Development of a complex patient identification process for the CMS’ Oncology Care Model.

32Background: The CMS’ Oncology Care Model (OCM) provides practices with enhanced monthly payments for beneficiaries with cancer receiving chemotherapy. While the program will distribute a retrospective beneficiary list, practices need to track and identify eligible patients upfront to initiate care management and financial counseling processes and to bill for the enhanced payment. The eligibility criteria require information that many practices do not have. We describe a stepwise approach to patient identification that can be used by other OCM practices. Methods: We ran a report that identified patients with Medicare who received an OCM-eligible drug. We classified drugs into four categories: IV chemo confirmed by our own billing, oral specialty tracked and/or filled by our specialty pharmacy, general prescriptions filled at offsite pharmacies, and oral drugs billed under Medicare Part B. Because patients on general oral drugs receive 11 refills when first prescribed, we could not rely on a new prescript...