Oncology & Hematology Coding Alert

Patients under private payers should see coverage for clinical trial standard-of-care costs. Many coders are taking the "wait and see" approach regarding how the Supreme Court's recent decision on the Affordable Care Act (ACA) will affect their day-to-day job functions. In that decision, the Supreme Court ruled the requirement that individuals must have health care coverage or face a penalty was an allowable tax (rather than a penalty). But the Court decided the federal government couldn't require states to expand existing Medicaid programs by planning to disqualify noncompliant states from Medicaid funding. Here are a few ACA areas to watch for hematology and oncology. Preventive services: If patients "have a new health insurance plan or insurance policy beginning on or after September 23, 2010," certain preventive services must be covered when delivered by a network provider. For these services, the patient is not responsible for a copayment, co-insurance, or meeting [...]