HCFA bends same-day rule for cancer patients
HCFA bends same-day rule for cancer patients
Congressional pressure pays off
A U.S. Senate coalition has convinced Medicare officials to make an exception to a rule against same-day consultations for medically necessary services for beneficiaries treated at multidisciplinary cancer clinics.
Medicare has a policy against paying for multiple consultations by different specialists for the same patient on the same day. But, "in case of oncological care, such coverage rules are outdated and inappropriate since cancer patients inherently require multi-modality care," Sen. Jesse Helms, R-NC, and 11 other lawmakers wrote to Nancy-Ann DeParle, administrator of the Health Care Financing Administration (HCFA) in Baltimore.
As a result of current coverage rules, "patients are often required to make several appointments over several days in order to obtain all the necessary consultations from all the various specialists," the letter stated.
HCFA’s exemption is good news, according to Christian Downs, director of provider economics at the Association of Community Cancer Centers in Rockville, MD. "It is critical, especially, for cancer patients to be able to come to a cancer center and to be able to receive their services all at one time."
When it comes to consultations, "Medicare policy does not stipulate a frequency limit on the number of consultations provided by physicians for a single patient on any given day. The determining factor is the medical necessity of the services provided," DeParle wrote in a letter informing Helms of HCFA’s new policy clarification.
For multiple, concurrent same-day consults, "payment may be made for the services of more than one physician during a given time when such services are considered by the Medicare Part B carrier to be reasonable and necessary," she wrote. To qualify, each physician must play an active role in the patient’s treatment, and physician services must not be duplicative.
When carriers are deciding if such services are reasonable and needed, they should consider the physicians’ specialties, the patient’s condition, and the medical necessity of the particular services, wrote DeParle.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.