially curable, locally advanced unresectable, and metastatic pancreatic cancer were published online…in the Journal of Clinical Oncology.”

Despite stakeholder outcry, CMS launches home health prior-authorization demo

• FLASCO
• June 10, 2016
• Clinical Practice Updates
• No Comments

Source: Modern Healthcare By Virgil Dickson Despite outcry from industry stakeholders, advocates and beneficiaries, the CMS is moving forward with a three-year demonstration in which beneficiaries from five states would need to get prior approval before they get home health services. The demonstration will launch in Florida, Illinois, Massachusetts, Michigan and Texas—states that are all tagged…

New NCCN Imaging Appropriate Use Criteria Resources Help Assure Patients Receive Best Cancer Care Available

• Amanda Bridges
• June 2, 2016
• Clinical Practice Updates
• No Comments

New NCCN Imaging Appropriate Use Criteria Compendium provides a single access point for all imaging recommendations within the NCCN Guidelines FORT WASHINGTON, PA — The National Comprehensive Cancer Network® (NCCN®) has published the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) to support clinical decision-making around the use of imaging in patients with cancer, helping…

ASCO Value Framework Update

• Amanda Bridges
• June 2, 2016
• Clinical Practice Updates
• No Comments

The American Society of Clinical Oncology (ASCO) today published an updated framework for assessing the relative value of cancer therapies that have been compared in clinical trials. The framework, published in the Journal of Clinical Oncology, defines value as a combination of clinical benefit, side effects, and improvement in patient symptoms or quality of life in…

CMS Quarterly Regional Publication for Healthcare Professionals

• Amanda Bridges
• May 26, 2016
• Clinical Practice Updates
• No Comments

New Guidelines on Bladder Cancer Management: AUA/SUO

• FLASCO
• May 12, 2016
• Clinical Practice Updates
• No Comments

Source: Medscape New joint guidelines on the management of bladder cancer issued by the American Urological Association (AUA) and the Society of Urologic Oncology (SUO) validate many long-standing practices used in the management of superficial bladder cancer but also affirm the real benefits associated with newer technologies to better visualize bladder tumors. Most notabable among…

FDA Clarifies Compounding Rules

• Amanda Bridges
• April 25, 2016
• Clinical Practice Updates
• No Comments

The Food and Drug Administration issued three draft guidance documents on Friday that answer providers’ and pharmacists’ burning questions about drug compounding standards. The proposed rules clarify the amount of drugs that providers can compound without a prescription, set requirements for health system compounding pharmacies and clarify how large-scale compounding sites known as “outsourcing facilities” may be…