C
a
l
i
f
o
r
n
i
a
O
n
c
o
l
o
g
y
W
e
e
k
l
y
"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.
September 12, 2017
September is
Prostate Cancer
&
Blood Cancer
Awareness month.
|
|
|
|
|
- Anthem Blue Cross not paying "interim payment" as required by law (California News)
- Free webinars on Duplicate Claims and Critical Care this week!(Noridian News)
- Prolonged services without direct patient contact payable by Medicare PFS (Affiliate News)
|
California News
- MOASC and ANCO have been informed by the California Medical Association (CMA) of Anthem Blue Cross is not paying the "interim payment" as required under the recently effective law (AB 72) limiting out-of-network billing for covered, non-emergent services performed at an in-network facility.
The new law requires fully insured commercial plans and insurers to make "interim payments" to non-contracted physicians for non-emergent services performed at in-network health facilities, and places limitations on the ability of physicians in such circumstances to collect their full billed charges. The interim rate defined in AB 72 is the greater of the average contracted rate (including only commercial contracts) or 125 percent of the amount that Medicare reimburses on a fee-for-service basis for the same or similar services in the geographic region in which the services were rendered.
- The Legislative session ends at midnight this Friday, September 15th. Legislators have been amending bills, debating and voting. Several key health care bills saw action last week.
AB 205 (Wood)/SB 171 (Hernandez). Medi-Cal: Medi-Cal managed care plans
. The joined bills would require the Department of Health Care Services to make several changes to the operation of the Medi-Cal managed care program, to conform to new federal requirements.
The bills were amended last week and will be voted on this week.
AB 315 (Wood). Pharmacy benefits management.
The bill would regulate pharmacy benefit managers (PBMs) in California and require PBMs to provide certain information certain to purchasers. The legislation would shed new light on a significant player in the pharmaceutical supply chain. The bill is supported by MOASC, ANCO, organized medicine, pharmacists, consumer groups, and opposed by PBMs and health plans. Last week, Assemblyman Wood announced he was holding his bill and not moving it this year. Dr. Wood indicated the Administration asked him to consider requiring disclosure of certain information to the Department of Managed Health Care so the department can produce reports that can be used by purchasers and policy makers to inform their decision making. Given the late timing, Dr. Wood decided to hold the bill and work on moving it next year. There is also some thinking that this change may be connected to SB 17 (Hernandez), which does not provide confidentiality protection to drug manufacturers.
SB 17 (Hernandez). Health care: prescription drug costs.
The bill will require pharmaceutical manufacturer to notify purchasers in advance of a price increase for an existing product when the increase exceeds a specified threshold. Opposition is primarily from the pharmaceutical industry. The bill was passed out of Appropriations Committee with several amendments. Senator Hernandez held a press conference last week with supporters of the bill, including several Assemblymembers, including new co-author Jim Wood and patient advocates urging its passage.
SB790,
the bill to limit gifts to providers, is not moving forward in this legislative year; the author has indicated he will try again to advance this legislation next year.
- CMA's Practice Resources (CPR; September) is now available online at www.cmanet.org/cpr and features articles entitled Physicians report Anthem not complying with AB72 interim payment rules; Webinar: How to challenge AB72 interim payment for out-of-network services; No-cost MACRA technical assistance available to California physicians; Updates to prior authorization form for prescription medications and new timelines for response now in effect; Noridian reports spike in provider deactivations and lost revenue; CMS is now accepting QPP hardship applications for 2017; Anthem Blue Cross offering fall seminars on 2017 operational updates; The Coding Corner: Proper coding for bilateral procedures.
- Forthcoming CMA webinars include:
* MACRA: Guidance on the Merit-Based Incentive Payment System (MIPS; September 20)
* Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (September 27). Learn more and register at www.cmanet.org/events.
|
|
|
- Noridian/JEMAC has posted more updates to its website:
* MLN Connects
Announcements--Hospice Provider Preview Reports Available through September 28; 2015 Inpatient and Outpatient Hospital Utilization and Payment Data Available
Claims, Pricers & Codes
--October 2017 Average Sales Price Files Available
Events--New Medicare Card Project: Clearinghouses and Vendors Special Open Door Forum-September 12; Qualified Medicare Beneficiary Program Billing Requirements Call-September 19; Reporting Hospice Quality Data: Tips for Compliance Cell-September 20; PQRS: Feedback Reports and Informal Review Process for PY2016 Results Call-September 26; Physician Compare Call-September 28
Publications--
* MolDX: ResponseDX Tissue of Origin-R2
* MolDX: Percepta Bronchial Genomic Classifier LCD-R1
* MolDX: APC and MUTYH Gene Testing LCD-R1
- Intensity Modulated Radiation Therapy (IMRT) LCD - R4
The following JE Local Coverage Determination (LCD) has been revised. Read the complete update.
- Noridian supports and encourages the use of self-service technology. The Noridian Medicare Portal allows providers an on-demand method to retrieve their Standard Paper Remittance (SPR) Advices. This will eliminate paper delays and administrative burdens traditionally associated with SPRs. Read the complete update
- September Webinars - Register Now
Noridian is hosting free, web-based workshops (webinars). This article includes a listing of this month's webinar topics. Read the complete update
webinars include:
* Duplicate Claims (September 13)
* Critical Care (September 14)
* Basic E and M Common Errors (September 20)
* Recoupment Overpayment Timeline and Payment Options Webinar (September 21)
|
|
|
- Limited drug access, power outages and floodwater injuries are challenges the residents of Houston AND Florida, will have to face right away.
Because a disaster can strike any time, be sure to review emergency plans
annually. Personal and business situations change over time as do preparedness needs. When employers hire new employees or when a company or organization changes functions, plans should be updated accordingly and employees should be informed of the changes. Make plans ahead of time and be sure to practice them.
Are you ready for the natural disasters facing your community through earthquake, fire and flood? Not only do we have emergency disasters in California, but every community across the United States has such emergencies! Find out how you can protect your practice and your patients from these disruptions through MOASC's Oncology Patient Emergency Network (OPEN). Contact the MOASC Office moasc@moasc.org for more information on the OPEN program to assist you and your patients in times of disaster.
- SAVE THE DATE! Join us for the 2017 Clinical Staff, Oncology Billing & Administrator Programs. November 8, 2017- Clinical Staff Program (Nurses, pharmacists, NPP's) and November 9, 2017- Administrators Program and Billers Program, at the DoubleTree Suites by Hilton Anaheim Resort, from 8:30am to 12:30pm. Topics to be presented and discussed are: Pharmacy Standards/USP Regulations; Immunotherapy and Targeted Therapy; MACRA/MIPS; Pain Management; A/R & Billing Updates, and more. For more information contact the MOASC office at moasc@moasc.org or 909-985-9061 x1.
|
|
|
- The Conquer Cancer Foundation of the American Society of Clinical Oncology is now accepting applications for the 2018 Young Investigator Award (YIA). The Association of Northern California Oncologists (ANCO) is funding one 2018 YIA for a qualified northern California applicant, and urges all eligible northern California physicians to apply. The YIA is a one-year, $50,000 grant that provides research funding to promising physicians to support their transition from final years of training to faculty appointment and to encourage and promote quality research in clinical oncology. Applications in all areas of cancer research are accepted from U.S. and international applicants. For 2018, CCF has dedicated funding for the following areas: breast cancer, northern California researchers, global oncology, kidney cancer, lung cancer, pediatric cancer, sarcoma, and supportive care. Other areas of interest include cholangiocarcinoma, chronic lymphocytic leukemia, gynecological caners, and melanoma. YIA applications opened on July 1 and are due by 11:50PM ET on September 21. Eligibility criteria, award details, and the request for proposals are available on the CCF website (www.conquer.org/YIA). For questions about the YIA or assistance with your application, please e-mail grants@concquer.org.
- Stanford Cancer Center's MDS Center is co-sponsoring the MDS Foundation's Educational Patient-Caregiver Forum on Saturday, October 28. The Forum takes place at 875 Blake Wilbur Drive, Room 2103, Stanford CA 94305 from 9:30AM through 2PM.
- 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 to register your interest in receiving registration and housing information when it becomes available in the Fall.
|
|
|
- National Prostate Health Month, is an annual campaign to raise awareness of the disease. The George Washington (GW) Cancer Center's Prostate Cancer Awareness Month Social Media Toolkit, newly updated for 2017, was designed to help stakeholders establish a Prostate Cancer Awareness Month social media strategy, manage social media accounts, implement Facebook and Twitter best practices, disseminate Prostate Cancer Awareness Month messaging and evaluate their social media efforts. You can use this toolkit and adapt its messaging for your unique audience and areas of expertise. To access the toolkit, clink on this link: Prostate Cancer Awareness Month Social Media Toolkit.
- During September, The Leukemia & Lymphoma Society is raising awareness about blood cancers through its outreach efforts. Please let your patients know about the FREE services provided by LLS to patients and their families, such as financial support, co-pay assistance, online community network, clinical trial access and more infocenter@LLS.org.
- Last Friday, Energy and Commerce Committee Chairman Greg Walden and Oversight and Investigations Subcommittee Chairman Tim Murphy sent letters to various 340B covered entities asking a series of questions about how they use the program and requesting more information on topics like charity care, child sites, and contract pharmacies. This series of letters builds on prior efforts by the Committee, namely this summer's request for information from HRSA and Subcommittee hearing. To read the press release, click here. To read the letters, click here.
|
|
|
- CMS invites representatives from organizations of all sizes to assess current and future functionality of the Quality Payment Program website (http://qpp.cms.gov) as well as make recommendations for improvements. If interested, e-mail Partnership@cms.hhs.gov to participate in a one-on-one feedback session.
- Read COA, ASCO & ASH comments on the 2018 QPP proposed rule below.
The legal team at Johnson & Johnson created "2018 MACRA QPP Proposed Rule Update" highlights and Q&A documents. These provide a concise summary of the 2018 MACRA QPP Proposed Rule.
CRA QPP CY2018 MACRA QPP
|
Affiliate Association News
- Applications for ASCO's Leadership Development Program will be accepted through September 24. Through the Program, participants will gain extensive exposure to the roles and mission of ASCO, its Leadership, and the Society's powerful place in developing the future of cancer care. Applicants must have completed their final subspecialty training between 2008 and 2013. Learn more and apply at http://www.asco.org/training-education/professional-development/leadership-development-program.
- As reported by MOASC Board Member, Sabina Wallach, M.D., in the August 8, 2017 edition of the California Oncology Weekly, ASCO confirms that CPT codes 99358 and 99359 (prolonged services without direct patient contact) are payable under the Medicare Physician Fee Schedule. These codes are reported when a prolonged, non-fact-to-face service is provided to a patient in addition to a face-to-face service. However, these codes may not be reported during the same service period as a complex Chronic Care Management service (CCM) or a Transitional Care Management (TCM) service; they can only be used to report extended qualifying time of the billing physician or other practitioner (not other clinical staff); and, cannot be reported for time spent in non-face-to-face care described by more specific codes having no upper time limit in the CPT code set.
- Myelofibrosis, polycythemia vera and essential thrombocythemia were added to the NCCN Evidence Blocks™.
-
B-Cell Lymphomas, are currently available as Version 4.2017
of the NCCN Guidelines and NCCN Drugs & Biologics Compendium (NCCN Compendium®)
.
Version 3.2017, to the NCCN Guidelines for B-Cell Lymphomas, published on March 27, 2017, is available at the following link:
https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf.; and for Kidney Cancer (Version 1.2018).
-
Distress Management as Version 2.2017, updates
were published to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®).
NCCN has published
NEW
recommendations within the NCCN Radiation Therapy Compendium™ based on radiation recommendations in the following NCCN Guidelines:
Cervical Cancer (Version 1.2017)
Uterine Neoplasms (Version 3.2017)
Vulvar Cancer (Version 1.2017)
CLL/SLL (Version 1.2018)
Kidney Cancer (Version 1.2018)
- For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Biomarkers Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.
- NCCN is collaborating with Evinance to integrate the NCCN Clinical Practice Guidelines in Oncology into the Evinance Decision Support Platform to allow for point-of-care access to treatment recommendations derived from the NCCN Guidelines. Learn more at https://www.nccn.org/about/news/newsinfo.aspx?NewsID=970.
|
|
|
|
- AstraZeneca invites ANCO and MOASC members to attend a live virtual launchcast for Lynparza on Tuesday, September 12 or Thursday, September 14 at 7:15PM or 8:15PM. To register or for further details please go to
- Merck informs ANCO and MOASC that the United States Food and Drug Administration has issued a statement about the risks associated with the use of Keytruda in combination with dexamethasone and an immumomodulatory agent (lenalidomide or pomalidomide) for the treatment of patients with multiple myeloma. The statement is based on review of data from two clinical trials (Keynote-183 and Keynote-185). The statement does not apply to patients taking Keytruda for an approved indication. Keytruda is not approved for treatment of multiple myeloma.
|
|
|
|
MOASC CALENDAR
Professional Educational Series
November 8-9
|
|
|
|
|
|
|
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
|
|
| |
|
