Practice Management Series 2004 2005

1
Practice Management Series2004 - 2005

• Presented in Conjunction with

2
Thomas R. Barr, MBALouisiana Oncology
SocietyMay 14, 2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
3
Who should attend

• Physician Leader of the Practice
• President of the PA, Founder
• Practice Administrator
• CEO, Executive Director, COO
• Contracting Officer
• Contract Administrator, Director of Billing
• Clinical Manager
• Medical Director, Nursing Team Leader

4
At the end of this session, you will

• Know why your practice needs to change
• Understand investment mentality and be able to
  classify your practice in terms of investment
  potential
• List the common characteristics of effective
  physician practice leaders
• Understand the relationship between the physician
  practice leader and the practice administrator
• Be able to apply simple self assessment tools to
  position your group to take advantage of market
  changes today

5
The Old DaysMedian Per FTE Medical
OncologistCompiled from MGMA Cost Survey through
2003 Report on 2002 Data. Second order polynomial
trend lines by OM
Why Change?
6
Eroding MarginsPer Oncologist with projections
by Oncology Metrics
Why Change?
Now
Then
7
Service Line Changes Five physician practice
2004 Compared to 2003
Why Change?
8
Service Line Changes Five physician practice
2005 Compared to 2003
Why Change?
9
Why Change

• Because we must change
• Population economics demand it
• GDP growth cant match Boomers march into SEER
  cohorts
• Other sectors or medicine have done it
• DRGs, ACPs, Cardiology, Radiology
• Market dynamics support it
• Everywhere the old order changes, and happy are
  those who can change with it. Sir William Osler,
  1895

Because it is wise to change
10
Developing Investment Mentality
Rising Demand
Increasing Market Share
Problem Child
Rising Star
?
Mature Investment
Dog

Modified BCG Business Growth Matrix
11
Dog ?
Problem Child

• Practice sees a low of new cancer cases in
  market
• Overall market for cancer services is stagnant,
  shrinking, or being consumed by competitors
• Presently failing, either rapidly or slowly and
  showing declining period-to-period revenue
• Stagnation of capital investment
• Susceptible to sudden closings
• Smart dogs join up to form a dog pack

• Typical of a new practice or outreach clinic in a
  new service area
• operations need investment
• offer the potential of rapid growth
• always have high costs initially
• must be properly capitalized to keep from running
  out of money just before they take off
• shows real potential
• has a sustainable customer base

12
Mature Investment
Rising Star

• High market share
• Stable business with revenue growth driven by
  existing customers and products.
• Weak need or desire to innovate means low to no
  capital needed
• Profits are high and the contribution margin is
  also high
• Must maintain the strong market position as
  competition wants to enter and claim margin

• Certain growth in demand for cancer services.
• Declining or stable number of providers able to
  meet increasing demand
• Significant barriers to entry for new competitors
• Financing mechanism for many service buyers
• Legacy of inefficient operations offer
  significant process improvement opportunities
• Promising new technology offering significant
  opportunity for service line expansion

13
Evaluating Product and Service Lines for
Additional Investment
Investment Mentality

• In-house pharmacy is a Product Line
• Research is a Product Line
• Chemo. Admin. is a Service Line
• Patient EM is a Service Line
• Laboratory is a Service Line
• RT is a Service Line
• CAT/PET is a Service Line

?
?


14
To execute growth, you must have Management

• Physician Leader
• Seeing patients but on a reduced schedule
• About .5 FTE physician
• One of the founders or otherwise senior
• Active in hospital or community
• Can say I dont know, let me think about that
• Was (or is) the productivity leader
• Trusts the administrator
• Administrator
• Trained MBA, CPA, MHA
• Can read and write basic contracts
• Computer literate and analytically proficient
• Can say I dont know, let me think about that
• Trusts the physician leader

15
To execute growth, you must have Patients
Investment Mentality

• Counting the number of new patients that are seen
  in your practice is the starting point of most
  feasibility studies.
• New patients are the denominator across which to
  leverage investment and costs.
• 1,500 new patients/yr. can generally support a
  CT and/or PET with reasonable margins

16
New Patients / PhysicianAOHA/MGMA 2003 Report on
2002 Data
Investment Mentality
17
Building New Patient FlowPhysician Practice
Leaders Role

• Promote and support the ability of the physician
  team to build and maintain a powerful referral
  system that will provide at least 400 new
  patients/year/physician.
• Design clinical staffing pattern sufficient to
  support time for physicians to pay attention to
  referral patterns.

18
Building New Patient FlowPhysician Practice
Leaders Role

• Build partnership and pay policy that rewards
  individual and group efforts to build patient
  referrals.
• Routinely measure and discuss referral patterns
• Support your administrator by not allowing staff
  to circumvent or undermine your joint initiatives.

19
Building New Patient FlowAdministrators Role

• Develop reliable ways to count new patients and
  their referral source
• Monitor and understand the insurance status of
  incoming patients looking for patterns by
  referral source
• Reward front office staff for facilitating
  incoming calls from referrals sources to a
  physician
• Support your physician leader by not allowing
  staff to circumvent or undermine your joint
  initiatives.

20
To plan for growth, you must have Managerial
Measurement
Investment Mentality

• Not for tax purposes
• You get to make estimates and judgments.
• On an accrual basis
• Balance sheet shows what you own and what you
  owe.
• PL shows what you earned, (whether you have been
  paid or not) and what you bought (whether you
  have paid for it or not).

21
Sample Balance Sheet
Investment Mentality
22
Managerial measurements produce Financial
Indicators that are

• Important to the bottom line
• Easy and reliable
• Benchmarked on a FTE physician basis
• Tied to new patient accrual

23
Sample PL Per Physician
24
Steps to Managerial growth orientedService Line
Accounting

• Identify revenue centers from procedure
  productivity report. This will also give you the
  gross revenue (collections) for each center.
• Allocate the direct cost to each revenue product
  or service line as these are incurred in the
  production of the product of service.
• Allocate shared, or indirect, costs across
  product and service lines in relation to the
  gross profit from each product line. Collections
  - direct costs gross profit.
• Calculate net profit for each product line. Gross
  revenue direct costs indirect cost net
  profit.

25
Managerial MeasurementPhysician Practice
Leaders Role

• Learn to read your basic financial statements
  Balance Sheet, PL, Statement of Cash Flows
• After you learn to read them, dont insist that
  other physicians do the same
• Understand how the basic financial statements
  inform your managerial measurements

26
Managerial Measurement Physician Practice
Leaders Role

• Be the one who reports managerial measures to the
  physicians of your group
• Only report the three managerial metrics you
  think are most important for example
• New patients/FTE physician ytd. vs. goal vs.
  prior period
• Revenue/FTE physician ytd. vs. goal vs. prior
  period
• Cost/FTE physician - ytd. vs. goal vs. prior
  period
• Support your administrator by not allowing staff
  to circumvent or undermine your joint initiatives.

27
Managerial Measurement Administrators Role

• Learn to read your basic financial statements
  Balance Sheet, PL, Statement of Cash Flows
• After you learn to read and understand them,
  review these regularly with your physician
  practice leader
• Understand how the basic financial statements
  inform your managerial measurements

28
Managerial Measurement Administrators Role

• Be prepared to provide supporting details when
  the physician leader reports managerial measures
  to the physicians of your group
• Double check the managerial measures to make sure
  they agree with the basic financial statements
  and are consistent with past reports.
• Support your physician leader by not allowing
  staff to circumvent or undermine your joint
  initiatives.

29
To execute growth, you must have Capital

• All business expansion requires capital
  investment.
• All business expansion that is properly executed
  supports both the cost of capital and repayment
  of capital.
• ROI means Return on Investment

30
To execute growth, you must have Capital
Investment Mentality

• IRR means Internal Rate of Return
• Retained Earnings are the source of most business
  capital.
• Debt is a tool of expansion.

31
Capital ResourcesPhysician Practice Leaders
Role

• Understand the clinical drivers behind all
  capital investments
• Assure yourself that new patient referrals are
  not threatened by capital projects
• Talk to other physicians who have made similar
  decisions and learn from them

32
Capital ResourcesPhysician Practice Leaders
Role

• Be the financial spokesperson to your groups
  physicians
• Explain the need to create capital reserves and
  retain earnings
• Be willing to equitably shoulder capital risk
• Support your administrator by not allowing staff
  to circumvent or undermine your joint
  initiatives.

33
Capital Resources Administrators Role

• Perform all analysis for new product line
  development
• Capital requirements, affect on referral
  relationships, cash flow, and staffing needs
• Development convincing managerial measurements
  that inform capital decisions
• Establish banking relationships and instruments
  that cushion practice from capital shocks

34
Capital Resources Administrators Role

• Plan a margin of safety into every capital
  project
• Establish an internal Hurdle ROI and only
  recommend projects that are above that rate
• Be willing to equitably shoulder capital risk
• Support your physician leader by not allowing
  staff to circumvent or undermine your joint
  initiatives.

35
"Risk comes from not knowing what you're doing."
Why do all of this?

• Warren Edward Buffett  (1930- ), Reasonably
  successful American financier, chairman of
  Berkshire Hathaway Inc.

36
Practice Management Series2004 - 2005

• Presented in Conjunction with

37
Elaine TowleLouisiana Oncology SocietyMay 14,
2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
38
Generating Practice Efficiencies

• Streamlining work flow
• Increasing patient flow per physician
• Maximizing charge capture
• Managing expensive inventories
• Lowering cost

39
Who should attend

• Physician Leader of the Practice
• President of the PA, Founder
• Practice Administrator
• CEO, Executive Director, COO
• Contracting Officer
• Contract Administrator, Director of Billing
• Clinical Manager
• Medical Director, Nursing Team Leader

40
At the end of this session, you will

• Be able to perform a simple assessment to
  identify areas where cost savings may be found
• Know how to plan to implement beneficial changes
  in these areas
• Believe that 2004 offers the time to prepare for
  new realities of community oncology practice

41

• Efficiency
• Ability to produce the desired effect with a
  minimum of effort, expense or waste
• Websters New Twentieth Century Dictionary,
  Unabridged

42
Why is efficiency important?

• The oncology world has changed.
• life as you know it is over
• Medicare Prescription Drug Improvement and
  Modernization Act (MMA) 2003

43
The Old DaysMedian Per FTE OncologistCompiled
from MGMA Cost Survey through 2003 Report on 2002
Data. Second order polynomial trend lines by OM
44
The Old Days Per Median Oncologist Source
MGMA\AOHA Cost Survey
45
MMA ImpactPer Oncologist with projections by
Oncology Metrics
Why Change?
Now
Then
46
Practice EfficiencyFocus on Largest Expenses
First AOHA/MGMA 2003 Report on 2002 Data
47
Practice Efficiency

• Drug Management
• Staffing
• Ensure that you are using all staff in the most
  appropriate way for the size of your practice
• Manage your overtime
• Task Analysis
• Who does it?
• Can anyone else do it?
• How do they do it?
• Can it be done better?
• Consider variations in small, larger practices

48
Benchmarking

• Why?
• Benchmark your practice metrics to discover
  potential work flow and/or staffing efficiencies
• Lower the cost of practice operations
• Better inventory control
• Improved patient scheduling
• Streamlined work flow from clinic to billing
  office

49
Benchmarking

• How?
• Informal conversations, visits with colleagues,
  oncology practice list serves
• More formal use a standard such as MGMAs Cost
  Survey for Hematology Oncology Practices
• Most important to benchmark against yourself over
  time

50
COGS BenchmarkingUsing the MGMA AOHA
Hematology/Oncology Cost Survey 2003 Report
Based on 2002 Data
1 Cost
51
COGS BenchmarkingUsing the MGMA AOHA
Hematology/Oncology Cost Survey 2003 Report
Based on 2002 Data
1 Cost

• Write down your COGS for 2003
• Multiply it by .87 to adjust for 13.4 increase
  in COGS 2002 to 2003 (based on prior 2 years
  increase)
• Divide it by 1,053,518, the survey median COGS
  per Physician in 2002
• Result is the number of physicians that your COGS
  would support
• Compare this to actual physicians and if it is
  much higher or lower, keep asking why

52
Drug Management
1 Cost

• Drug procurement and inventory management
  processes must be tight
• Contracting
• Ordering
• Inventory management
• Monthly reports - match inventory levels to
  billed units
• Who is managing this process for your practice?

53
Drug Management
1 Cost

• Look at how you add new drugs to your practice
  formulary to assure financial feasibility
• Practice standardization, pharmaco-economics
  review
• Start simple - hydration, anti-emetics
• Then look at treatment protocols by disease, one
  disease at a time
• Knowledge is power, you cant control what you
  dont measure

54
Drug Management
1 Cost

• Pharmacy safety
• OSHA fines are expensive
• Nursing policies
• Errors are expensive charge capture errors,
  chemo preparation errors
• Who is mixing your drugs?
• Recent articles indicate 50 nurses, 50
  pharmacists
• Dependent on practice size, state regulations

55
Physician Productivity Benchmarking Using the
MGMA AOHA Hematology/Oncology Cost Survey 2003
Report Based on 2002 Data
2 Cost

56
Physician Productivity Benchmarking Using the
MGMA AOHA Hematology/Oncology Cost Survey 2003
Report Based on 2002 Data
2 Cost

• Write down the number of consultations and new
  patients (99241-99255, 9920199205) in 2003
• Divide it by 231, the survey median of
  consultations per physician in 2002
• Result is the number of physicians that your new
  patient service volume would support
• Are you above or below the actual number of
  physicians in your practice?
• Why?

57
Relative Benchmarks

• 1. New Patients and COGS are both greater than
  the actual number of physicians and yielding
  about the same physician count
• Indicates good physician utilization and pharmacy
  control
• 2. New Patients about right but COGS shows higher
  number of physicians
• Indicates potential savings at COGS management

58
Increasing Patient FlowPhysicians Should
2 Cost

• Communicate with referring physicians this
  drives practice growth
• See new patients this drives practice growth
• Be seen at the hospital and participate in
  medical staff life
• See follow-up patients on a regular, clinically
  appropriate basis
• Delegate some follow-up visits to other providers
  as appropriate PA, NP, RN
• Ensure quality of care throughout practice

59
Increasing Patient FlowPhysicians Should Not
2 Cost

• Routinely be late for clinic
• Spend time filling out forms (ex. disability,
  tumor registry)
• Routine patient education
• Return routine patient phone calls (prescription
  refills, etc.)
• Micro-manage staff
• Undermine authority of administrator

60
Increasing Patient FlowAdministrators Should
2 Cost

• Assure that there are adequate exam rooms for
  each physician
• Provide appropriate patient scheduling,
  individualized by physician if necessary
• Use other staff, clinical and administrative, to
  free up physician time whenever possible

61
Increasing Patient FlowAdministrators Should Not

• Practice medicine or offer their clinical opinion
  to anyone, ever!
• Undermine the clinical authority of any of the
  practice physicians
• Undermine the business and leadership authority
  of the physician leader

62
Increasing Patient Flow Should you consider a
Non-Physician Practitioner?
2 Cost

• Also known as mid-level providers, includes PA,
  NP, CNS
• Increase patient volume at less expense than
  adding a physician
• Allow more flexibility in scheduling patient
  visits, more consistent schedule than physicians
• Generate revenue for practice even if physician
  is out of office
• Coverage for physician vacations better
  continuity of care

63
Increasing Patient Flow Non-physician
Practitioners Should
2 Cost

• Work as an adjunct to the physicians
• See routine follow-up patients, chemotherapy
  visits, other routine visits
• Allow physicians to see more new patients,
  consultations
• Serve as a resource for nurses, other staff

64
Increasing Patient Flow Non-physician
Practitioners Should Not...
2 Cost

• See new patients
• Practice beyond their state scope of practice

65
Practice EfficiencyNurses Should
3 Cost

• Administer chemotherapy patient assessment,
  check doses, discuss side effects, prepare chemo
  in some practices
• Counsel patients symptom relief, social issues
• Phone triage - answer patients symptom-related
  phone calls
• Patient education
• Help with drug assistance programs and indigent
  drug forms

66
Practice EfficiencyNurses Should Not
3 Cost

• Handle pre-certs, pre-auth
• File
• Schedule appointments

67
Practice EfficiencyChart flow

3 Cost

• Can you find a chart when you need it?
• How does it get from file to desk or file to exam
  room?
• Who gets it there?
• Do you have a policy on charts leaving the
  office?
• How long (and how many staff) does it take to
  find a chart that is MIA?

68
Practice EfficiencyPatient Flow
3 Cost

• How do your patients get from waiting room to
  exam room?
• Who checks vital signs, preps patients for their
  visit?
• Who assists the physician with exams?
• Who gives injections?
• Does it have to be a nurse?

69
Other Efficiency Opportunities

• Billing is important
• Review your billing processes
• Charge capture
• Who selects the level of service?
• Chart reviews to find lost charges and injections
• Charge entry
• How quickly are your charges billed to insurance?
• Superbill
• Is it updated every year?
• Training
• Billers, nurses
• Coding updates

70
Other Efficiency Opportunities

• Collecting is important too!
• Financial Counseling
• Identify patients with no insurance, poor
  insurance
• Identify patients with no 2nd insurance
• Refer patients to appropriate resources
• Inform the physician and nurse of insurance
  issues as soon as they are identified

71
Other Efficiency Opportunities

• Purchasing
• Chemotherapy Drugs shop wholesalers
• Medical supplies put out to aggressive bidding
  process
• Office supplies whos in charge? Dont let the
  little things add up

72
Other Efficiency Opportunities

• Information Systems
• Practice management system
• Network administration
• Software and hardware support
• Clinical Management Systems - LIS, EMR

73

• Efficiency
• Ability to produce the desired effect with a
  minimum of effort, expense or waste
• Websters New Twentieth Century Dictionary,
  Unabridged

74
Practice Management Series2004 - 2005

• Presented in Conjunction with

75
Elaine TowleLouisiana Oncology SocietyMay 14,
2004
1. Oncology Moving Forward
2. Adapting to Changes in Medicare
3. Generating Practice Efficiencies
4. Organizing for Service Expansion
76
Adapting to Changes in Medicare

• Identifying and understanding the Medicare
  changes in 2004 and their effect on your practice

77
Who should attend

• Physician Leader of the Practice
• President of the PA, Founder
• Practice Administrator
• CEO, Executive Director, COO
• Contracting Officer
• Contract Administrator, Director of Billing
• Clinical Manager
• Medical Director, Nursing Team Leader

78
At the end of this session, you will

• Be able to assess the degree to which your
  practice has made the necessary changes to adapt
  to new Medicare regulations
• Understand the new regulations and be sensitive
  to the threats and opportunities they embody
• Be prepared to adapt to further changes as we
  move to a very low margin on all chemotherapeutic
  and supportive care products
• Understand the role of the physician practice
  leader and the administrator in adapting to these
  changes

79
Medicare Prescription Drug, Improvement, and
Modernization Act of 2003

• Average Wholesale Price decrease with most drugs
  at 85 of AWP April 1, 2003
• Drugs without an AWP as of this date will be
  reimbursed at 95 of AWP
• As of April 1, 2004, 5 drugs repriced, on appeal,
  by CMS
• 2004 Conversion factor at 37.3374 (1.5 over
  2003)
• 0.17 RVUs added for chemotherapy administration
  practice expense
• 32 transitional add-on to the practice expense
  component for 2004 only

80
Relative Value Calculations

• Code 96410 (infusion, 1st hour)

81
Relative Value Calculations

• Code 99214 (level 4 office visit)

82
MMA ImpactPer Oncologist with projections by
Oncology Metrics
Why Change?
Now
Then
83
2005 - ASP

• Transitional 32 increase reduced to 3 for chemo
  therapy administration codes
• ASP 6 for drugs
• RVUs will be reviewed

84
2006 Competitive Bidding Option Added

• Physicians must choose between
• ASP 6 or Competitive Acquisition
• (bidding process has not yet
• been established)

85
Billing Hotspots

• 99211 Minimal visit, physician presence not
  required
• As of 1/1/04 cannot be used the same day
  chemotherapy is administered
• Other EM services may be billed with a -25
  modifier if medically necessary
• Document all services

86
Billing Hotspots

• 96408 Chemotherapy administration, intravenous
  push technique
• Prior to 1/1/04 only one push code was allowed by
  Medicare
• After 1/1/04 multiple push codes are allowed for
  chemotherapy drugs when multiple chemotherapy
  drugs are administered on the same day
• It is not clear how commercial carriers will
  address this change

87
Billing Hotspots

• 96410 Chemotherapy administration,
• infusion technique, up to one hour
• Multiple infusion codes are still not allowed,
  even when multiple chemotherapy drugs are
  administered on the same day

88
Drug Billing Units Changes

• Before 2004
• Oxaliplatin 50mg J3490 unlisted code
• Neulasta 1mg J3490 unlisted code
• Epirubicin 50mg J9178
• 2004
• Oxaliplatin 0.5mg J9263
• Neulasta 6mg J9205
• Epirubicin 2mg J9178

89
Revenue Trends
Margin in the drugs we used
Margin on Services we Provide
Slopes are not equal. Overall combined margins
are declining
2004
2005
2006
2007
90
Act Now

• Stop billing leaks
• Capture all service charges
• E M
• Chemotherapy administration
• Therapeutic Infusion
• Laboratory
• Documentation is critical
• Dont lose any drug charges!
• Chemotherapy
• Supportive care

91
Act Now

• Understand rule changes
• Document and bill by the rules (CMS, AMA)
• Disseminate billing and coding information in
  your practice
• Update drug pricing/charges ASAP
• Update fee schedule, superbill at least yearly
• Dont miss any billing opportunities

92
Act Now

• Financial consultation
• Know your patients insurance status BEFORE
  treatment
• Identify co-pay, co-insurance problems
• Have a plan for indigent care
• local/state resources
• pharmaceutical companies
• www.needymeds.com

93
FAQ Multiple pushes of chemotherapy agents are
now allowed on the same day

• Q. Is it necessary to append a modifier to CPT
  Code 96408 (CHEMOTX ADMIN IV, PUSH)?
• A. No modifier should be necessary. The CMS-1500
  form should include the HCPCS code for each drug
  administered via push and CPT code 96408 with the
  corresponding number of units.

94
FAQ EM Service with Chemo Administration

• Q. Is a separate (non-chemotherapy, non-cancer
  related) diagnosis required to bill a separately
  identifiable evaluation and management service in
  conjunction with chemotherapy administration?
• A. No. There is no requirement that a separate
  diagnosis must be reported to justify billing for
  a separately identifiable EM service in
  conjunction with chemotherapy administration.

95
FAQ EM Service with Chemo Administration

• Q. What sort of documentation is required to
  justify billing an EM visit in conjunction with
  a chemotherapy administration code?
• The documentation requirements have not changed.
  Chart documentation for the EM service must
  justify the level of visit being billed, in
  accordance with either the 1995 or 1997 Medicare
  documentation guidelines.
• Bill for the EM service using the -25 modifier
  along with the appropriate EM Code.
• NOTE 99211 cannot be billed if chemotherapy is
  administered the same day.

96
FAQ EM Codes with non-chemotherapy infusion

• Q. Can CPT 99211 (established patient, may not
  require physician presence) be billed with
  non-chemotherapy drug infusion code (90780
  -90781)?
• ASCOs understanding of CMSs current payment
  policy is that a 99211 should NOT be billed on
  the same date of service as the nonchemotherapy
  infusion.
• If a higher level office visit occurs, the -25
  modifier should be used with the EM code and
  appropriate documentation should be provided.

97
FAQ EM Codes with non-chemotherapy injection

• Q. Can CPT 99211 be billed with non-chemotherapy
  drug injection codes (90782 90788)?
• A. No. CMS has not changed its existing policy.
  It is not permissible to bill for a
  non-chemotherapy injection code on the same day
  as another physician service. If a 99211 visit is
  billed, 90782 should not be billed.

98
FAQ Billing Units

• Q. Some billing software will not accept the 3
  digit unit that is required to bill
  Eloxatin/Oxaliplatin. The new HCPC code is for
  only 0.5 mg. A typical dosage of 150 mg will
  equal 300 units (3 digits). How should this be
  billed?
• HIPAA compliant electronic transactions should be
  able to accommodate 3 digit billing fields so if
  yours doesnt, think about an upgrade. In the
  meantime, you should bill on separate lines with
  no two lines having the same number of units.
  For example, you would bill 300 units as
  J9263 x 99 units
• J9263 x 98 units
• J9263 x 97 units
• J9263 x 6 units.

99
Role of the Physician Practice Leader

• Stay current on the moving target of Medicare
  rules and regulations
• Reinforce to your partners the importance of
  Medicare compliance
• A great resource is the CMS Carrier Advisory
  website, and the CAC website
• Work with your state society to establish
  productive relationships with your Medicare
  carrier and commercial payers
• Support your Practice Administrator as they
  implement policies to deal with these changes

100
Role of the Administrator

• Update your coding books, reference materials,
  fee schedule, superbill annually or as changes
  occur
• Ensure that your staff is knowledgeable about
  reimbursement issues for all payers
• Establish and implement policies to immediately
  respond to changes as they occur
• Enroll in Medicare list serves to stay up-to-the-
  minute on changes
• Work cooperatively with your physician leader in
  providing leadership for your staff in this
  challenging environment

101
Know Your Medicare Carrier

• Carrier Website
• http//www.lamedicare.com/
• Carrier Medical Director
• Lynn Hickman, MD
• Carrier Contact Information
• Subscribe to your carriers listserv
• Circulate carrier bulletins to staff

102
Know Medicare Nationally
103
Know Medicare Nationally
104
ASCO Resources

• Practical Tips for the Practicing Oncologist
  2nd edition (3rd edition is coming soon!)
• Ask a Coding Question
• Call 703-299-1050 or
• Email practice_at_asco.org

105
ASCO Resources

• www.asco.org/MMA
• Look for the FAQs - updated as new information
  available
• www.asco.org/CAC
• A great resource for information on the Medicare
  Carrier Advisory Committee process