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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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California News
- The California Medical Association's (CMA) Practice Resources for February are now available online at www.cmanet.org/cpr and features articles entitled: Are you exempt from ICD-10 PQRS penalties in 2016?; Mede-Cal's fiscal intermediary to change name from Xerox; Webinar: Learn how to manage your professional reputation online; and, The Coding Corner: How and when to append modifier 25.
- CMA's Year-Round Resolutions for Q2 -
Testimony Opened yesterday, February 13, and have approved nine (9) resolutions for consideration in the second quarter (Q2) of the 2016-2017 year-round resolution process. The resolutions have been posted online at www.cmanet.org/hod to receive your testimony. The testimony period will be open until March 13, 2017. After testimony closes, the Council or Subcommittee to which each resolution has been assigned will consider it. Your testimony and feedback will be considered by the Councils as they make policy recommendations. Please take a moment to read any background materials and/or analyses, which can be found in the upper right corner of each resolution page. Please click here to access the discussion portal for year-round resolutions. You will need to log-in with your CMA web account.
Resolutions to be considered in Q2 include:
Resolution Submission Timeline for Q3 of 2017
If you have a resolution you would like to submit for consideration, please e-mail it to resolutions@cmanet.org. The resolution submission deadline for the third quarter (Q3) of 2017 is April 22, 2017, but you are encouraged to submit well in advance of the deadline to ensure that your policy idea is considered promptly.
- The California Dialogue on Cancer is pleased to announce the American Cancer Society's upcoming 80% by 2018 California Colorectal Cancer Roundtable events in Sunnyvale on March 21st and Los Angeles on March 22nd. The featured speaker for the Roundtables will be Richard Wender, MD, Chief Cancer Control Officer of the American Cancer Society. These events will be an opportunity to connect with different groups (community clinics, health plans, companies, hospitals, and community members) who are working toward our collective goal of 80% nationwide screening for adults aged 50+ by 2018. Participation is free. Please register by March 10th. For more information, click on the following links.
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- 2017 In-Person Seminars - Your Input Needed
Noridian Provider Outreach and Education (POE) is planning the 2017 In-person seminar topics and locations. As valued members of our Noridian community, we are inviting our providers to participate in a quick survey that will guide us to better serve your needs and improve our events for all attendees.
Read the complete update
* MLN Connects Provider News
Announcements--Clinical Laboratories: Easer to Report Lab Data
Claims, Pricers, and Codes--January 2017 OPPS Pricer File
Events--Understanding and Promoting the Value of Chronic Care Management Services Call-February 21
Publications--
* MolDX-Genetic Testing for Lynch Syndrome LCD-R1
* MolDX: bioTheranostics Cancer TYPE ID Billing and Coding Guidelines-R3
* 2017 In-Person Seminars-Your Inout Needed
* Positron Emission Tomography Scans Coverage-R8
* MolDX-CDD: Oncotype DX Breast Cancer for DCIS (Genonic Health) Final LCD-Effective March 27, 2017
* Revalidation Enrollment on Demand Tutorials
* EDISS Gateway Transition Extension
* Noridian Medicare Portal Registration for Part B Providers Webinar (February 16)
* Chronic Care Management (CCM) Webinar (February 22)
* Radiation Oncology (February 28)
* Duplicate Claims Webinar (March 1)
- Noridian Medicare Portal Functionality Webinar for Part B Providers - March 23, 2017
The Noridian Provider Outreach and Education (POE) staff is hosting a Noridian Medicare Portal Functionality for Part B Providers webinar on March 23, 2017 at Noon Pacific Time.
Read the complete update
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- MOASC's LunchTime Series presentation of, "Physician in Transition, Six Timely Considerations for You & Your Practice,"
will be presented Wednesday, February 22 at 12:00 pm Pacific Time, by Charles Denny, M.A., Charles Denny Consulting. Please RSVP to
moasc@moasc.org or call 909-985-9061 x 1.
- On Saturday, March 11, 2017 join nationally known, and regionally based, key-opinion leaders to assess your tools for thriving in an era of Personalized Medicine! Join us for the 2017 MOASC Oncology Summit. There's an Oncology Revolution going on: Are your treatment choices still relevant in the era of Immuno-oncology and Molecularly-targeted therapies? We will discuss how to use the new tools of "Personalized Medicine" to guide treatment choices for Lung Cancer, Prostate Cancer and Multiple Myeloma. This will be a practically-oriented, clinically relevant discussion and you will leave with new insights into your own practice patterns and how to make sure you are embracing the future today! For complete information on this superb program, please contact the MOASC Office at 800-310-3553 x1,
moasc@moasc.org
or
www.moasc.org
.
- The City of Hope conference,
How the Experts Treat Hematologic Malignancies
, will be March 16 to 18, 2017 at the Mandarin Oriental, Las Vegas
. City of Hope experts will provide the conferee with the most recent advances in bone marrow transplant, multiple myeloma, lymphoma and leukemia. Updates on improved curative and palliative treatments and evolving molecular and immunologically-based system therapies, as well as important, completed or ongoing clinical trials, will be profiled and discussed. This activity has been approved for AMA PRA Category 1 Credit™. Please register at one of the following: 626-218-5622 or
CityofHope.org/cme
cme@coh.org
- The 2nd Annual UC Irvine Health Hematology Symposium, presented by the Department of Pathology and the Department of Medicine, Division of Hematology/Oncology, will take place on Saturday, March 25, 2017, at Disney's Paradise Pier Hotel, Anaheim, CA.
Topics will include: * Molecular diagnostics in selected disorders; * Myelodysplastic syndrome;
* Primer on flow cytometry for the general practitioner; * Venous thromboembolism;* Approach to the evaluation of anemia;* Selected vector-borne diseases;* Lupus anticoagulant and antiphospholipid antibody syndrome.
For registration or more information please contact Dannielle Lampkin at
dlampkin@uci.edu
or 714-456-8621 or visit the Hematology Symposium registration website,
- Last Saturday, February 11, 2017, MOASC and the University of California Irvine (UCI) presented their 2nd Annual Spotlight on ASH
. UCI faculty, who attended the 2016 Annual ASH Conference, brought the premier topics and discussions to clinicians at the Hyatt Regency in Huntington Beach. Contact the MOASC office
moasc@moasc.org
if you would like the handouts & links to the presentations, or call 800-310-3553 x 1.
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ANCO is pleased to announce the 17th Multidisciplinary Management of Cancers: A Case-based Approach
on March 17-19, 2017 at The Silverado Resort and Spa in Napa. Registration and housing now open at
www.multicancers.org
.
REGISTRATION ENDS February 28 AND THIS MEETING SELLS OUT EVERY YEAR
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- "...THE DRUG PRICING DEBATE IS GETTING MORE COMPLEX -
You can add Sen. Chuck Grassley (R-Iowa) to the list of lawmakers interested in examining the pharmacy benefits manager (PBM) industry as part of the drug pricing debate, his office told POLITICO, yesterday. Reps. Doug Collins (R-GA) and Buddy Carter (R-GA) are also scrutinizing the companies that administer the drug benefits for many health insurers. It's an attractive issue for free-market conservatives, a source familiar with the concerns of folks on the Hill told Prescription PULSE. The industry is dominated by just three major players that control an overwhelming share of the market. What's more, the companies are vertically integrated. They don't just negotiate drug benefits, but also own many of the pharmacies. And, there's a lack of transparency surrounding the industry that doesn't sit well with lawmakers. Collins previously introduced a bill that would create more transparency around PBM reimbursement rates to pharmacies. Lawmakers are also interested in digging deeper into whether the discounts negotiated by payers are passed on to patients. 'PBMs represent one of the more detrimental and unknown pieces of the health care system, and we're looking at legislative solutions to the problem, which is that patients and independent pharmacies are losing out because PBMs keep their pricing acrobatics hidden from the public,' Collins said..."
Politico Pro Health.
- The Institute for Clinical and Economic Review (ICER) will develop a report assessing tiger comparative effectiveness and value of emerging therapies for treatment of ovarian cancer. A three-week "open input" period opened on February 8 and comments are accepted from any and all stakeholders. The report will be the subject of a September 2017 meeting. For more information about ICER, go to http://icer-review.org.
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- CMS has released their updated telehealth factsheet, reflecting the changes made to Medicare telehealth reimbursement in the CY 2017 fee schedule. The changes included adding new CPT codes for end-stage renal disease (ESRD) related services for dialysis and advance care planning codes to the list of codes eligible for reimbursement when delivered through telehealth. It also includes an explanation of the new place of service (POS) code specifically designated to indicate telehealth was used. For more information, see the full factsheet.
- CMS has updated information regarding the Medicare Outpatient Observation Notice aka "MOON". Now full instructions related to implementation of the MOON program have been issued. All hospitals and Critical Access Hospitals (CAHs) are required to provide the MOON according to CMS guidelines no later than March 8, 2017. The MOON is a standardized notice to inform beneficiaries (including Medicare health plan enrollees) that they are an outpatient receiving observation services and are not an inpatient of the hospital or critical access hospital (CAH). It is mandated by the Federal Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act), passed on August 6, 2015. The NOTICE Act requires all hospitals and CAHs to provide written and oral notification under specified guidelines.
Information about MOON is located on the national CMS website housed on the Beneficiary Notices Initial page.
Click Here.
- AVOID 2018 MEDICARE PAYMENT ADJUSTMENTS!
CMS has extended the deadline from February 28, 2017 to March 13, 2017 for the 2016 Quality Reporting Document Architecture (QRDA) data submission for the EHR reporting mechanism. This affects Individual eligible professionals (EPs), PQRS group practices, qualified clinical data registries (QCDRs), and qualified EHR data submission vendors (DSVs). EPs who do not satisfactorily report 2016 quality measure data to meet the PQRS requirements will be subject to a downward PQRS payment adjustment on all Medicare Part B Physician Fee Schedule (PFS) services rendered in 2018. A complete list of 2016 data submission timeframes is below:
March 13, 2017 deadlines:
EHR Direct or Data Submission Vendor (QRDA I or III) - 1/3/17 - 3/13/17
Qualified Clinical Data Registries (QRDA III) - 1/3/17 - 3/13/17
March 17, 2017 deadline:
Web Interface - 1/16/17 - 3/17/17
March 31, 2017 deadlines:
Qualified Registries (Registry XML) - 1/3/17 - 3/31/17
QCDRs (QCDR XML) - 1/3/17 - 3/31/17
Submission ends at 8:00 p.m. Eastern Time (ET) on the end date listed. An Enterprise Identity Management (EIDM) account with the "Submitter Role" is required for these PQRS data submission methods.
Click Here
to go to the CMS web site for more information.
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Affiliate Association News
- Please join the Community Oncology Pharmacy Association (COPA) and Accreditation Commission for Health Care (ACHC) for a free webinar on February 23 from 9:00 - 10:00 pm Pacific. The webinar you will hear firsthand from national accreditation leaders from COPA and ACHC, as well as from oncology pharmacy providers that have gone through the accreditation process. The information will be invaluable to those considering accreditation or have specific questions about the process. Access to tools in helping pharmacies achieve this accreditation will also be discussed. RSVP: Please Click Here to Register. Note: You will receive an email confirmation once your registration is complete.
- The Leukemia & Lymphoma Society is pleased to announce their upcoming Blood Cancer Conference in Anaheim on March 4, 2017. These educational conference has been developed to meet the needs of patients, survivors, caregivers and healthcare professionals. Conference attendees will receive the most current information and access to local resources to help navigate and make informed decisions about treatment and survival. The conference is free, but registration is required.
For more information and conference registration, go to:
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Three Meetings in One! The 2017 Community Oncology Conference April 27-28, 2017
at the Gaylord National Hotel & Convention Center. The annual Community Oncology Conference is, and always has been, developed by community oncology providers, administrators, staff, and patients to address their needs in the real world. The Conference offers three distinct agenda tracks with content covering clinical, business, and patient advocacy topics. Each provides fantastic opportunities for education and networking built into the sessions.
- The clinical track will be presented in multiple learning formats, including panel discussions, interactive sessions, and case studies.
- The business track will be geared to both clinical and non-clinical attendees and will cover a variety of topics, including success in the Oncology Care Model (OCM), aligning payment to quality and value, and more.
- An abbreviated pharmacy track will feature sessions relating to oncology pharmacy accreditation, in-office dispensing challenges, dealing with PBMs, and other relevant pharmacy topics.
- The COA Patients Advocacy Network (CPAN) will host a special patient advocacy track focused on building strong patient and staff community oncology advocates.
The packed agenda covers the timeliest topics in today's community oncology landscape, including how to survive MIPS/MACRA, the Oncology Care Model (OCM), the 340B Program, immuno-oncology, the Oncology Medical Home, and the latest value tools.
- Applications are now being accepted for ASCO's Quality Training Program at
www.asco.org/training-education/professional-development/quality-training-program
. This comprehensive 6-month program is oncology-focused and teaches clinicians how to improve quality using evidence-based decisions and how to reduce clinical and process variation for predictable and sustainable results. In 2017, there will be two regional locations, including Portland, OR (Session 1: April 20-21; Session 2: June 28-29; and Session 3: October 18).
- ACCC is creating tools and resources for cancer programs as part of its Optimizing Electronic Health Records (EHRs) education initiative. To assist in shaping these resources, please share your EHR pain points and success via their survey at
- ASCO's Criteria for High-Quality Clinical Pathways in Oncology, a set of 15 inter-related criteria that provide an overarching framework for assessing pathway programs in the United States, are featured as a special article in the Journal of Oncology Practice at (
http://ascopubs.org/doi/abs/10.1200/JOP.2016.019836
).
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A new White Paper by the law firm of Frier Levitt, LLC
and commissioned by the Community Oncology Alliance (COA) examines the ongoing practice by Pharmacy Benefit Managers (PBMs) to
increase corporate profits through murky "direct and indirect remuneration" fees-commonly known as "DIR Fees" charged to community oncology practices, as well as retail and specialty pharmacies ("Pharmacy Providers"). DIR Fees, which have no basis in regulation or law, artificially inflate the costs paid by Medicare beneficiaries for prescription drugs, pushing them into the Medicare Part D "donut hole" faster, fueling rising drug prices, and ultimately adding to the burden on taxpayers. PBMs must report all discounts given after the drugs are sold to CMS. These are called "Direct and Indirect Remuneration" or "DIR." PBMs often receive additional discounts from manufacturers after the initial sale of drugs to patients.
DIR Fact Sheet
.
- COA would like for you to please read the article below from the National Community Pharmacists Association (NCPA). They have been fighting this battle on DIR fees for some time as COA had discussed last year. It is quite supportive of the COA position on DIR fees since they also share the same points brought out in the COA white paper. Ricky Newton
rnewton@COAcancer.org
is asking if you know any of the officers on the board of NCPA, or are any of your staff members of NCPA? He would like to reach out to them about collaborating with their organization on the DIR issues the same way COA is with NASP. Thank you for your assistance.
- COA is seeking your feedback regarding difficulty obtaining Cost Exceed overrides with Optum Rx Insurance. It appears the new year brought a change whereby all override requests can only be obtained through Briova Specialty Pharmacy. OptumRx would not authorize an override because the patient is not registered in their system, and only the patient can register themselves. OptumRx would not allow the physician practice to register on behalf of the patient. The time lapse of more than 24 hours to obtain an override requires repeated calls to OptumRx. OptumRx would question the physician's office for filling the medication, and continuously tries to take over the prescription to fill at OptumRx's location,even after being informed that the drug is being filled at the physician dispensary. If you are experiencing similar issues with any payer, please communicate with the MOASC Office your specific issue at
moasc@moasc.org
. Thanks!
- ASCO is pleased to remind members that you can use the QOPI platform to meet the MIPS reporting requirement of one measure through manual reporting. While one is the minimum requirement to avoid the 2019 penalty, ASCO encourages practices to report on at least four measures to become fully acquainted with the system and ensure that the CMS requirements are met. In addition, ASCO is using 2017 as a transition year to modify the QOPI Quality Clinical Data Registry (QCDR) to allow practices to meet 2018 MIPS reporting requirements. In the meantime, ASCO encourages all oncology practices to use 2017 to ensure they are positioned to report at the significantly higher volume (60% of their eligible charges for ALL measures) requirement in 2018.
- Download ASH's MACRA 101 for Hematologists at
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NCCN has published updated NCCN Clinical Practice Guidelines in Oncology
(NCCN Guidelines®) with NCCN Evidence Blocks™ for head and neck cancers (V1.2017); soft tissue sarcoma (V2.2017); and, systemic light chain amyloidosis (V1.2017). For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Compendium®, the NCCN Chemotherapy Order Templates (NCCN Templates®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit
www.nccn.org
.
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- Janssen Biotech is hosting an educational program entitled Darzalex-based Triplet Therapy for Multiple Myeloma Patients at First Relapse with Amy Marsala, N.P., UC San Francisco, on March 17 at Morimoto, 610 Main Street, Napa. RSVP at
www.medforcereg.net/SOMP1085229
- nanoString informs ANCO and MOASC that Humana has issued a positive coverage decision for the Prosigna Breast Cancer Gene Signature Assay. Humana's coverage decision is in line with updated ASCO guidelines released in February 2016 where Prosigna is considered medically necessary to assess the necessity of adjuvant chemotherapy in ER+, HER-, none-negative breast cancer patients, when adjuvant chemotherapy is not precluded due to another factor.
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| MOASC CALENDAR
Spotlight on ASH
February 11, 2017
LunchTime Series
February 22, 2017
Oncology Summit
March 11, 2017
NCCN Meeting in Florida
March 23-25, 2017
COA Annual Meeting
April 27-28, 2017
ASCO National Meeting in Chicago
June 2-6, 2017
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(NCCN, San Francisco, March 11)
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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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