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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.
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TODAY, tips to improve and enhance patients' communications. (California News)
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TOMORROW, What You Need to Know about CMS' Proposed 2018 OPPS and PFS Rules (Affiliate Assoc. News)
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TOMORROW, Grand Opening of the UCI's new digestive disease center. (MOASC News)
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California News
- TODAY, Tuesday, August 8th, at 5pm PT, Noam Z. Drazin, MD, Cedars Sinai Medical Group, will share helpful tips to improve and enhance patients' communications
with their health care team and empower participants to advocate for themselves when discussing individual concerns including screening, fertility, fear of recurrence, new research, clinical trials, and immunotherapy. A peer supporter will share their personal story and a live question and answer session will follow the presentation. To register for the free webinar click here.
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The CMA and Network of Ethnic Physician Organizations (NEPO) are hosting a joint annual poster session to showcase research by medical students
, residents and fellows across California. All medical students, residents and fellows in the state are invited to submit abstracts by August 14, 2017, 11:59 pm PT, for their original research, regardless of membership status. Students who serve marginalized and underserved populations are strongly encouraged to apply. Research categories include basic science, clinical research, clinical vignette, health policy, and social science research. Applicants may only submit one abstract with a 350-word limit, and must explain the relevance of their research to health policy. The poster session will take place Friday, October 20, 2017, in conjunction with the CMA House of Delegates and the NEPO Building Healthy Communities Summit, both being held at the Disneyland Hotel in Anaheim. Poster session participants will receive complimentary registration to attend the NEPO Summit. For more information, see the
poster session flyer. To be considered for the poster session, submit your abstract to Kerry Sakimoto, ksakimoto@cmanet.org.
- Please join the California Partnership for Access to Treatment (CPAT) for a complimentary webinar on August 15th from 12 - 1pm PT, on the Future of Healthcare in California. All attendees receive a free CPAT advocate toolkit. Share your lunch hour with CPAT and learn all about the hot-button healthcare issues being discussed in Sacramento.
- The California Dialogue on Cancer announces the publication of an article written by CDOC's Lung Cancer, Cancer Plan Collaboration Team (CPCT) in the Medical Board of California's quarterly newsletter. The article,Low Dose Computed Tomography Screening Can Save Patients' Lives, discusses the recommendations of the United States Preventive Services Task Force and the Centers for Medicare and Medicaid Services regarding low dose computed tomography (low dose CT or LDCT) lung cancer screening as an important tool in the diagnosis of lung cancer. You can read the article here, or find it on the Medical Board of California's website: www.mbc.ca.gov.
- Premiums for the Affordable Care Act consumers in California are expected to increase by an average of 12.5 percent next year, but that number could almost double if cost-sharing reductions are scrapped. All 11 insurers that currently sell plans in California will apply for the exchange next year, though Anthem intends to withdraw from 16 of the state's 19 regions.
- The California Medical Association's (CMA) Practice Resources (August 2017) is now available online at www.cmanet.org/cpr and features articles entitled: Join CMA to learn how to challenge the interim payment for out-of-network services at in-network facilities; Medi-Cal postponing deactivation of inactive providers; UnitedHealthcare plans to discontinue payment for consultation services; CMS releases proposed Medicare physician fee schedule for 2018; Survey finds nation's physicians not ready to fulfill MACRA reporting requirements; New video shows physicians how to avoid Medicare payment penalties; CMS dedicates new webpage to Medicare Beneficiary Identification number change; Physicians apprehensive regarding requests for provider directory information; Has a contracted payer stopped paying claims?; Updated payer profiles for 2017 now available; The Coding Corner: CMS seeking to simplify E/M documentation guidelines.
- Forthcoming CMA webinars include:
* Assembly Bill 72: How to Challenge the Interim Payment for Out-of-Network Services at In-Network Facilities (September 27)
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* MLN Connects
Announcements--
Claims, Pricers, & Codes
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Publications--
* ASP Medicare Part B Drug Pricing Files and Revisions-October 2017 CR10187
* August Webinars-Register Now
* Medicare B News JE July 2017 Bulletin-Now Available
* New Waived Tests CR10198
* MolDX: DecisionDx-UM (Uveal Melanoma) Final LCD-Effective September 22, 2017
- Forthcoming Noridian/JEMAC webinars include:
* Self Service Re-openings in NMP for Part B Providers (August 8)
* Duplicate Claims (September 13)
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- You are invited to attend the upcoming physician reception on August 9 for the Grand Opening of the University of California Irvine's new digestive disease center. UCI Invitation.
- MOASC Board member, Sabina Wallach, MD, FRACP, FACP, attended the
ASH/ASCO Annual Meeting of the Hematology and Oncology Carrier Advisory Committee (CAC) Network
on July 20 and 21 at ASCO Headquarters in Alexandria, VA. The purpose of the meeting is to provide an opportunity to strengthen communication and collaboration among CAC representatives, ASH, ASCO, Contractor Medical Directors, and hematology and oncology state society representatives. Following is Dr. Wallach's report.
* MIPS and MACRA criteria were reviewed. Also, pathology reimbursement for molecular studies.
Most importantly, we were advised to use 2 additional clinical codes.
*Prolonged Service Without Direct Patient Contact:
99358
first hour of prolonged service on a given date regardless of place of service, even if not continuous;
99359
each additional 30 minutes beyond the first hour.
Vignettes include record review at home or office for new patient (OK to bill separately from date of initial NP visit) OR telephone consultation to manage operative bleeding in previously unknown hospital patient.
*Prolonged Clinical Staff Services with Physician or Other Qualified Health Care Professional Supervision, 99415 and 99416.
Prolonged service may be provided by clinical staff when supervised by a physician or other qualified healthcare provider. The AMA created two new codes for this sort of encounter:
99415
Prolonged clinical staff service (the service beyond the typical service time) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; first hour (List separately in addition to code for outpatient Evaluation and Management service)
99416
each additional 30 minutes (List separately in addition to code for prolonged service)
Report these services only with E/M codes 99201-99215.
Report 99415 in addition to the primary E/M service for the initial 45-74 minutes of prolonged clinical staff services (i.e., time in excess of that described by the primary E/M service reported). Per CPT® guidelines, report 99416 for each additional 30 minutes of prolonged clinical staff services beyond the initial 74 minutes, as follows:
Click on the link below for more information.
- In the June 27, 2017 edition of the California Oncology Weekly, MOASC asked for reader feedback on Blue Shield's pilot cancer care program
(Blue Shield Letter) with an update in the July 11, 2017 publication, where we shared the California Department of Managed Health Care response to MOASC. MOASC is now in receipt of Blue Shield's response to the CMA's persistence."...SCOA was selected as the pilot group because we have had a long standing close relationship with SCOA and knew that they shared our views about transforming Oncology care. We did not deploy a selection process to identify partners. We are not currently looking for additional partners. Going forward we will be interested in expanding the strategy should we see positive results in the pilot with SCOA. We have no specific timeframes for a possible expansion at this time..."
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- 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.
- ANCO's 2017 Professional Education Meeting will take place on September 6 at the San Jose Fairmont and feature talks on QPP/MACRA, ASCO's COME HOME Project, USP 797/800, and California Legislative/Regulatory Updates. Download the meeting announcement and registration form at www.anco-online.org/ProfEduc2017.pdf.
- ANCO's 3Q2017 Hematologic Malignancies Update will take place on September 9 at the Stanford Park Hotel in Menlo Park. Watch for a meeting announcement in late July. Bruno Medeiros, M.D., Stanford University, Charalambos Andreadis, M.D., University of California, San Francisco, and Brian Sworder, M.D., Ph.D., Stanford University, will review the latest research on novel treatment modalities for leukemia and lymphoma, along with case studies for these diagnoses. These Updates are supported by Janssen Biotech, Merck, Pfizer Oncology, and Pharmacyclics. Download the meeting announcement and registration form at www.anco-online.org/3Q2017HemeMalig.pdf.
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- Before adjourning, the Senate confirmed President Donald Trump's pick for surgeon general, Dr. Jerome Adams, and several other Department of Health and Human Services officials.
- The Senate unanimously passed a "right to try" bill that would prohibit the federal government from denying terminally ill patients access to experimental drugs that have not been approved by the Food and Drug Administration. The chamber also sent legislation to President Donald Trump to reauthorize four user fee agreements that fund the FDA's review of drugs and medical devices.
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- The annual Medicare open enrollment period begins on October 15, 2017, and ends on December 7, 2017. During this time, Medicare beneficiaries can choose health and drug plans for 2018 by comparing their current coverage and plan quality ratings to other plan offerings or choose to remain in traditional Medicare. CMS anticipates releasing the premiums and costs for Medicare health and drug plans for the 2018 calendar year in mid-September.
- Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for CY 2018
was issued by the Centers for Medicare & Medicaid Services (CMS) in July which would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in calendar year (CY) 2018. These updates would help reduce regulatory burdens and allow practitioners to improve outcomes based on the unique needs of their patients, according to CMS. This is one of several Medicare payment rules for CY 2018 that reflects a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. Please read the Fact Sheet outlining feedback CMS is requesting from stakeholders! CMS is requesting comment solicitation on items such as Evaluation and Management (E&M) due to E&M codes stated as being outdated with need for revision.
CMS is seeking comment from stakeholders on specific changes to be made to update the guidelines, reduce associated burdens, and better align E&M coding and documentation with the current practice of medicine. CMS is especially seeking comment on how to focus on initial changes to the guidelines for history and exam due to documentation for these elements being more significantly outdated.
Click Here to review the CMS fact sheet on the proposed rule.
- The Centers for Medicare and Medicaid Services (CMS) has introduced new information on the government QPP website qpp.cms.gov to help provider determine whether clinicians have "special status" and can therefore be considered exempt from the Quality Payment Program. To determine if a clinicians' participation should be considered as special status under the Quality Payment Program, CMS retrieves and analyzes Medicare Part B claims data.
A series of calculations are run to indicate a circumstance of the clinician's practice for which special rules under the Quality Payment Program will affect the number of total measures, activities or entire categories that an individual clinician or group must report. These circumstances are applicable for clinicians in: Health Professional Shortage Area (HPSA), Rural, Non-patient facing, Hospital Based, and Small Practices. For more information, Click Here to visit the Quality Payment Program website.
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Affiliate Association News
- ACCC and the Advisory Board Oncology Roundtable are collaborating on a comprehensive survey to capture the challenges and successes of cancer programs across the country. The Trending Now in Cancer Care survey examines the hottest topics in oncology today, including hospital and physician alignment strategies, value-based care models, EHR use and interoperability, clinical staffing challenges, and more! The survey is now open but will close on August 21. Take the survey at http://www.accc-cancer.org/surveys/CancerProgramTrends-2017.asp.
- ASH's Meeting on Hematologic Malignancies will be held in Chicago, IL, September 8-9, 2017. The program's "How I Treat" presentations showcase speakers' evidence-based treatment approaches, identify cutting-edge scientific data that can be translated into new strategies for diagnosis and treatment, and address what to do in cases where there is no data. This meeting is a unique opportunity to join colleagues and top experts in treatment of hematologic malignancies in an intimate, smaller-meeting setting and discuss the latest drug developments and most relevant research findings advancing patient care today. Visit www.hematology.org/malignancies for information related to next year's meeting!
- The Community Oncology Alliance (COA) announces the launch of the COA Fellows Initiative that seeks to engage and educate oncology fellows on the value of practicing in the community setting. The initiative is designed to inform and assist oncology fellows as they prepare for their career in the practice of medicine. The COA Fellows Initiative is designed to explore all practice setting options, including research, academia, government agency, and hospital or community-based. The initiative is constructed to present a fair and balanced look, not only at the future of hematology and oncology, but also at choices for care delivery. As the only non-profit organization dedicated to advocating for community oncology and, most importantly, the patients they serve, COA members will share their expertise about private practice in the community setting.
- NCCN has published and/or updated their Chemotherapy Order Templates; Clinical Practice Guidelines in Oncology, Drugs & Biologics Compendium; Evidence Blocks; Guidelines for Patients; Imaging Appropriate Use Criteria; and/or, Radiation Therapy Compendium for gastric cancer (V2.2017), malignant pleural mesothelioma (V2.2017), myeloproliferative neoplasms (V1.2018), neuroendocrine tumors (V3.2017), non-small cell lung cancer (V8.2017), survivorship (V2.2017). Go to www.nccn.org for more information.
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- AstraZeneca
informs ANCO and MOASC that the United States Food and Drug Administration has approved Acalabrutinib
for the treatment of patients with mantle cell lymphoma (MCL) who have received at least one prior therapy.
- Bristol-Myers Squibb Oncology
informs ANCO and MOASC that the United States Food and Drug Administration has approved Opdivo for the treatment of patients 12 years and older with mismatch repair deficient (dMMR) and micro satellite instability high (MSI-H) metastatic colorectal cancer that has progressed following treatment with fluoropyrimidine, oxaliplatin and irinotecan.
- Celgene informs ANCO and MOASC that the United States Food and Drug Administration has approved IDHIFA for the treatment of adult patients with relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase-2 (IDH2) mutation as detected by an FDA-approved test.
- Jazz Pharmaceuticals informs ANCO and MOASC that the United States Food and Drug Administration has approved Vyxeos, a liposome-encapsulated combination of daunorubicin and cytarabine, for the treatment of adults with newly-diagnosed therapy-related AML (t-AML) or AML with myelodysplasia-related changes (AML-MRC).
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MOASC CALENDAR
Professional Educational Series
November 8-9
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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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