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News You Can Use: Earn Federal Reimbursement for User-Friendly Cancer Screening

Doctors and patients alike prefer iFOBT for colorectal tests

Get Medicare payments for a less invasive colorectal screening test

Many insurers won't pay for immunoassay fecal-occult blood tests used to screen for colorectal cancer - but soon you'll be able to collect reimbursement from Medicare.
 
In a Nov. 4 decision memorandum (#CAG-00180N), CMS says Medicare will soon pay for immunoassay fecal-occult blood tests (iFOBT) screens once a year for Medicare beneficiaries aged 50 and older. The iFOBT will serve as an alternative to - or a replacement for - the screening guaiac fecal-occult blood test.
 
Physicians and patients alike may prefer the iFOBT because fewer specimens need to be collected and dietary restrictions aren't necessary. "The immunoassay fecal-occult blood test appears to be both accurate and easy to use, but it is not yet covered by most payers," says CMS Chief Medical Officer Sean Tunis, MD. "Medicare reimbursement for this test should lead to reduced morbidity and mortality for colorectal cancer."
 
CMS will soon issue a national coverage determination for the iFOBT. To see the decision memo, go to .

Manual System updates unmuddy modifier -GY and offer other helpful hints

Heads up, hospitals - you don't have all the current information you need about modifiers, Medicare deductibles, and payment rules. CMS' most recent updates to its Manual System furnish you with more than a handful of fresh information regarding its policies. Here are the highlights of recent change requests (CRs):
 
clarification on the use of modifier -GY (Item or service statutorily excluded or does not meet the definition of any Medicare benefit) to identify clinical diagnostic laboratory services that aren't covered by Medicare (CR 2924)

  lists of the 2004 Medicare deductible, coinsurance, and premium rates (CR 2969)

  the release date of the next quarterly update to the National Correct Coding Initiative edits (CR 2938)

  updates to the Provider Statistical and Reimbursement  System (CR 2953)

  corrections to the hospital inpatient prospective payment  system rule (CR 2971)

  instructions for fiscal intermediaries on implementing phase three of the Program Integrity Management Reporting System (CR 2646 and CR 2913). 
To see these updates in full, visit .
 
Senate approves Medicare bill

On Nov. 25, the United States Senate approved the most dramatic overhaul of the Medicare program since its inception, with a vote of 54-44.
 
Under the terms of the legislation, which President George W. Bush is expected to sign, in 2004 seniors would get a discount drug card, which the Bush administration predicts will provide savings of 15 to 25 percent. The year 2006 would mark the advent of a full-scale drug benefit, as well as a framework for preferred provider organizations to provide coverage in 10 to 50 regions across the country.
 
In addition to prescription drugs, the bill also revamps Medicare to [...]

- Published on 2004-01-01