Anthem cuts, FDA news, drug spending, new Medicare cards, and care discrepancies. View this email in your browser
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Dermatology World Weekly
January 3, 2018
The January issue of Dermatology World is now available online at www.aad.org/dw. This month’s issue discusses the expansion of private equity in dermatology. Also, don’t miss DW’s tips on how to invest in technology without breaking the bank. Check out the tablet-friendly version, download the DW app, or visit www.aad.org/dw.
 
Anthem delays, changes modifier 25 cuts

Anthem, Inc. has announced that, while it will still reduce reimbursement for E/M services billed with modifier 25, reimbursement will be reduced by 25 percent rather than by 50 percent, as was originally announced. Anthem also announced that the policy will go into effect on March 1 in California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin. For some states, this is a delay in implementation. Anthem also indicated that the policy will be effective in Georgia and Virginia upon network contract renewal.

The American Academy of Dermatology Association (AADA), along with the American Medical Association (AMA) and other medical specialties, have fought Anthem’s proposed policy change, concerned that it contradicted well-accepted coding conventions and guidelines. The AADA will continue to work with the AMA and other medical specialties to challenge the revised policy. Read more about the Academy’s attempts to rein in this policy, and other payer policies, in Dermatology World.

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FDA approves PD-1 inhibitor for melanoma

The U.S. Food and Drug Administration (FDA) has approved nivolumab (Opdivo) ― a PD-1 inhibitor ― as an adjuvant treatment for melanoma patients with involvement of lymph nodes or metastatic disease who have undergone complete resection.

In other FDA news, Genentech has submitted a supplemental Biologics License Application to the FDA for the use of rituximab (Rituxan) for the treatment of moderate-to-severe pemphigus vulgaris. The drug has already been granted Breakthrough Therapy Designation and Orphan Drug Designation for the treatment of pemphigus vulgaris. Rituximab was approved as a treatment of relapsed or refractory low-grade or follicular, CD20-positive, B-cell non-Hodgkin’s lymphoma in 1997 and has since been approved for a number of indications including rheumatoid arthritis, granulomatosis with polyangiitis, and microscopic polyangiitis.

Read more about how chimeric antigen receptor T cells can potentially cause a surgical strike against pemphigus in this month’s issue of Dermatology World.

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Spending on drugs slowed in 2016

According to the Centers for Medicare and Medicaid Services (CMS) spending on prescription drugs increased only 1.3% to $328.6 billion in 2016 ― a significantly slower increase than the 8.9% spending growth in 2015. While spending on drugs appears to have slowed in 2016, concerns remain about the increasing cost of drugs and patient access to medications. The cost of drugs is being addressed in many states ― California is attempting to address drug transparency and has passed legislation that would require manufacturers to provide advance notice prior to a significant drug price increase. The Pharmaceutical Research and Manufacturers of America (PhRMA) has filed a complaint in attempts to block the law.

Read more about the rising cost of drugs and the efforts that are being made to combat this issue in Dermatology World. Also, access more than 30 prior-authorization letters with ease at the AADA’s Practice Management Center.

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Countdown to Medicare card transition begins

Starting April 1, 2018, CMS will begin replacing the Social Security number-based Health Insurance Claim Number (HICN) with a Medicare Beneficiary Identifier (MBI) on the new Medicare cards. The agency has implemented a public education campaign about the change and has developed tools and resources for providers to use when educating patients about the change. CMS expects that practices will be able to start transitioning to the new MBI identification system in April 2018. During this period, CMS will accept either the HICN or the MBI for CMS claim adjudication. CMS will only accept claims with the MBI listed starting Dec. 31, 2019.

The switch from Social Security numbers to MBIs may help protect patients from identity theft, but what can you do now to protect your information? Read more about how to protect yourself and your practice from a cybersecurity breach in Dermatology World. Also, check out the Academy’s Guide to HIPAA and HITECH for Dermatology Manual and learn more about the steps you need to take to protect your patient data and avoid a breach. In addition, stay tuned for next month’s issue of Dermatology World that will discuss how to protect your patients’ data from hacking attempts.

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Health care discrepancies may exist for Native Americans

According to a recent poll conducted by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 23% of Native Americans indicated that they have been discriminated against when going to a physician’s office or health care clinic. Additionally, about 44% of Native men and 17% of Native women indicated that the quality of available physicians or health care services in their communities was worse than that in other communities. A similar health care discrepancy has been identified for the LGBT community as well. Read more about the cultural competencies of caring for lesbian, gay, and bisexual patients in Dermatology World.

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Links to this month's issue

Autoimmune disease
 
New Year, new codes
Social media 101
 
Tech bells and whistles

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