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"Where California Oncologists Go For Answers!"
A collaborative publication of the
Medical Oncology Association of Southern California, Inc.
and the
Association of Northern California Oncologists, Inc.
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- 3 days left to submit an informal review request for several CMS performance reporting programs. CMS News
- ACCC webinar this Thursday, entitled "CMS Final CY2018"Affiliate Association News
- Contracting information resourcesMOASC News
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California News
- A Capital Public Radio analysis of data from the California Department of Managed Health Care found that the number of contested denials handled by the department has nearly tripled over the past five years - from roughly 1,500 in 2012 to more than 4,200 in 2016. The department said the increase is because of a jump in the number of insured Californians during that time; the state's uninsured rate has steadily declined since the Affordable Care Act rollout in 2014.Capital Public Radio: Number Of California Patients Fighting Insurance Denials Is Up, Cases Nearly Triple. Why?
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- Noridian/JEMAC has posted more updates to its website:
* MLN Connects
Announcements--Medical Clinical Laboratory Fee Schedule: Final CY2018 Payment Rates; 2017 Medicare FFS Improper Payment Rates Below 10 Percent for First Time Since 2013; 2016 PQRS Feedback Reports and Annual QRURs: Informal Review Period Ends December 1
Claims, Prices & Codes--
Events--Quality Payment Program Year 2 Final Rule Call-November 30
Publications--Medicare Fraud & Abuse Poster-New; Medicare Fraud & Abuse: Prevention, Detection, and Reporting Booklet-Revised;
* HCPCS Codes Used for Home Health Consolidated Billing Enforcement-Annual Update
* Claim Status Category Codes and Claim Status Codes Update
* Therapy Cap Values for CY2018
* 2018 Medicare Physician Fee Schedule Now Available
* MSP Payment Calculator Now Offers Enhanced Details
* MolDX: Bladder Tumor Marker FISH Billing and Coding Guidelines-R2
* DecisionDx-UM Billing Guidelines Article Retirement-Effective September 22, 2017
* MolDX: AlloSure Donor Derived Cell-Free DNA Test Final LCD-Effective December 11, 2017
* PET Radiopharmaceutical/Tracer Unclassified Codes
* QMB Indicator in the Medicare Fee-for-Service Claims Processing System-Third Revision
* 2018 Medicare Parts A & B Premiums and Deductibles Announced
* MolDX: Molecular RBC Phenotyping LCD-R2
* Special Histochemical Stains and Immunohistochemical Stains LCD-R3
* MolDX: Circulating Tumor Cell Marker Assays-R2
* Therapy Code List-2018 Annual Update CR10303
- Upcoming Noridian/JEMAC webinars include:
* Modifier 59, NCCI, and MUE Webinar (November 29)
* Preventive and Screening Services Webinar (December 6)
* Modifier 59, NCCI, and MUE Webinar (December 13)
* Understanding National and Local Coverage Determinations Webinar (December 13)
* Telehealth Services Webinar (December 14)
Visit
https://med.noridianmedicare.com/web/jeb/education/training-events
for more information
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- DHCS has detailed the requirements of Medi-Cal plans to provide palliative care services to their beneficiaries in accordance with SB1004 (2014). DHCS will implement the Medi-Cal palliative care program through managed care and fee-for-service providers beginning January 1, 2018. Read the DHCS all-plan letter at
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- Hear MOASC President, Warren Fong, M.D.'s interview with Larry Marino, host of KRLA's
Sunday Morning Newsmakers to discuss the 340B program. The interview will run
on Sunday, December 3, on KRLA's AM 870 "The Answer".
- Please see attached comment letter from Citizens Against Government Waste to CMS related to OPPS and 340B. Comment to CMS Final Rule.
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The number of contested denials handled by the department has nearly tripled!
YOUR RESPONSE IS NEEDED!
During the roundtable discussion at the MOASC Educational Series program, the following topics were discussed:
- UHC problem with NDC numbers and the N4 code,
- Monarch/SCOA takes 160 days for payment,
- Blue Shield wants records and takes 45+ days to review, even when office sends the records at the beginning of treatment.
ACTION:
Are you experiencing these, or other, problems with the health plans from whom you seek reimbursement? Through December 8th, please provide the MOASC Office
moasc@moasc.org
with examples of the specific payer issues. MOASC will compile and forward to the California Insurance Commissioner or the Department of Managed Health Care for resolution. Thank you.
- MOASC Members are in the thick of contract negotiations with local IPAs and health plans. Do you know enough about your practice to negotiate the rate that's right for you?
Read ASCO's whitepaper and COA's data study,
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- ANCO's Medicare Reimbursement for Oncology 2017 & Revenue Cycle State of the State with Bobbi Buell takes place in San Jose on January 3 and Sacramento on January 4. Learn the latest information impacting Medicare's reimbursement for oncology in 2018 and what to do about your denial rate, days to pay, and days to file using data specific to northern California. This will be a unique opportunity to get benchmarks that you can use for billing and appeals at your facility. Download the meeting announcement and registration form at www.anco-online.org/MedicareUpdate2018.pdf.
* SAVE THE DATE: ANCO, in association with the Organizing Committee of the San Antonio Breast Cancer Symposium and Encore Medical Education, is hosting the Best of San Antonio Breast Cancer Symposium San Francisco (Best of SABCS San Francisco) at The Claremont Hotel on Saturday morning, January 27, 2018. Hope S. Rugo, M.D., is the Regional Director for the Best of SABCS San Francisco. Stay tuned for registration information.
- The 18th Multidisciplinary Management of Cancers: A Case-based Approach returns to the Silverado Resort and Spa in Napa on March 16-18, 2018. The meeting is sponsored by the Association of Northern California Oncologists, Stanford Cancer Institute, UC Davis Comprehensive Cancer Center, and UCSF Helen Diller Family Comprehensive Cancer Center. Go to www.multicancers.org for more information, to register, and arrange for housing.
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- Given the diversity in our society, health organizations should be mindful of the languages their clients, beneficiaries, and customers use. The ideas people have about health, their health literacy skills, and how they communicate about health reflect their languages and cultures. The Centers for Disease Control has provided information on tools for Cross-Cultural Communication. Visit the CDC Culture and Health Literacy web page.
- Fate of Detroit-area doctor who committed fraud by putting hundreds of patients through needless cancer treatments, is being decided by an expert. The recommendation for approval is payment of $4.1 million in claims, including $2 million in funeral costs, filed by the victims. Read More
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CMS News
- This Friday, December 1 at 5 pm PT your preview period for the
Physician Compare
will end
. The Centers for Medicare & Medicaid Services (CMS) opened the Physician Compare preview period on October 18. The 30-day preview period provides an opportunity for clinicians and groups to preview their 2016 performance information before it is publicly reported on Physician Compare profile pages later this year and in the Physician Compare Downloadable Database.
- Friday, December 1 at 5pm PT, is also the deadline for you to access and review your 2016 PQRS feedback report and 2016 Annual QRUR, to determine whether you are subject to the 2018 PQRS downward payment adjustment and your practice's 2018 Value Modifier payment adjustment. The PQRS feedback reports show your program year 2016 PQRS reporting results, including if you are subject to the 2018 PQRS downward payment adjustment. The payment adjustments shown in the reports are based on proposals that were included in the 2018 Medicare Physician Fee Schedule Proposed Rule (https://federalregister.gov/d/2017-14639). If you believe your payment adjustment status was made in error, you may request an informal review of your 2016 PQRS results and/or 2018 Value Modifier calculation during the informal review period from now until 5:00 pm Pacific Time (PT) on December 1, 2017.
- CMS officials decided not to move forward on its Shared Decision Making model after too few accountable care organizations signed up to participate. ACOs in the Medicare Shared Savings Program or Next Generation model would have received incentives to test a four-step clinical decision-making process for certain conditions.
Health Exec
- The unintended consequences in CMS' Hospital Reduction Readmissions Program may not be in patient's best health-interest
.
Overall, the CMS' Hospital Reduction Readmissions Program has motivated hospitals to change wasteful care practices. But health policy experts wonder if the tactics hospitals have adopted might not always be in the best interest of patients. Read More
- The Centers for Medicare and Medicaid Services is expanding the Medicare Advantage value-based insurance design model to an additional 15 new states and will allow insurers greater flexibility in enrolling beneficiaries with chronic conditions. Starting in 2019, insurers in the selected VBID model states can expand the model to include more Medicare beneficiaries with chronic conditions than previously identified by CMS.
For 2019, this will be expanded to include: California, Colorado, Florida, Georgia, Hawaii, Maine, Minnesota, Montana, New Jersey, New Mexico, North Carolina, North Dakota, South Dakota, Virginia, and West Virginia.
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Affiliate Association News
- ACCC will host a webinar entitled CMS Final CY2018 Outpatient Prospective Payment System (OPPS) & Physician Fee Schedule (PFS) Rules: What You Need to Know on Wednesday, November 29 at 10PM PST. Register at
- MOASC Member, City of Hope invites you to the State of the Science Summit on Lung CancerAdvanced Non-Small Cell Lung Cancer, Monday, December 04, 2017, 6:00 pm - 9:15 pm at the Pasadena Hilton 168 S Los Robles Ave, Pasadena, CA 91101
Topics of Discussion:
* Biomarkers in NSCLC * Surgical resection in an era of biomarker driven therapy * Assessing challenges of disparity in lung cancer therapy * Combination strategies with immunotherapy in frontline NSCLC * Immuno-radiotherapy in non-small cell lung cancer * Targeted Therapies: EGFR, sequencing * Targeted Therapies: ALK, sequencing
* Checkpoint Inhibition for surgically resectable patients * Question & answer sessions
- At the 59th ASH Annual Meeting, experience these one-of-a-kind educational opportunities, and engage in new education sessions. Don't miss either of the two newly announced U.S. Food and Drug Administration (FDA)-sponsored sessions on new drugs. A joint session, co-sponsored by the FDA, will take place Sunday, December 10, and feature
new drug approvals in acute lymphoid leukemia and non-hodgkin lymphoma
.
Then, on Monday, December 11, the FDA will host another joint session which will feature
new drug approvals in acute myeloid leukemia
.
At both sessions, speakers will give an in-depth analysis of newly approved drugs and their current and future roles in the treatment of these diseases.
- ASCO seeks applications for volunteers at its ASCO Volunteer Portal
https://volunteer.asco.org
.
Your application will be used for all upcoming Volunteer Corps opportunities and 2018 committee consideration. Apply by January 31, 2018 for 2018 committee consideration.
- ASCO University is having a 2017 Year-End Sale offering discounts on ASCO Annual Meeting or Symposium captured presentations; and, ASCO-SEP, 5th Edition Book/eBook. Discounts are valid through December 4 at
https://university.asco.org
.
- The second annual
ASCO-SITC Clinical Immuno-Oncology Symposium,
January 25-27 in San Francisco,
will feature more than 40 expert faculty discussing the latest clinical and translational advances in immuno-oncology. These specialists will facilitate in-depth discussions on cutting-edge research currently shaping the clinical application of immunotherapy, as well as provide insight into what this research means for future patient care.
- Registration is now open for the 2018 Community Oncology Conference! The Conference will center on keeping patients and their needs paramount in transforming our nation's cancer care system. Over two packed days of learning and networking, community oncology practices and allied professionals will gain insights into how to overcome the challenges to patient care that they face on a daily basis. Balancing the many external and internal forces in community oncology requires constant adaption and teamwork. Attending the 2018 Community Oncology Conference will help keep you current with all that it takes to deliver community cancer care, while remaining focused on expert, tailored care for every patient.
Register Today to Save Your Seat!
- The abstract submitter is now open for the
2018 ASCO Annual Meeting.
Submit an abstract by February 13, 2018, at 8:59 PM (PST) to be considered for presentation or publication at this year's Annual Meeting, held June 1-5, in Chicago, Illinois.
- ASH has started accepting applications for the ASH Congressional Fellowship Program for 2018 - 2019. This year-long opportunity will place a hematologist on Capitol Hill to work in a Congressional office and help shape health care and hematology policy. This opportunity will be available for one ASH member starting in September 2018. For requirements, more information or to apply today, please visit the
Congressional Fellowship Program
website.
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NCCN has published updates to the below.
For the complete updated versions, please visit
NCCN.org. Recent updates include: cancer and chemotherapy-induced anemia (V2.2018), cervical cancer (V1.2018), non-small cell lung cancer (V1.2018), occult primary (V1.2018), T-cell lymphomas (V1.2018), vulvar cancer (V1.2018).
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- Pfizer Oncology is proud to announce that SUTENT®(sunitinib malate) has been approved for adjuvant treatment of adult patients at high risk of recurrent renal cell carcinoma (RCC) following nephrectomy. SUTENT is the first approved treatment for patients with RCC in this setting. For patients requiring financial assistance, Pfizer Oncology has support programs that may be able to help. You can learn more at the product website SUTENT.com.
- Find out about access and coverage support for your patients
- Heron Therapeutics informs ANCO and MOASC that CMS has assigned HCPCS J-code J1627 to Sustol for states of service on or after January, 2018. In addition, the United States Food and Drug Administration has approved Cinvanti for the prevention of acute and delayed chemotherapy-induced nausea and vomiting (CINV).
- THIS FRIDAY, December 1, oncologists and hepatologists are invited to attend a Hepatocellular Carcinoma (HCC) Advisory Board Meeting in Costa Mesa, CA. Scientific Global Communications and their pharmaceutical client are interested in convening community physicians (hepatologists and oncologists) who currently treat HCC patients to gain insight around management approaches as they relate to the emerging treatment landscape. Attendees will be provided a fee for service for their participation (and travel expenses will be covered).
Please feel free to share this information with any of your colleagues who are involved in the management of HCC in the community to assess their interest in participation. Please contact Kerri Riccardo Kriccardo@scientificglobal.com c: 914.522.2589, at Scientific Global Communications if you are interested
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MOASC CALENDAR
Spotlight on Hematology
January 27, 2018
Huntington Beach, CA
Oncology Summit
March 3, 2018
Huntington Beach, CA
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(San Francisco, January 18-20)
(San Francisco, January 25-27)
Best of SABCS San Francisco (Berkeley, January 27)
(San Francisco, February 8-10)
(Napa, March 16-18)
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The
Medical Oncology Association of Southern California
(MOASC) is a leading oncology society that advances and protects the ability of cancer patients to obtain, and the ability of the oncology physicians to provide, optimal cancer care. The
Association of Northern California Oncologists
(ANCO) is an association of hematologists/oncologists dedicated to promoting high professional standards of cancer care by providing a forum for the exchange of ideas, data, and knowledge.
The material contained in the
California Oncology Weekly
is intended as general information for ANCO and MOASC members. Because diagnostic, treatment, contracting, coding, and billing decisions should be made on a case-by-case basis, any such information contained in the
California Oncology Weekly
may not apply in any given situation. Members are encouraged to contact their own consultants or advisors to obtain specific advice on matters relating to contracting, coding, and billing. The information contained in
California Oncology Weekly
should not be used as a substitute for such advice.
This publication provides a summary of regulations affecting oncology and its business practices. Reading this newsletter does not substitute for understanding regulations and verifying the validity of every claim. This information is time-sensitive and is subject to change. MOASC or ANCO accepts no liability for any statements or articles herein.
CPT codes are owned and trademarked by the American Medical Association. All Rights Reserved.
MOASC: P.O. Box 161, Upland, CA 91785 | P (909) 985-9061 | F (909) 804-5006| www.moasc.org
ANCO: P.O. Box 151109, San Rafael, CA 94915 | P (415) 472-3960 | F (415) 472-3961 | www.anco-online.org
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