California Oncology Weekly
"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.
February 27, 2018
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THIS SATURDAY, March 3rd!
Join your colleagues to learn and discuss
Harnessing the Power of Immunotherapy
(MOASC News)
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California News
- The CMA has received reports that in December 2017, Anthem Blue Cross mistakenly notified some enrollees that their physician had been terminated from the Anthem network. Corrective notices were issues to both physicians and patients. If your practice was affected by this error, then CMA wants to hear from you at its Reimbursement Helpline (888-401-5911) or at economicservices@cmanet.org.
- The California Department of Managed Health Care (DMHC) has issued proposed regulations for calculating payors' "average contracted rate" under California's new out-of-network billing and payment law. The law (AB 72), which took effect July 1, 2017, requires fully insured commercial payors to make "interim payments" to non-contracted physicians for covered, non-emergent services performed at in-network health facilities. The interim rate is the greatest of 125 percent of Medicare or the plan/insurer's average contracted rate (ACR).
Under the new law, the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) are each required to specify a methodology to determine the ACR by January 1, 2019. CDI is also expected to issue its proposed ACR methodology very soon. If your practice has received incorrect payments or denied claims related to the new law, CMA wants to hear from you. Practices can contact CMA at (888) 401-5911 or economicservices@cmanet.org. To learn more about this law, find out if payors are reimbursing you correctly and learn how to dispute the interim rate, visit CMA's AB 72 Resource Center.
- California Public Protection & Physician Health Inc. (CPPPH) is offering a series of free informational workshops about the Medical Board of California's new Physician Health and Wellness Program. The workshops will discuss: how the new program will work, when it will be available to physicians, and what role medical group and medical staff well-being committees will play. CPPPH, together with the California Society of Addiction Medicine and California Medical Association (CMA), are encouraging all wellbeing committees and medical staff leaders to attend one of these workshop sessions so they can consider how they may use this new resource when it becomes available.
Southern California sessions will be March 3, 2018, at the San Diego County Medical Society and March 24, 2018, at LAC-USC Medical Center. Northern California dates will be added soon. These special sessions are FREE, but advance registration is required.
- TRICARE is experiencing transition challenges in the West Region, and is aware of the customer service issues Tricare patients are experiencing. Learn more about how Tricare is fixing these issues, including waiving their usual authorization process through March 18. Read the full article here.
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- Noridian/JEMAC has posted more updates to its website:
Publications
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* MolDX: Afirma Assay by Veracyte Billing and Coding Guidelines-R2
* Outpatient Therapy Cap Repeal and KX Modifier Use
* MolDX: FDA-Approved BRAF Tests Billing and Coding Guidelines-R1
* MolDX: ThermoFisher Oncomine Dx Target Test For Non-Small Cell Lung Cancer Billing and Coding Guidelines
* MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing LCD-R3
* MolDX: RPS19 Gene Tests Billing and Coding Guidelines-R1
* ICD-10 and Other Coding Revision to NCDs CR10473
* MolDX: FDA-Approved KRAS Tests-R2
* MolDX: BCR-ABL Coding and Billing Guidelines-R1
* MolDX: FDA-Approved EGFR Tests Billing and Coding Guidelines-R2
* Counting Units for Therapy Codes
* MPFSDB-April 2018 Update CR10488
* RARC, CARC, MREP and PC Print Update CR10489
Low Volume Appeals Settlement
* HPTCS April 2018 Code Set Update CR10402
- Upcoming Noridian/JEMAC webinars include:
* Basic Non-Covered Services Webinar (February 28)
* Preventive Services and Screenings Webinar (March 7)
* Modifier 59, NCCI and MUE Webinar (March 22)
* Electronic Claim Submission Webinar (March 28)
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Medi-Cal News
- California now requires palliative care services be made available to Medi-Cal patients. L.A.'s largest Medi-Cal plan brought 300 health care providers from around the Los Angeles region for a day-long conference to learn more about a new state regulation that took effect in early 2018, regarding palliative care and end-of-life planning. In 2014, California passed a law requiring Medi-Cal Managed Care patients get access to palliative care. Now, patients with advanced cancer, congestive heart failure, liver disease, and chronic obstructive pulmonary disease can get more services to address suffering associated with their illness. Over these four years, the state has been ramping up to prepare for the new patient need.
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- THIS SATURDAY! Join your colleagues to learn and discuss Harnessing the Power of Immunotherapy at MOASC's 3rd Annual Oncology Summit®, March 3, 2018 at the Waterfront Hilton, Huntington Beach. Topics & speakers: *Head and Neck Ezra Cohen, MD, UCSD *Colon Cancer Marvan Fakih, MD, COH *Lung Cancer Karen Reckamp, MD, COH *Breast Cancer Sara Hurvitz, MD, UCLA *Melanoma Omid Hamid, MD, The Angeles Clinic & Research Institute. Register at
moasc@moasc.org.
- Following the MOASC Oncology Summit®, you are invited to participate in the Biocept Advisory Board Meeting, Saturday, March 3, 2018, 2pm - 5pm, immediately following the MOASC Oncology Summit®. Topic: Liquid Biopsies: The Future is Now. Register early as there is limited seating for the advisory board. Honorarium is provided.
- City of Hope presents a dual track of "How the Experts Treat Hematologic Malignancies,"
March 14-17, 2018 in Las Vegas. Please contact Continuing Medical Education at (626)218-5622 or CityofHope.org/cme
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MOASC Member, UC Irvine, presents their 3rd Annual UCI Hematology Symposium on Saturday, April 21, 2018
. The program will feature regional and national experts bringing you state-of-the-art updates on sickle cell disease, modern anticoagulants, CAR-T Cell therapy, and others. New this year, we will feature a Case Conference segment with individual case presentations and interactive discussions. We hope to see you at the 3rd Annual UCI Health Hematology Symposium.
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- 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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- The deadline is this Friday, March 2, 2018, for reporting offers of health coverage made during the 2017 calendar year. The Internal Revenue Service (IRS) issued an extension of the due date for insurers and employers to provide individuals with either Form 1095-B, Health Coverage, or Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.
- ASH has been in touch with the FDA's drug shortage office regarding the critical nature of the national shortage of Etoposide Injection. The FDA's drug shortage office is working directly with the manufacturers to resolve the shortage. They noted that two of three manufacturers, including Accord and Fresenius Kabi, have recently released some product. The FDA also noted that all three manufacturers are planning to release additional product throughout February, and the Agency is hoping for a resolution of the situation by March. Please contact Katherine Stark at ASH if you are dealing with a critical case that requires this therapy, or other shortages or issues accessing critical therapies. Please visit the ASH drug shortage page.
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CMS News
- Those interested in participating in a new voluntary bundled-payment model that will be considered an advanced alternative payment model under MACRA have until March 12 to apply. The Bundled Payments for Care Improvement-Advanced Model includes 32 clinical-care episodes that providers can choose from, 29 of which are in the inpatient setting and three in the outpatient setting. The first cohort will begin Oct. 1. The model performance period will run through Dec. 31, 2023. Under the model, clinician payment will be based on quality performance during a 90-day episode of care. See the full text of this CMS Press Release.
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Physicians face March deadlines for 2017 MIPS data submission. The data submission deadline for the 2017 Merit-Based Incentive Payment System are March 16 for the "group" reporting deadline, and March 31 for most "individual physicians," through the CMS web interface, to avoid a penalty in 2019. CMS has created a Top Ten List of things to know and do before the March deadlines, along with important dates to remember.
Key Dates:
March 31, 2018:
Last day for all other MIPS reporting, including via qpp.cms.gov
April 1, 2018:
CMS will begin providing performance feedback
January 2019:
Payment Adjustments applied
- Comprehensive Error Rate Testing (CERT) reviews are conducted by Medicare through your Medicare Administrative Contractor (MAC). These are random audits to gather payment errors. Responding to a CERT request for documentation is required and your claim being reviewed can result in an overpayment and refund. The CMS Provider Minute:
Utilizing Your MAC video gives you the tools necessary to be successful in navigating CERT review. Learn about: Your MAC's role; CERT process; Your role.
- CMS held a call on Low Volume Appeals Settlement Option. CMS speakers discuss how to identify whether you are eligible and which of your pending appeals may be settled. The Recording, transcript and clarification information from this call is now available:
Click Here to access the webpage to download the presentation, access to the audio recording, transcript and clarification.
- A new CMS Provider Compliance Tips for Infusion Pumps and Related Drugs Fact Sheet is available. Learn about: Requirements for Infusion pumps; How to prevent claim denials;
Documentation needed to submit a claim. Click Here to download more information.
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CMS seeks physicians for QPP study
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The CMS is recruiting physicians to take part in its Burdens Associated with Reporting Quality Measures study, which will look at how to improve the Quality Payment Program. The study will examine workflows and data submission, as well as physician issues in collecting and reporting quality data.
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Affiliate Association News
- The
2018 Community Oncology Conference-Keeping Patients at the Center, is scheduled for April 12 -13, 2018 at the Gaylord National Harbor Hotel.
The four tracks of the 2018 Community Oncology Conference really make this four meetings in one
. They cover the breadth and depth of what we do every day in community oncology: Clinical; Business, Advocacy and Pharmacy. Check out the full Conference schedule to see all the great speakers and sessions:
conference.communityoncology.org/2018-conference-agenda/
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The discounted Community Oncology Conference room block is selling out fast. Be sure to register and reserve your room today. Join more than 1,300 oncologists/hematologists, pharmacists, practice administrators, nurses, advocates, payers, and industry partners for two days of learning and networking. Visit www.COAConference.org for details.
- Come early, May 31 & June 1, and expand your educational opportunities at the
2018 ASCO Annual Meeting.
(
June 2 - 5).
ASCO has two types of educational programs that offer innovative learning opportunities prior to the official start of the Annual Meeting. Space for these sessions is limited - register today.
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Registration for ASCO's QOPI Round 1
opened on February 20 and will close on June 1.
- ASCO's Clinical Care Advances 2018 is now available online at www.asco.org/CCA and names adoptive cell immunotherapy as the advance of the year.
- NCCN has published updates to the below. For the complete updated versions, please visit NCCN.org. Recent updates include: cancer-related fatigue (V2.2018), distress management (V2.20180, Mantle cell lymphoma (V2.2018), T-cell lymphomas (V3.2018), testicular cancer (V2.2018).
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- AstraZeneca
will host a dinner program entitled Head to Head Progression-Free Survival Data for Patients who have progressed after EGFR TKI Therapy with Hatim Husain, M.D., Moores Cancer Center, University of California, San Diego, on March 17 at Morimoto Restaurant in Napa. RSVP to Jason Yonehiro, (415) 205-3699 or
jason.yonehiro@astrazeneca.com.
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MOASC CALENDAR
Oncology Summit
March 3, 2018
Huntington Beach, CA
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(Napa, March 16-18)
(San Francisco,
April 27-28)
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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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